Over 40 healthcare providers launch campaign to improve accuracy and the timeliness of diagnosis
A coalition of over 40 healthcare and patient advocacy organisations have come together to improve the quality of medical diagnoses. Researchers estimate that up to 80,000 deaths a year in US hospitals can be attributed to inaccurate or delayed diagnoses.
ACT for Better Diagnosis, an initiative of the Society to Improve Diagnosis in Medicine (SIDM), aims to improve the diagnostic process by calling on organisations to identify and spread practical steps to better ensure diagnoses are Accurate, Communicated and Timely.
Coalition members include:
- ABIM Foundation
- American Society for Health Care Risk Management
- Medical Professional Liability Association
- Association of American Medical Colleges
- American Academy of Family Physicians
- Association of Clinical Scientists
- Midwest Alliance for Patient Safety
- American Academy of Paediatrics
- Children’s Hospital of Philadelphia
- National Association of EMS Physicians
And many more.
“Providing an accurate medical diagnosis is complex and involves uncertainty, but it’s obviously essential to effective and timely treatment,” said Paul L. Epner, Chief Executive Officer and co-founder of SIDM.
“Nearly everyone will receive an inaccurate diagnosis at some point in their life and for some, the consequences will be grave. Major improvement is needed to systematically identify how to improve diagnostic quality and reduce harm to patients.”
Each year, diagnostic errors affect 12mn adults in outpatient settings and are the most common cause of medical errors reported by patients.
Working in collaboration over several months, members of the SIDM-led Coalition to Improve Diagnosis, made up of premier national healthcare and patient advocacy organisations, identified initial obstacles they believe impede diagnostic accuracy, including:
- Incomplete communication during care transitions—When patients are transferred between facilities, physicians or departments, there is potential for important information to slip through the cracks.
- Lack of measures and feedback—Unlike many other patient safety issues, there are no standardised measures for hospitals, health systems, or physicians to understand their performance in the diagnostic process, to guide improvement efforts or to report diagnostic errors. Providers rarely get feedback if a diagnosis was incorrect or changed.
- Limited support to help with clinical reasoning—With hundreds of potential explanations for any one particular symptom, clinicians need timely, efficient access to tools and resources to assist in making diagnoses.
- Limited time—Patients and their care providers overwhelmingly report feeling rushed by limited appointment times, which poses real risks to gathering a complete history that is essential to formulating a working diagnosis and allows scant opportunity to thoroughly discuss any further steps in the diagnostic process and set appropriate expectations.
- The diagnostic process is complicated—There is limited information available to patients about the questions to ask, or whom to notify when changes in their condition occur, or what constitutes serious symptoms. It’s also unclear who is responsible for closing the loop on test results and referrals, and how to communicate follow-up.
- Lack of funding for research—The impact of inaccurate or delayed diagnoses on healthcare costs and patient harm has not been clearly articulated, and there is a limited amount of published evidence to identify what improves the diagnostic process.
The organisations behind the effort—representing clinicians, patients, health systems, researchers and testing professionals—acknowledge that improvement will require sustained work over several years with all stakeholders engaged.
“The diagnosis process—thinking through a patient’s clinical presentation—is a defining task for our profession, and for internal medicine specialists and subspecialists in particular,” said Dr Ana María López, President, American College of Physicians.
“Critically assessing diagnostic decision-making reveals knowledge gaps, communication pitfalls, and risk for errors.”
Also participating in the coalition are federal liaisons, including the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services and Veterans Health Administration.
How health plans can reduce healthcare inequalities
The COVID-19 pandemic has put inequalities accessing the healthcare system in the spotlight. Jim Clement, Vice President of Product & Services at cloud provider Inovalon, tells us that health plans play the most integral role in advancing the health equity movement.
Why did it a global pandemic to highlight the issue of healthcare inequities?
Health inequity in the US has been well understood by healthcare professionals for many years, but it has become more evident due to the COVID-19 pandemic. It wasn’t until the racial and ethnic differential seen in response to COVID-19 related infections, deaths and vaccinations that many Americans became acutely aware of the health inequity due to sociodemographic factors such as race, geography, education and income.
Fortunately, there’s now a growing health equity movement afoot in America which aims to improve public health and achieve equity in health status for all people by ensuring opportunities are available to attain the highest level of health. While the entire healthcare ecosystem is important to this transformation, it is health plans that arguably play the most integral role.
How can health plans help?
Achieving health equity means obstacles to health must be removed, including poverty, discrimination, powerlessness, and lack of access to the basics like physicians, hospitals, medicine, technology, and health education. This is not only a social justice initiative, but also a clear call to action for health plan organisations that are bearing the economic brunt of the costs due to health disparities.
Health plan organisations that recognise the alignment between efforts to improve health equity and broader member engagement initiatives will be in the best position to move the needle. Plans must also understand that the provision of medical services within hospital walls, physician offices and other health services providers is necessary, but not sufficient.
By recognising that health inequity also includes non-medical factors such as employment, income, housing, transportation, childcare, and more, plans will be better equipped to ensure their members are set up for success.
What do healthcare providers need to do generally to address inequities?
Outreach by both health plans and providers is critical to ensuring people have knowledge of available services, the reason those services are critical to their health, and options to access those services based on their unique circumstances. With both stakeholders beating the same drum, progress can be made quickly.
Given the impact of social determinants of health (SDOH), should healthcare providers take a more active role in addressing these, or other agencies?
While communicating with patients is critically important, what is truly required to address inequalities is helping patients take medical actions – like regular PCP visits, monitoring A1C and accepting health coaching – that are necessary to maximise their health, along with non-medical actions –like availing themselves of community resources that address homelessness, food insecurity and employment services.
The most progressive providers and payers have or are putting in place programs to address these non-medical issues. In addition, non-medical tools such as transportation services can certainly help drive the effectiveness of medical services.
How important is it to educate patients about their health and how can this be done?
Education is a social determinant of health and a key lever to be used to drive health equity. Patients who do not understand their medical conditions or the consequences of non-compliance with their treatment plans are prone to poor outcomes.
For health plans, understanding member needs is one of the biggest drivers of quality care. A continuous cycle of engagement through feedback and appropriate responses will provide health plans with an opportunity to uncover, discuss, and resolve problems faster.
Improving member outreach and engagement can be made easier with a programmatic approach involving four stages of intentional outreach: Getting to know your members, educating members, seeking feedback from members and gaining member loyalty. Each stage not only contributes to a better member experience but also to improved outcomes and higher satisfaction scores.
Now that the issue has come to the fore, what do you think things will look like in 5 years or so?
I predict that health plans that get member engagement, education and equity right will achieve better health and greater value, faster. Those who get it wrong or delay will suffer the consequences of competitive disadvantage and pay a larger share of the rising costs associated with health inequity.