• Traber D Giardina, Viral Vaghani, Divvy K Upadhyay, Taylor M Scott, Saritha Korukonda, Christiane Spitzmueller, and Hardeep Singh.
• Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) and Department of Medicine, Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, TX, 77030, USA. traberd@bcm.edu.
• J Gen Intern Med. 2024 Sep 5.

BackgroundThe 21st Century Cures Act enables patients to access their medical records, thus providing a unique opportunity to engage patients in their diagnostic journey.ObjectiveTo explore the concordance between patients' self-reported diagnostic concerns and clinician-interpreted information in their electronic health records.DesignWe conducted a mixed-methods analysis of a cohort of 467 patients who completed a structured data collection instrument (the Safer Dx Patient) to identify diagnostic concerns while reviewing their clinician's notes. We conducted a qualitative content analysis of open-ended responses on both the tools and the case summaries. Two clinical chart reviewers, blinded to patient-reported diagnostic concerns, independently conducted chart reviews using a different structured instrument (the Revised Safer Dx Instrument) to identify diagnostic concerns and generate case summaries. The primary outcome variable was chart review-identified diagnostic concerns. Multivariate logistic regression tested whether the primary outcome was concordant with patient-reported diagnostic concerns.SettingGeisinger, a large integrated healthcare organization in rural and semi-urban Pennsylvania.ParticipantsCohort of adult patients actively using patient portals and identified as "at-risk" for diagnostic concerns using an electronic trigger algorithm based on unexpected visit patterns in a primary care setting.ResultsIn 467 cohort patients, chart review identified 31 (6.4%) diagnostic concerns, of which only 11 (21.5%) overlapped with 51 patient-reported diagnostic concerns. Content analysis revealed several areas of discordant understanding of the diagnostic process between clinicians and patients. Multivariate logistic regression analysis showed that clinician-identified diagnostic concerns were associated with patients who self-reported "I feel I was incorrectly diagnosed during my visit" (odds ratio 1.65, 95% CI 1.17-2.3, p < 0.05).ConclusionPatients and clinicians appear to have certain differences in their mental models of what is considered a diagnostic concern. Efforts to integrate patient perspectives and experiences with the diagnostic process can lead to better measurement of diagnostic safety.© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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