ArticleJournal of general internal medicine2016
Accuracy of the Safer Dx Instrument to Identify Diagnostic Errors in Primary Care.
Article in Journal of general internal medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
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Who cites it
26 citing papers in PubMed.
- Identification of diagnostic discrepancies as a quality assurance measure in emergency medicine - a validation study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Trial
- Incidence, contributing factors, and predictors of diagnostic errors in medical inpatients: A retrospective cohort study.Journal of hospital medicine · 2026Article
- Priorities for improving paediatric diagnosis: findings from a modified Delphi study.BMJ quality & safety · 2026Article
- A digital quality measure for emergency presentation of pancreatic cancer.British journal of cancer · 2026Article
- Diagnostic errors in patients admitted directly from new outpatient visits.Diagnosis (Berlin, Germany) · 2025Article
- Charting Diagnostic Safety: Exploring Patient-Provider Discordance in Medical Record Documentation.Journal of general internal medicine · 2025Article
- Assessing the Revised Safer Dx InstrumentDiagnosis (Berlin, Germany) · 2024Article
- Development and Implementation of a Digital Quality Measure of Emergency Cancer Diagnosis.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2024Article
- Japanese Internists' Most Memorable Diagnostic Error Cases: A Self-reflection Survey.Internal medicine (Tokyo, Japan) · 2024Article
- Developing methods to identify resilience and improve communication about diagnosis in pediatric primary care.Frontiers in medicine · 2024Article
- Prevalence and Characteristics of Diagnostic Error in Pediatric Critical Care: A Multicenter Study.Critical care medicine · 2023Article
- Opportunities for Diagnostic Improvement Among Pediatric Hospital Readmissions.Hospital pediatrics · 2023Article
- Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- Comparison of Diagnostic Recommendations from Individual Physicians versus the Collective Intelligence of Multiple Physicians in Ambulatory Cases Referred for Specialist Consultation.Medical decision making : an international journal of the Society for Medical Decision Making · 2022Article
- Incidence of Diagnostic Errors Among Unexpectedly Hospitalized Patients Using an Automated Medical History-Taking System With a Differential Diagnosis Generator: Retrospective Observational Study.JMIR medical informatics · 2022Article
- Cerebrovascular disease hospitalizations following emergency department headache visits: A nested case-control study.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2022Article
- Incidence, origins and avoidable harm of missed opportunities in diagnosis: longitudinal patient record review in 21 English general practices.BMJ quality & safety · 2021Article
- Analyzing diagnostic errors in the acute setting: a process-driven approach.Diagnosis (Berlin, Germany) · 2021Article
- Factors Associated With Diagnostic Error on Admission to a PICU: A Pilot Study.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2020Article
- Symptom-Disease Pair Analysis of Diagnostic Error (SPADE): a conceptual framework and methodological approach for unearthing misdiagnosis-related harms using big data.BMJ quality & safety · 2018Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
importanceDiagnostic errors are common and harmful, but difficult to define and measure. Measurement of diagnostic errors often depends on retrospective medical record reviews, frequently resulting in reviewer disagreement.
objectivesWe aimed to test the accuracy of an instrument to help detect presence or absence of diagnostic error through record reviews.
designWe gathered questions from several previously used instruments for diagnostic error measurement, then developed and refined our instrument. We tested the accuracy of the instrument against a sample of patient records (n = 389), with and without previously identified diagnostic errors (n = 129 and n = 260, respectively).
resultsThe final version of our instrument (titled Safer Dx Instrument) consisted of 11 questions assessing diagnostic processes in the patient-provider encounter and a main outcome question to determine diagnostic error. In comparison with the previous sample, the instrument yielded an overall accuracy of 84 %, sensitivity of 71 %, specificity of 90 %, negative predictive value of 86 %, and positive predictive value of 78 %. All 11 items correlated significantly with the instrument's error outcome question (all p values ≤ 0.01). Using factor analysis, the 11 questions clustered into two domains with high internal consistency (initial diagnostic assessment, and performance and interpretation of diagnostic tests) and a patient factor domain with low internal consistency (Cronbach's alpha coefficients 0.93, 0.92, and 0.38, respectively).
conclusionsThe Safer Dx Instrument helps quantify the likelihood of diagnostic error in primary care visits, achieving a high degree of accuracy for measuring their presence or absence. This instrument could be useful to identify high-risk cases for further study and quality improvement.
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