ArticleJournal of general internal medicine2018
Diagnostic Discordance, Health Information Exchange, and Inter-Hospital Transfer Outcomes: a Population Study.
Article in Journal of general internal medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effects of Health Information Exchanges in the Adult Inpatient Setting: a Systematic Review.Journal of general internal medicine · 2023Pooled it
- Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors.Diagnostics (Basel, Switzerland) · 2026Review
- TriNetX and Real-World Evidence: A Critical Review of Its Strengths, Limitations, and Bias Considerations in Clinical Research.ASIDE internal medicine · 2025Article
- Learning from Reflection on Patient Outcomes Data: How EHR Can Support Trainees in Graduate Medical Education on Inpatient Rotations.Perspectives on medical education · 2025Article
- Outcomes of Patients Transferred to Tertiary Center by Life-Saving System in Saudi Arabia. A Propensity Score Matching Observational Study.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2024Article
- Development and Evaluation of I-PASS-to-PICU: A Standard Electronic Template to Improve Referral Communication for Interfacility Transfers to the Pediatric ICU.Joint Commission journal on quality and patient safety · 2024Article
- Impact of electronic information exchange on repeat imaging during 30-day readmissions among Medicare beneficiaries.The American journal of managed care · 2024Article
- Advancing health information during interhospital transfer: An interrupted time series.Journal of hospital medicine · 2023Article
- Implementation of a standardised accept note to improve communication during inter-hospital transfer: a prospective cohort study.BMJ open quality · 2023Article
- Association of Fragmented Readmissions and Electronic Information Sharing With Discharge Destination Among Older Adults.JAMA network open · 2023Article
- Article
- Characteristics of Patients Who Visited Emergency Department: A Nationwide Population-Based Study in South Korea (2016-2018).International journal of environmental research and public health · 2022Article
- The role of electronic health record developers in hospital patient sharing.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- A Research Agenda for Diagnostic Excellence in Critical Care Medicine.Critical care clinics · 2022Review
- Evaluating Electronic Health Record Limitations and Time Expenditure in a German Medical Center.Applied clinical informatics · 2021Article
- Super fragmented: a nationally representative cross-sectional study exploring the fragmentation of inpatient care among super-utilizers.BMC health services research · 2021Article
- Factors associated with Interhospital transfers of emergency general surgery patients from emergency departments.The American journal of emergency medicine · 2021Article
- Impact of Patient-Level Characteristics on In-hospital Mortality After Interhospital Transfer to Medicine Services: an Observational Study.Journal of general internal medicine · 2020Observational
- Multiple Administrations of Intravenous Thrombolytic Therapy to a Stroke Mimic.The Journal of emergency medicine · 2020Article
- Mind the gap: the potential of alternative health information exchange.The American journal of managed care · 2019Article
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Authors and funding
7 authors.
Funding
Abstract
backgroundStudying diagnostic error at the population level requires an understanding of how diagnoses change over time.
objectiveTo use inter-hospital transfers to examine the frequency and impact of changes in diagnosis on patient risk, and whether health information exchange can improve patient safety by enhancing diagnostic accuracy.
designDiagnosis coding before and after hospital transfer was merged with responses from the American Hospital Association Annual Survey for a cohort of patients transferred between hospitals to identify predictors of mortality.
participantsPatients (180,337) 18 years or older transferred between 473 acute care hospitals from NY, FL, IA, UT, and VT from 2011 to 2013. MAIN MEASURES: We identified discordant Elixhauser comorbidities before and after transfer to determine the frequency and developed a weighted score of diagnostic discordance to predict mortality. This was included in a multivariate model with inpatient mortality as the dependent variable. We investigated whether health information exchange (HIE) functionality adoption as reported by hospitals improved diagnostic discordance and inpatient mortality. KEY
resultsDiscordance in diagnoses occurred in 85.5% of all patients. Seventy-three percent of patients gained a new diagnosis following transfer while 47% of patients lost a diagnosis. Diagnostic discordance was associated with increased adjusted inpatient mortality (OR 1.11 95% CI 1.10-1.11, p < 0.001) and allowed for improved mortality prediction. Bilateral hospital HIE participation was associated with reduced diagnostic discordance index (3.69 vs. 1.87%, p < 0.001) and decreased inpatient mortality (OR 0.88, 95% CI 0.89-0.99, p < 0.001).
conclusionsDiagnostic discordance commonly occurred during inter-hospital transfers and was associated with increased inpatient mortality. Health information exchange adoption was associated with decreased discordance and improved patient outcomes.
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