Extent of diagnostic agreement among medical referrals

Rationale, aims and objectives Diagnostic uncertainty is often encountered in a medical practice. Patients with ambiguous, uncertain, and undiagnosed problems are frequently referred for second opinions. Comparing referral diagnoses to final diagnoses provides an opportunity to determine how frequen...

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Bibliographic Details
Published in:Journal of evaluation in clinical practice 2017-08, Vol.23 (4), p.870-874
Main Authors: Van Such, Monica, Lohr, Robert, Beckman, Thomas, Naessens, James M.
Format: Article
Language:English
Subjects:
Academic Medical Centers
Cost-Benefit Analysis
Cross-Sectional Studies
Diagnosis
diagnostic uncertainty
face‐to‐face visit
Female
Humans
Male
Medical diagnosis
Medical referrals
Physicians
Primary Health Care - statistics & numerical data
provider referrals
Referral and Consultation - economics
Referral and Consultation - statistics & numerical data
Retrospective Studies
Specialization - statistics & numerical data
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Summary:Rationale, aims and objectives Diagnostic uncertainty is often encountered in a medical practice. Patients with ambiguous, uncertain, and undiagnosed problems are frequently referred for second opinions. Comparing referral diagnoses to final diagnoses provides an opportunity to determine how frequently final diagnoses vary and changes the direction of medical care. Methods A retrospective study was done at a single academic medical center using a sample of 286 patients referred by physician assistants, nurse practitioners, and physicians from primary care practices from January 1, 2009 to December 31, 2010. Patients' referral and final diagnoses were compared and classified into 1 of 3 categories: referral diagnosis and final diagnosis the same, referral diagnosis better defined/refined, and referral diagnosis distinctly different from final diagnosis. Episode costs for the respective categories were calculated for the referral visit and services that occurred at our facility within the first 30 days. Results In 12% (36/286) of cases, referral diagnoses were the same as final diagnoses. Final diagnoses were better defined/refined in 66% (188/286) of cases; but in 21% of cases (62/286), final diagnoses were distinctly different than referral diagnoses. Total costs for cases in category 3 (different final diagnoses) were significantly higher than costs for cases in category 1 (P = .0001) and category 2 (P = 
ISSN:1356-1294
1365-2753
DOI:10.1111/jep.12747