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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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| Published in: | Journal of evaluation in clinical practice 2017-08, Vol.23 (4), p.870-874 |
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| Language: | English |
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| container_issue | 4 |
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| container_title | Journal of evaluation in clinical practice |
| container_volume | 23 |
| creator | Van Such, Monica Lohr, Robert Beckman, Thomas Naessens, James M. |
| description | 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 = |
| doi_str_mv | 10.1111/jep.12747 |
| format | article |
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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 = <.0001).
Conclusion
Referrals to advanced specialty care for undifferentiated problems are an essential component of patient care. Without adequate resources to handle undifferentiated diagnoses, a potential unintended consequence is misdiagnoses resulting in treatment delays and complications leading to more costly treatments.</description><identifier>ISSN: 1356-1294</identifier><identifier>EISSN: 1365-2753</identifier><identifier>DOI: 10.1111/jep.12747</identifier><identifier>PMID: 28374457</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>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</subject><ispartof>Journal of evaluation in clinical practice, 2017-08, Vol.23 (4), p.870-874</ispartof><rights>2017 John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4197-a1744e8941a5910fa6c5bfc2d716053a2f59c7988077421fcdff839c319b7d973</citedby><cites>FETCH-LOGICAL-c4197-a1744e8941a5910fa6c5bfc2d716053a2f59c7988077421fcdff839c319b7d973</cites><orcidid>0000-0002-6079-6405</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28374457$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Van Such, Monica</creatorcontrib><creatorcontrib>Lohr, Robert</creatorcontrib><creatorcontrib>Beckman, Thomas</creatorcontrib><creatorcontrib>Naessens, James M.</creatorcontrib><title>Extent of diagnostic agreement among medical referrals</title><title>Journal of evaluation in clinical practice</title><addtitle>J Eval Clin Pract</addtitle><description>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 = <.0001).
Conclusion
Referrals to advanced specialty care for undifferentiated problems are an essential component of patient care. Without adequate resources to handle undifferentiated diagnoses, a potential unintended consequence is misdiagnoses resulting in treatment delays and complications leading to more costly treatments.</description><subject>Academic Medical Centers</subject><subject>Cost-Benefit Analysis</subject><subject>Cross-Sectional Studies</subject><subject>Diagnosis</subject><subject>diagnostic uncertainty</subject><subject>face‐to‐face visit</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical referrals</subject><subject>Physicians</subject><subject>Primary Health Care - statistics & numerical data</subject><subject>provider referrals</subject><subject>Referral and Consultation - economics</subject><subject>Referral and Consultation - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Specialization - statistics & numerical data</subject><issn>1356-1294</issn><issn>1365-2753</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp1kMtKAzEUhoMoVqsLX0AG3Ohi2pxcJpOllHqjoAtdhzSTlClzqckM2rc3daoLwbP5D-HjT_IhdAF4AnGma7uZABFMHKAToBlPieD0cLfzLAUi2QidhrDGGCjm4hiNSE4FY1ycoGz-2dmmS1qXFKVeNW3oSpPolbe23p3rum1WSW2L0ugq8dZZ73UVztCRi2HP9zlGb3fz19lDuni-f5zdLlLDQIpUQ7zG5pKB5hKw05nhS2dIISDDnGriuDRC5jkWghFwpnAup9JQkEtRSEHH6Hro3fj2vbehU3UZjK0q3di2DwrynEGWCcIievUHXbe9b-LrFEhCQQiKaaRuBsr4NoT4H7XxZa39VgFWO5kqylTfMiN7uW_sl9HAL_ljLwLTAfgoK7v9v0k9zV-Gyi-p5Hut</recordid><startdate>201708</startdate><enddate>201708</enddate><creator>Van Such, Monica</creator><creator>Lohr, Robert</creator><creator>Beckman, Thomas</creator><creator>Naessens, James M.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6079-6405</orcidid></search><sort><creationdate>201708</creationdate><title>Extent of diagnostic agreement among medical referrals</title><author>Van Such, Monica ; Lohr, Robert ; Beckman, Thomas ; Naessens, James M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4197-a1744e8941a5910fa6c5bfc2d716053a2f59c7988077421fcdff839c319b7d973</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Academic Medical Centers</topic><topic>Cost-Benefit Analysis</topic><topic>Cross-Sectional Studies</topic><topic>Diagnosis</topic><topic>diagnostic uncertainty</topic><topic>face‐to‐face visit</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medical referrals</topic><topic>Physicians</topic><topic>Primary Health Care - statistics & numerical data</topic><topic>provider referrals</topic><topic>Referral and Consultation - economics</topic><topic>Referral and Consultation - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Specialization - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Van Such, Monica</creatorcontrib><creatorcontrib>Lohr, Robert</creatorcontrib><creatorcontrib>Beckman, Thomas</creatorcontrib><creatorcontrib>Naessens, James M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of evaluation in clinical practice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Van Such, Monica</au><au>Lohr, Robert</au><au>Beckman, Thomas</au><au>Naessens, James M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extent of diagnostic agreement among medical referrals</atitle><jtitle>Journal of evaluation in clinical practice</jtitle><addtitle>J Eval Clin Pract</addtitle><date>2017-08</date><risdate>2017</risdate><volume>23</volume><issue>4</issue><spage>870</spage><epage>874</epage><pages>870-874</pages><issn>1356-1294</issn><eissn>1365-2753</eissn><abstract>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 = <.0001).
Conclusion
Referrals to advanced specialty care for undifferentiated problems are an essential component of patient care. Without adequate resources to handle undifferentiated diagnoses, a potential unintended consequence is misdiagnoses resulting in treatment delays and complications leading to more costly treatments.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28374457</pmid><doi>10.1111/jep.12747</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-6079-6405</orcidid></addata></record> |
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| 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 |
| title | Extent of diagnostic agreement among medical referrals |
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