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New AHRQ Study Finds Failure to Order Needed Tests a Leading Cause of Diagnostic Errors

Electronic Newsletter, Issue 285

January 6, 2010

AHRQ News and Numbers

The rate of hospitalizations that could have been potentially prevented with better outpatient care fell faster for seniors than for younger patients between 2003 and 2007. The analysis compared potentially preventable or avoidable hospitalizations for patients age 65 and older and ages 18 to 64. [Source: Agency for Healthcare Research and Quality, HCUP Statistical Brief #83: Potentially Preventable Hospitalization Rates Declined for Older Adults, 2003-2007.]

Today's Headlines

  1. New AHRQ Study Finds Failure to Order Needed Tests a Leading Cause of Diagnostic Errors
  2. Effective Health Care Program Posts Two Studies on the Treatment of COPD
  3. New Guides Released on Elective Induction of Labor
  4. AHRQ Web Conference on Atypical Antipsychotic Drugs and Risk of Sudden Cardiac Death—Free CPE Credit Offer
  5. New AHRQ Report Finds Non-surgical Method for Diagnosing Breast Cancer Safe, Nearly as Effective as Surgical Biopsy
  6. Meet the AHRQ Pharmacy Health Literacy Center
  7. AHRQ Released New Health Literacy Tool
  8. Free Meeting for Users of AHRQ Surveys on Patient Experience and Patient Safety Culture Set for April 19-21, 2010press release
  9. AHRQ issues funding opportunity announcement on Comparative Effectiveness to Optimize Prevention & Healthcare Management for the Complex Patient
  10. AHRQ Seeks Nominations for Chair of CERTs Steering Committee
  11. AHRQ in the Professional Literature

1.  New AHRQ Study Finds Failure to Order Needed Tests a Leading Cause of Diagnostic Errors

AHRQ researchers found that failure to order tests, report results to patients, or follow up with abnormal test findings are leading types of diagnostic errors. Results were based on a survey issued to nearly 300 primary care and specialist physicians who reported 583 cases of diagnosis error, the largest-ever study of diagnostic errors in medicine. Researchers also found that tests were overlooked because clinicians often failed to consider the diagnosis, leading to delays in ordering the tests or making the correct diagnosis. The most common missed or delayed diagnoses include pulmonary embolism, drug reactions or overdose, lung cancer, colorectal cancer, acute coronary syndrome, including heart attack, breast cancer and stroke. The study, led by Gordon Schiff, M.D., associate director of Brigham and Women's Hospital Center for Patient Safety Research and Practice, Boston, which is part of the Cook County Hospital/Rush University AHRQ-supported Developmental Center for Research in Patient Safety. According to Dr. Schiff, the survey found that other major categories of errors involved failure to consider a diagnosis or overweighing a competing diagnosis, failures in history taking, physical examination, and referral or consultation delays. Findings from the study, "Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors," are published in the November 9 issue of the Archives of Internal Medicine.

 

2.  Effective Health Care Program Posts Two Studies on the Treatment of COPD

AHRQ released two separate studies of the treatment of chronic obstructive pulmonary disease (COPD)) that evaluate outcomes associated with six treatment regimens, including inhaled corticosteroids, long-acting beta-agonists, and ipratropium, with theophylline compared to each regimen without theophylline in patients with COPD. Patients receiving regimens that included theophylline had slightly increased risks of death, bronchial irritations, and COPD-related hospitalizations. Both studies were conducted by researchers from the University of Illinois at Chicago and were funded by AHRQ's Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program. Print copies are available by sending an E-mail to ahrqpubs@ahrq.gov.

 

3.  New Guides Released on Elective Induction of Labor

The number of pregnant women who delivered via induced labor more than doubled in the last decade, a trend that has implications not only for the health status of newborns and their mothers, but also for the nation's health care costs. To help women and their health care providers understand the potential pros and cons of choosing induced labor, AHRQ has produced two free, evidence-based research summary guides. Thinking About Inducing Your Labor: A Guide for Pregnant Women, clearly explains induced labor—the use of medicine or other methods to get labor started—while offering women reasons why they may or may not want to choose the procedure over waiting for traditional childbirth. A companion guide for clinician, Elective Induction of Labor: Safety and Risks, includes a summary of the clinical evidence on the safety of elective induction of labor versus waiting, and also offers information about maternal and fetal outcomes with elective induction. Print copies are available by sending an E-mail to ahrqpubs@ahrq.hhs.gov.

4.  AHRQ Web Conference on Atypical Antipsychotic Drugs and Risk of Sudden Cardiac Death—Free CPE Credit Offer

Now available online is a free Web conference for clinical pharmacists that discuss findings from a recent AHRQ-funded study, "Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death." The study's lead researcher Wayne Ray, Ph.D., Vanderbilt University, Nashville, TN, an AHRQ Center for Education and Research on Therapeutics, presents the findings from the study. The event, intended for clinical pharmacists, was held on May 1, 1:00—2:00pm, EDT, and is presented by AHRQ's Effective Health Care Program and cosponsored by the American Pharmacists Association. Receive free CPE credit by participating in the home study version of the event. Select to access the event; an article on the study.

5.  New AHRQ Report Finds Non-surgical Method for Diagnosing Breast Cancer Safe, Nearly as Effective as Surgical Biopsy

Some methods of minimally invasive biopsy for breast cancer are nearly as accurate as surgical biopsy but have much less risk of harms, according to a new AHRQ report. The report, prepared by the ECRI Institute's Evidence-based Practice Center under contract to AHRQ's Effective Health Care Program, compares traditional surgical biopsies with various types of "core needle biopsies," which involve removing tissue through a special large hollow needle inserted through the skin. Based on reviews of published scientific evidence to gauge the effectiveness, risk and impact of core needle biopsies on patients, the report found that certain core needle biopsies could distinguish between malignant and benign lesions approximately as accurately as open surgical biopsy, which is commonly considered the "gold standard" method of evaluating suspicious lesions. Core needle biopsies have a much lower risk of severe complications than open surgical procedures, researchers found in a report published this month in Annals of Internal Medicine. Select to read our press release.

 

6.  Meet the AHRQ Pharmacy Health Literacy Center

AHRQ is pleased to announce its Pharmacy Health Literacy Center to help retail pharmacists meet the needs of customers with low or limited health literacy. Research shows that many people misread or misunderstand instructions on how to take medications as prescribed. But effective communication can reduce medication errors and the adverse outcomes they may cause. The AHRQ Pharmacy Health Literacy Center features four tools for retail pharmacies: Is Our Pharmacy Meeting Patients' Needs: a Pharmacy Health Literacy Assessment Tool User's Guide; Strategies to Improve Communication between Staff and Patients: Training Program for Pharmacy Staff; How to Create a Pill Card; and Telephone Reminders: A Tool to Help Refill Medications on Time. The Web site also features additional assistance for pharmacies interested in using the assessment tool; a list of resources to learn more about health literacy; and a discussion board for visitors to post comments and questions to learn from other pharmacists.

7.  AHRQ Released New Health Literacy Tool

AHRQ released the Consumer Assessment of Healthcare Providers and Systems™ (CAHPS) Item Set for Addressing Health Literacy in English and Spanish. The primary purpose of the CAHPS Item Set for Addressing Health Literacy is to measure, from the patients' perspective, how well health care professionals communicate with their patients. Only 12 percent of U.S. adults have proficient health literacy. Over a third of U.S. adults—77 million people—could have difficulty with common health tasks, such as following directions on a prescription drug label or adhering to a childhood immunization schedule using a standard chart. The Item Set for Addressing Health Literacy offers:

  • Ability to identify specific topic areas for quality improvement (e.g. communication about test results, medications, and forms);
  • Measure of health care professionals' health literacy practices;
  • Ability to recognize behavior that inhibits effective communication (e.g. talking too fast);
  • Assistance in designing a safer, shame-free environment where patients feel comfortable discussing their health concerns (e.g., showing interest in questions);

The CAHPS Item Set for Addressing Health Literacy consists of 29 supplemental items designed for use with the CAHPS Clinician and Group Survey. The items address six areas: (1) communication with doctors, (2) communication about health problems and concerns, (3) communication about medications, (4) communication about tests, (5) communication about forms, and (6) communication about disease self-management. Select to access the health literacy tool.

8.  Free Meeting for Users of AHRQ Surveys on Patient Experience and Patient Safety Culture Set for April 19-21, 2010

Register now for an AHRQ-sponsored joint meeting for users of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys and the AHRQ Surveys on Patient Safety Culture. The meeting will be held on April 19-21, 2010, at the Hyatt Regency Baltimore in Baltimore, MD. Attendees will hear about recent developments in the CAHPS surveys and the Surveys on Patient Safety Culture, learn ways to administer these surveys, and discover how organizations are using results of the surveys to improve health care quality and patient safety. Speakers will also discuss strategies for reporting CAHPS survey results to consumers.

9.  AHRQ issues funding opportunity announcement on Comparative Effectiveness to Optimize Prevention & Healthcare Management for the Complex Patient

AHRQ issued new Funding Opportunity Announcements (FOA) under the American Recovery & Reinvestment Act of 2009 on comparative effectiveness research. Select to read the announcements.

10.  AHRQ Seeks Nominations for Chair of CERTs Steering Committee

AHRQ's Centers for Education and Research on Therapeutics (CERTs) program is seeking highly qualified individuals for consideration to take on the role of chair and chair-elect of the CERTs National Steering Committee. The deadline for receipt of nominations is January 31, 2010.

11.  AHRQ in the Professional Literature

We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience. Unfortunately, some of you may not be able to access the abstracts because of firewalls or specific settings on your individual computer systems. If you are having problems, you should ask your technical support staff for possible remedies.

Wang M, Burau KD, Fang S, et al. Ethnic variations in diagnosis, treatment, socioeconomic status, and survival in a large population-based cohort of elderly patients with non-Hodgkin lymphoma. Cancer 2009 Dec 1; 113(11):3231-3241. Select to access the abstract.

Stout NK, Goldie SJ. Keeping the noise down: common random numbers for disease simulation modeling. Health Care Manage Sci 2008 Dec; 11(4):399-406. Select to access the abstract.

Bell JF, Wilson JS, Liu GC. Neighborhood greenness and 2-year changes in body mass index of children and youth. Am J Prev Med 2008 Dec; 35(6):547-53. Select to access the abstract.

Berdahl TA. Racial/ethnic and gender differences in individual workplace injury risk trajectories: 1988-1998. Am J Public Health 2008 Dec; 98(12):2258-63. Select to access the abstract.

Farley DO, Haviland A, Champagne S, Jain AK, Battles JB, Munier WB, et al. Adverse-event-reporting practices by U.S. hospitals: results of a national survey. Qual Saf Health Care 2008 Dec; 17(6):416-23. Select to access the abstract.

Khare RK, Courtney DM, Powell ES. Sixty-four-slice computed tomography of the coronary arteries: cost-effectiveness analysis of patients presenting to the emergency department with low-risk chest pain. Acad Emerg Med 2008 Jul; 15(7):623-32. Select to access the abstract.

Matchar DB, Harpole L, Samsa GP, et al. The headache management trial: a randomized study of coordinated care. Headache 2008 Oct; 48(9):1294-310. Select to access the abstract.

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Current as of January 2010
Internet Citation: New AHRQ Study Finds Failure to Order Needed Tests a Leading Cause of Diagnostic Errors. January 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/news/newsletters/e-newsletter/285.html

 

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