The Moore Foundation is funding ten new projects for concepts and approaches for clinical quality measures specifically targeting diagnostic excellence. The foundation announced this new funding opportunity in 2019 as part of its Diagnostic Excellence Initiative, and this will be the third cohort of individuals to receive funding.
Twelve million Americans experience a diagnostic error each year. It is likely that each of us will experience a diagnostic error in our lifetime. Delayed or missed diagnoses result in delays in treatment, allow undiagnosed conditions to persist or even progress, and worsen outcomes. The development of clinical quality measures for diagnosis will provide clinicians and medical institutions the ability to track and measure their success and failure rates and provide them with an opportunity to solve for deficiencies and implement improvements.
The foundation’s Diagnostic Excellence Initiative aims to reduce harm from erroneous or delayed diagnoses. Over the last few decades, significant progress has been made to improve safety for medications and medical interventions, but work to acknowledge and improve diagnostic failure has been slower and more difficult. This initiative, and the projects of the selected grantees, will help tackle the challenge of defining standards and benchmarks for diagnostic excellence, as well as methods to measure success.
“We are continually impressed by the diverse and novel ideas presented by the clinical quality measure grantees, and this year is no different,” said Karen Cosby, M.D., program director for the Diagnostic Excellence Initiative. “These projects show great promise for developing methods to measure and improve diagnostic quality.”
A full list of awardees can be found below.
American Board of Family Medicine
Andrew Bazemore, M.D., M.P.H.
Senior Vice President of Research and Policy, American Board of Family Medicine
Co-Director, Center for Professionalism and Value in Healthcare
Improving the Diagnosis of Cardiovascular Disease through Continuity of Care
Continuity of primary care addresses the intricacies in health care delivery that can cause diagnostic errors and low-value care. Building on the idea that knowledge, trust, and respect develop between the patient and provider over time, continuity frames the personal nature of medical care in contrast to the potentially dehumanizing nature of disjointed care. This project aims to estimate the impact of continuity on intermediate predictors of cardiovascular outcomes that are influenced by timely and accurate diagnosis at the primary care level. The work will include development of a continuity of care quality measure for submission and endorsement by federal and private payers with the goal to disseminate and implement their measure in payment and accountability programs.
American College of Emergency Physicians
Sandra Schneider, M.D., F.A.C.E.P.
Senior Vice President of Clinical Affairs, American College of Emergency Physicians
Bill Malcolm, M.B.A., P.M.P.
Program Director, Data Science and Quality, American College of Emergency Physicians
Improving the Diagnosis of Ruptured Abdominal Aortic Aneurysms
Diagnosing ruptured abdominal aortic aneurysm (rAAA) is a time sensitive emergency. This measure will provide clinicians with direct feedback on timely recognition of rAAA and use of imaging - driving practice improvements and improving patient survival.
American Institutes of Research
Stacie Schilling, M.P.H.
American Institutes of Research
Improving the Diagnosis of Urinary Tract Infections in Women
An average 45 percent of patients with asymptomatic bacteriuria are misdiagnosed with Urinary Tract Infection (UTI) and are ultimately overprescribed antibiotics. Inappropriate treatment of misdiagnosed UTI is associated with greater risk of Clostridium difficile, 90-day readmission, and hospital length of stay. We aim to reduce misdiagnosis of UTI by measuring the appropriate use of urinary culture testing.
American Society of Hematology
Lisa Baumann Kreuziger, M.D., M.S.
Investigator, Blood Research Institute, Versiti
Associate Professor, Medical College of Wisconsin
Rachel Rosovsky, M.D., M.P.H.
Massachusetts General Hospital
Harvard Medical School
Implementing Clinical Pretest Probability Tools into Practice to Improve the Diagnosis of Pulmonary Embolism
This project aims to increase the use of clinical pretest prediction tools to safely limit iatrogenic harm from over-testing. They will operationalize their measures based on two diagnostic pathways – one will focus on whether a prediction tool was used to assess risk level for patients suspected of PE and the second will address whether or not appropriate clinical actions occurred based on the results of use of the tool.
Duke University, Duke Heart Center
Manesh Patel, M.D.
Professor of Medicine and Chief of Cardiology Duke University
Jason Katz, M.D., M.H.S.
Associate Professor of Medicine, Duke University
Improving the Early Diagnosis of Cardiac Decompensation and Shock
The goal of the project is to improve the detection rate of early-stage cardiogenic shock and decrease the time from detection to intervention. Cardiogenic shock is a life-threatening condition that remains difficult to rapidly diagnose because clinicians must synthesize multiple data points in real time, including vital signs, physical exam, laboratory data, imaging data, and other clinical findings. Rapid diagnosis is critical to facilitate early, targeted interventions before patients progress to extremis and die or develop permanent comorbidities, such as end-stage renal failure, that preclude the use of advanced heart failure therapies.
Hospital for Special Surgery, New York
Catherine MacLean, M.D., Ph.D.
Senior Vice President and Chief Value Medical Officer, Hospital for Special Surgery, New York
Development of Diagnostic Quality Metrics for Prosthetic Joint Infection
This project will develop quality measures that assess whether the indicated evaluation was performed among patients who have or who are at risk for periprosthetic joint infections (PJIs). The goal of the measure is to improve the timeliness and accuracy of diagnoses of PJIs to reduce the substantial morbidity and health care expenditures which result from delays in diagnosis and subsequent treatment.
National Committee for Quality Assurance
Sepheen C. Byron, M.H.S
Assistant Vice President, National Committee for Quality Assurance
Ravi Sharaf, M.D., M.S.
Director of Clinical Cancer Genetics and Associate Professor of Medicine, Weill Cornell Medicine
Quality Measures for Screening and Diagnosis of Lynch Syndrome, an Inheritable Risk for Colon Cancer
This project aims to develop a set of measures aimed at improving health outcomes for patients with Lynch syndrome by highlighting gaps in care related to the testing and diagnosis process.
Palo Alto Veterans Institute of Research
Paul Heidenreich, M.D., M.S.
Professor of Medicine, Stanford University School of Medicine
Chief of Medicine, Palo Alto Veterans Health Care System
Diagnosis of Vascular Risk to Reduce Heart Attack and Stroke
Many patients, and their providers, are unaware they are at high risk for a first heart attack or stroke which may be prevented with treatment to reduce their risk. This project will create a performance metric that measures the success of an organization in identifying patients at risk of a first heart attack or stroke before the event.
Yale University School of Medicine
Christopher L. Moore, M.D.
Professor, Department of Emergency Medicine, Yale University School of Medicine
Arjun Venkatesh, M.D., M.B.A., M.H.S.
Associate Professor and Section Chief of Administration, Yale University Department of Emergency Medicine
Improving Equity of Lung Cancer Diagnosis Following Chest Imaging in the Emergency Department
The goal of this project is to develop a measure of equity in the follow-up and diagnosis of cancer in emergency department patients. The specific measures are a set of within-system measures to quantify inequities and care, and benchmark overall performance of follow-up imaging and cancer diagnostic yields among patients with incidental lung nodules identified on chest CT in the emergency department, stratified by social determinants of health.
Yale University, Department of Health Policy and Management
Mark Schlesinger, Ph.D.
Professor of Health Policy, Yale School of Public Health
Using Patient and Family Narratives of Diagnostic Errors to Inform Efforts to Improve Diagnosis
This project is designed to identify otherwise overlooked diagnostic errors, understand their etiology and assess their consequences based on population-wide surveys eliciting narrative accounts of error-related experiences. This work builds on past research on narrative elicitation, which uses a short sequence of open-ended questions, appended to large-scale patient experience surveys, to collect actionable, reliable, and representative information from patients and/or patients’ families.