Improving diagnostic performance to reduce harm, improve health outcomes and save lives.
One of the most pressing issues in health care today is the quality and safety of care that people receive. Each year, millions of people suffer from medical errors and tens of thousands die from these errors. Medical errors are numerous and varied – from misdiagnoses to medication mishaps – and their causes equally diverse. Diagnostic errors are the most common cause of medical errors reported by patients, accounting for nearly 60 percent of all errors and an estimated 40,000-80,000 deaths per year. In its report Improving Diagnosis in Health Care, the National Academy of Medicine estimates that "nearly every American will experience a diagnostic error in their lifetime, sometimes with devastating consequences."
“Improving the diagnostic process is not only possible, it also represents a moral, professional and public health imperative.”
While much of the early attention and work in this field has been focused on avoiding diagnostic errors and their resulting harms, we advocate for a new emphasis and framing around the concept of diagnostic excellence. Achieving excellence in diagnosis goes beyond avoiding errors and includes consideration of cost, timeliness and patient convenience. Designing an optimal diagnostic process will require a careful balancing among these competing demands.
Our work to improve diagnostic performance will focus on three clinical categories – cardiovascular events, infections and cancers. We chose these health conditions as they are responsible for a disproportionate share of serious harm and preventable death because of sub-optimal diagnosis. These conditions are a starting point, and we hope that in the coming years other conditions and categories of diseases will benefit from the work we and our grantees do in this field.
As we embark on this work, our primary strategy is to strengthen accountability for diagnostic excellence by helping to develop and validate new measures for diagnostic performance. We start with this infrastructure because our health care systems are unable to systemically measure diagnostic performance in real time, which limits the ability to quantify performance and guide improvements. As the adage goes, “you can’t improve what you can’t measure.”
In addition, we will look at opportunities to support growth and capacity of the field – preparing leaders dedicated to working on the issue of diagnostic excellence. And, we will assess the potential for new technologies to improve diagnostic performance, working to both minimize barriers for innovation and advocate for the safe and responsible deployment of these technologies.