Patient safety strategies targeted at diagnostic errors: a systematic review.
ABSTRACT Missed, delayed, or incorrect diagnosis can lead to inappropriate patient care, poor patient outcomes, and increased cost. This systematic review analyzed evaluations of interventions to prevent diagnostic errors. Searches used MEDLINE (1966 to October 2012), the Agency for Healthcare Research and Quality's Patient Safety Network, bibliographies, and prior systematic reviews. Studies that evaluated any intervention to decrease diagnostic errors in any clinical setting and with any study design were eligible, provided that they addressed a patient-related outcome. Two independent reviewers extracted study data and rated study quality.There were 109 studies that addressed 1 or more intervention categories: personnel changes (n = 6), educational interventions (n = 11), technique (n = 23), structured process changes (n = 27), technology-based systems interventions (n = 32), and review methods (n = 38). Of 14 randomized trials, which were rated as having mostly low to moderate risk of bias, 11 reported interventions that reduced diagnostic errors. Evidence seemed strongest for technology-based systems (for example, text message alerting) and specific techniques (for example, testing equipment adaptations). Studies provided no information on harms, cost, or contextual application of interventions. Overall, the review showed a growing field of diagnostic error research and categorized and identified promising interventions that warrant evaluation in large studies across diverse settings.
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ABSTRACT: To request permissions please use the Feedback form on our webpage. http://researchspace.auckland.ac.nz/feedback General copyright and disclaimer In addition to the above conditions, authors give their consent for the digital copy of their work to be used subject to the conditions specified on the Library Thesis Consent Form and Deposit Licence.01/2015, Degree: PhD thesis, Supervisor: Dr Jeff Harrison and Dr Shane Scahill
Dataset: The devil in the details
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ABSTRACT: Background: Mental disorders, especially depression, have been increasingly described as a growing burden to global public health. This description is, however, not without controversy, and some scholars are skeptical of how, for instance, depression is viewed as an increasing widespread ill health problem. Discussion: While public health medicine has long engaged in strategies of disease prevention and health promotion, more individualized practices of risk are argued to have become a central dimension of the politics of life in the twenty-first century. By trying to assess potential risk factors for disease and disorders at earlier stages, the concepts of illness and risk may become increasingly blurred. Non-medical problems have become medical ones with risking leading to overdiagnosis and overtreatment as the definition of what constitutes an abnormality gets increasingly broader. If normal events are misdiagnosed as depression, this will risk leaving those who are depressed untreated (extended waiting lists to health care, wrong medications or lack of resources) and thereby create undertreatment and overtreatment simultaneously. Summary: For the sake of public health, arguments for increased diagnosis must therefore be related to a possible danger of medicalizing social problems and life crises. By including people with mild problems in estimates of mental illness, we risk losing support for treating those people who have legitimate disorders.Frontiers in Public Health 09/2014; 2(192).