Expanding perspectives on misdiagnosis
Klein Associates Division, Applied Research Associates, Fairborn, Ohio, USA.The American journal of medicine (Impact Factor: 5.3). 06/2008; 121(5 Suppl):S30-3. DOI: 10.1016/j.amjmed.2008.02.002
Article: Diagnosing DiagnosisAnnals of Emergency Medicine 12/2014; 64(6). DOI:10.1016/j.annemergmed.2014.08.009 · 4.33 Impact Factor
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ABSTRACT: To improve and learn from patient outcomes, particularly under new care models such as Accountable Care Organizations and Patient-Centered Medical Homes, requires establishing systems for follow-up and feedback. To provide post-visit feedback to physicians on patient outcomes following acute care visits. A three-phase cross-sectional study [live follow-up call three weeks after acute care visits (baseline), one week post-visit live call, and one week post-visit interactive voice response system (IVRS) call] with three patient cohorts was conducted. A family medicine clinic and an HIV clinic participated in all three phases, and a cerebral palsy clinic participated in the first two phases. Patients answered questions about symptom improvement, medication problems, and interactions with the healthcare system. A total of 616 patients were included: 142 from Phase 1, 352 from Phase 2 and 122 from Phase 3. Primary outcomes included: problem resolution, provider satisfaction with the system, and comparison of IVRS with live calls made by research staff. During both live follow-up phases, at least 96 % of patients who were reached completed the call compared to only 48 % for the IVRS phase. At baseline, 98 of 113 (88 %) patients reported improvement, as well as 167 of 196 (85 %) in the live one-week follow-up. In the one-week IVRS phase, 25 of 39 (64 %) reported improvement. In all phases, the majority of patients in both the improved and unimproved groups had not contacted their provider or another provider. While 63 % of providers stated they wanted to receive patient feedback, they varied in the extent to which they used the feedback reports. Many patients who do not improve as expected do not take action to further address unresolved problems. Systematic follow-up/feedback mechanisms can potentially identify and connect such patients to needed care.Journal of General Internal Medicine 03/2014; 29(8). DOI:10.1007/s11606-014-2783-3 · 3.42 Impact Factor
Australian and New Zealand Journal of Psychiatry 01/2014; 48(3). DOI:10.1177/0004867413518442 · 3.77 Impact Factor
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