Diagnostic error is the failure to establish or communicate an accurate and timely explanation of a patient’s health symptoms. The National Academy of Medicine estimates that 1 in 10 diagnoses are missed, delayed unnecessarily, or wrong, exposing patients to unnecessary and avoidable risks.
But most current proposals to improve diagnostic quality are only focusing on physicians and healthcare systems. Very few actually engage patients themselves to prevent, identify, and report diagnostic error. Seeing this gap, in partnership with the Maxwell School of Citizenship and Public Affairs at Syracuse University and the Society to Improve Diagnosis in Medicine (SIDM), we used Citizens Juries to engage healthcare consumers and professionals to develop informed and practical patient-focused strategies for reducing diagnostic error.
PROJECT SNAPSHOT
- Location: Syracuse, New York
History: 2014-2016
No. of Citizen Jury Days: 6 days
No. of Participants: 20
Targeted Participants: Citizens of Onondaga County, New York
Recruitment: Random selection
Target Outcome: Recommendations for review by a Citizens Panel and focus groups of medical professionals
Partners & Funders
The Agency for Healthcare Research and Quality (AHRQ) provided funding, and we collaborated with the Society to Improve Diagnosis in Medicine (SIDM) and the Program for the Advancement of Research on Conflict and Collaboration at the Maxwell School of Citizenship and Public Affairs at Syracuse University.
Our Approach
Citizens Jury
To start the project, we convened a Citizens Jury of twenty Onondaga County residents randomly selected and stratified to reflect the diversity of the region. The jury met for two three-day weekends in late 2015, and recommended strategies patients could pursue to reduce errors in diagnosis, incorporating input from healthcare professionals. These sixteen recommendations were grouped into five overarching categories:
- Present symptoms clearly and completely
- Assert yourself in the relationship
- Coordinate your care
- Ensure accurate records and tests
- Manage your care
Take a look at the full recommendations
Jury members also identified potential obstacles to those strategies and remedies health systems could implement to support productive patient-doctor relationships.
Citizens Panel
Next, we convened a group of ninety-three healthcare consumers in February of 2016 to assess the Jury recommendations. The group evaluated their relevance and feasibility for patients who haven’t received education about diagnostic error. With some variation between recommendations, the large majority of the panel found the recommendations understandable, thought they would make a positive impact on diagnostic quality, and indicated they would be likely and able to apply the recommendations to their own care.
Focus Groups
In the final step, the recommendations were presented to two focus groups of medical professionals in late 2016. Generally, the focus groups determined the recommendations would improve diagnostic quality and expressed they were open to patients acting out the recommendations. The first focus group was held at SIDM’s 2016 Diagnostic Error in Medicine International conference, and the second was held at Crouse Hospital in Syracuse, NY.
The project also used control groups to test the efficacy of deliberation in improving the quality of patient and practitioner recommendations, as compared to similar individuals given access to the same information but tasked with creating recommendations without group deliberation.
Clearing the Error Final Report
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If you’d like to explore the research in more detail, check out the research reports from Dr. Tina Nabatchi at Syracuse University:
Request ReportsOutcomes
Clearing the Error used Citizens Juries to help healthcare consumers develop informed, practical, and patient-focused recommendations for improving diagnostic quality. SIDM is currently using the jury recommendations and assessments to drive policy reform in regional healthcare systems, and recommendations will also inform patient education and outreach strategies.
Re-framing diagnosis as a partnership between healthcare professionals and patients, and effectively community the idea of diagnosis as ongoing process will likely lead to more positive relationships and improve diagnostic quality.
This project has been recognized as Research Project of the Year by IAP2 USA and IAP2 International.