Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Reducing Diagnostic Errors is Cost-Effective

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Focusing on the quality of care is a "win:win" for both practitioner and patient.  The ideal setting in which to study this parameter of care along with cost-effectiveness and accessibility is the patient-centered medical home (PCMH) because the medical home is, by design, comprehensive and well-coordinated.  Furthemore, that is where one may best address safety issues such as diagnostic (Dx) errors (i.e., missed, delayed, or incorrect diagnoses). 

Diagnostic errors are unfortunately all too frequent and they are the largest contributor to "ambulatory malpractice claims (40% in some studies)"; they "cost approximately $300 000 per claim on average."

The PCMH, again by definition, employs "electronic health records," (EHRs) which can be used to facilitate data access, analytics and advanced decision support including, but not limited to quality and utilization management.

Singh H, Graber M. "Reducing Diagnostic Error Through Medical Home–Based Primary Care Reform." JAMA 2010;304(4):463-464. doi:10.1001/jama.2010.1035

Recomendation

Vincent, et al's 5 "rights" comprise the recipe that can cure diagnostic errors and more: the Right (1) Teamwork, (2) Information Management, (3) Measurement and Monitoring, (4) Patient Empowerment and (5) Safety Culture.  [Reference Singh H, Graber M., above]

Consider, in this context, a common Managed Care technique: electronic algorithms that uncover risk or triggers such as real or potential adverse events or trends.  Information technology can now cull EHRs, claim forms, unlikely diagnostic codes or hidden errors.  One study, for example identified patients with unplanned hospitalizations that occured within 2 weeks of a primary care visit.  In this cohort group, they found a misdiagnosis rate of 20.9%, as compared to a 2.1% rate in a control group.