Diagnostic Errors in Primary Care Pediatrics: Project RedDE

Area of Science:

• Pediatric primary care
• Quality improvement
• Diagnostic error research

Background:

• Diagnostic errors (DEs) and missed opportunities for diagnosis (MODs) are significant causes of morbidity but are understudied in pediatrics.
• Pediatricians are interested in reducing high-frequency, subacute DEs, yet their epidemiology is not well understood.

Purpose of the Study:

• To investigate the frequency of specific high-frequency/subacute DEs and MODs in primary care pediatrics.
• To identify the prevalence of diagnostic errors related to elevated blood pressure and abnormal lab values.
• To determine the rate of missed opportunities for diagnosing adolescent depression.

Main Methods:

• A national quality improvement collaborative involving 25 primary care pediatric practices.
• Retrospective data collection over 5 months on elevated blood pressure (DE), abnormal laboratory values (DE), and adolescent depression evaluation (MOD).
• Mixed-effects logistic regression models were used to explore relationships between DE/MOD proportions and patient demographics.

Main Results:

• High rates of DEs/MODs were observed: 54% for elevated blood pressure, 11% for abnormal laboratory values, and 62% for adolescent depression evaluation.
• Providers failed to document recognition of elevated blood pressure in 51% of affected patients.
• Failure to document recognition of abnormal laboratory values without delay occurred in 9% of patients.

Conclusions:

• Diagnostic errors and missed opportunities for diagnosis occur frequently in pediatric primary care.
• These diagnostic issues have the potential to cause delays in care and patient harm.
• Further research and quality improvement initiatives are needed to address these prevalent issues in pediatric healthcare.