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Frequency and Duration of, and Risk Factors for, Diagnostic Delays Associated with Histoplasmosis
Aaron C Miller1, Alan T Arakkal2, Scott H Koeneman2
1Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA.
Abstract:
Histoplasmosis is often confused with other diseases leading to diagnostic delays. We estimated the incidence, length of, and risk factors for, diagnostic delays associated with histoplasmosis. Using data from IBM Marketscan, 2001-2017, we found all patients with a histoplasmosis diagnosis. We calculated the number of visits that occurred prior to the histoplasmosis diagnosis and the number of visits with symptomatically similar diagnoses (SSDs). Next, we estimated the number of visits that represented a delay using a simulation-based approach. We also computed the number of potential opportunities for diagnosis that were missed for each patient and the length of time between the first opportunity and the diagnosis. Finally, we identified risk factors for diagnostic delays using a logistic regression model. The number of SSD-related visits increased significantly in the 97 days prior to the histoplasmosis diagnosis. During this period, 97.4% of patients had a visit, and 90.1% had at least one SSD visit. We estimate that 82.9% of patients with histoplasmosis experienced at least one missed diagnostic opportunity. The average delay was 39.5 days with an average of 4.0 missed opportunities. Risk factors for diagnostic delays included prior antibiotic use, history of other pulmonary diseases, and emergency department and outpatient visits, especially during weekends. New diagnostic approaches for histoplasmosis are needed.
Insights
Histoplasmosis diagnosis is frequently delayed, with most patients missing diagnostic opportunities. Key risk factors include prior antibiotic use and other lung conditions, highlighting a need for better diagnostic tools.
Area of Science:
- Infectious Diseases
- Medical Diagnostics
- Epidemiology
Background:
- Histoplasmosis is frequently misdiagnosed, leading to significant delays in appropriate patient care.
- Diagnostic delays for histoplasmosis can result in prolonged illness and increased healthcare utilization.
Purpose of the Study:
- To estimate the incidence, duration, and risk factors associated with diagnostic delays in histoplasmosis patients.
- To identify missed diagnostic opportunities and their impact on patient outcomes.
Main Methods:
- Utilized IBM Marketscan data from 2001-2017, identifying patients diagnosed with histoplasmosis.
- Calculated pre-diagnosis visits and visits with symptomatically similar diagnoses (SSDs).
- Employed a simulation-based approach to estimate delays and missed diagnostic opportunities, using logistic regression for risk factor analysis.
Main Results:
- A significant increase in SSD-related visits occurred within 97 days prior to histoplasmosis diagnosis.
- An estimated 82.9% of patients experienced at least one missed diagnostic opportunity, averaging 39.5 days delay and 4.0 missed opportunities.
- Prior antibiotic use, history of pulmonary diseases, and emergency/outpatient visits (especially on weekends) were identified as risk factors for delays.
Conclusions:
- Most histoplasmosis cases involve significant diagnostic delays and missed opportunities.
- Urgent development of improved diagnostic approaches for histoplasmosis is necessary to reduce delays and improve patient management.
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