Using Patient Experience Surveys to Identify Potential Diagnostic Safety Breakdowns: A Mixed Methods Study

Area of Science:

• Healthcare Quality Improvement
• Patient Safety Research
• Health Services Research

Background:

• Diagnostic errors affect 1 in 20 US outpatients annually.
• Validated methods for collecting patient feedback on diagnostic safety are lacking.
• Patient experience surveys may contain valuable insights into diagnostic breakdowns.

Purpose of the Study:

• To evaluate associations between patient-perceived diagnostic breakdowns in free text comments and structured survey responses.
• To determine if patient feedback can identify diagnostic safety issues in ambulatory care.

Main Methods:

• Exploratory mixed methods study using patient experience surveys from adult outpatients.
• Data collected from March 2020 to June 2020 in a large US health system.
• Content analysis of qualitative comments and statistical analysis of quantitative data.

Main Results:

• Of 2525 surveys with negative comments, 24.5% reported diagnostic breakdowns (accuracy, timeliness, communication).
• Patients scoring providers low (≤50/100) were ~7x more likely to report diagnostic breakdowns.
• Patients scoring practices low were 2x more likely to report diagnostic breakdowns.

Conclusions:

• Routinely collected patient feedback is a valuable source for identifying ambulatory diagnostic breakdowns.
• Structured survey data can serve as a screening tool to flag potential diagnostic safety concerns.
• Further examination of flagged encounters is recommended to improve diagnostic safety.