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

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Patient feedback from surveys can identify diagnostic errors in outpatient care. Low scores on provider or practice questions strongly correlate with perceived diagnostic breakdowns, highlighting a valuable screening method.

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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.