| Title |
Diagnostic Discordance, Health Information Exchange, and Inter-Hospital Transfer Outcomes: a Population Study
|
|---|---|
| Published in |
Journal of General Internal Medicine, May 2018
|
| DOI | 10.1007/s11606-018-4491-x |
| Pubmed ID | |
| Authors |
Michael Usher, Nishant Sahni, Dana Herrigel, Gyorgy Simon, Genevieve B. Melton, Anne Joseph, Andrew Olson |
| Abstract |
Studying diagnostic error at the population level requires an understanding of how diagnoses change over time. To use inter-hospital transfers to examine the frequency and impact of changes in diagnosis on patient risk, and whether health information exchange can improve patient safety by enhancing diagnostic accuracy. Diagnosis coding before and after hospital transfer was merged with responses from the American Hospital Association Annual Survey for a cohort of patients transferred between hospitals to identify predictors of mortality. Patients (180,337) 18 years or older transferred between 473 acute care hospitals from NY, FL, IA, UT, and VT from 2011 to 2013. We identified discordant Elixhauser comorbidities before and after transfer to determine the frequency and developed a weighted score of diagnostic discordance to predict mortality. This was included in a multivariate model with inpatient mortality as the dependent variable. We investigated whether health information exchange (HIE) functionality adoption as reported by hospitals improved diagnostic discordance and inpatient mortality. Discordance in diagnoses occurred in 85.5% of all patients. Seventy-three percent of patients gained a new diagnosis following transfer while 47% of patients lost a diagnosis. Diagnostic discordance was associated with increased adjusted inpatient mortality (OR 1.11 95% CI 1.10-1.11, p < 0.001) and allowed for improved mortality prediction. Bilateral hospital HIE participation was associated with reduced diagnostic discordance index (3.69 vs. 1.87%, p < 0.001) and decreased inpatient mortality (OR 0.88, 95% CI 0.89-0.99, p < 0.001). Diagnostic discordance commonly occurred during inter-hospital transfers and was associated with increased inpatient mortality. Health information exchange adoption was associated with decreased discordance and improved patient outcomes. |
X Demographics
The data shown below were collected from the profiles of 10 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 3 | 30% |
| United Kingdom | 3 | 30% |
| Spain | 1 | 10% |
| Unknown | 3 | 30% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 7 | 70% |
| Science communicators (journalists, bloggers, editors) | 1 | 10% |
| Practitioners (doctors, other healthcare professionals) | 1 | 10% |
| Scientists | 1 | 10% |
Mendeley readers
The data shown below were compiled from readership statistics for 74 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 74 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 9 | 12% |
| Student > Master | 7 | 9% |
| Researcher | 6 | 8% |
| Professor > Associate Professor | 6 | 8% |
| Student > Doctoral Student | 6 | 8% |
| Other | 23 | 31% |
| Unknown | 17 | 23% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 27 | 36% |
| Nursing and Health Professions | 7 | 9% |
| Computer Science | 4 | 5% |
| Social Sciences | 3 | 4% |
| Economics, Econometrics and Finance | 2 | 3% |
| Other | 9 | 12% |
| Unknown | 22 | 30% |
Attention Score in Context
This research output has an Altmetric Attention Score of 414. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 08 February 2024.
All research outputs
#70,321
of 25,335,657 outputs
Outputs from Journal of General Internal Medicine
#75
of 8,159 outputs
Outputs of similar age
#1,611
of 338,537 outputs
Outputs of similar age from Journal of General Internal Medicine
#2
of 132 outputs
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