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Title: Identification of factors associated with diagnostic error in primary care.
Authors: Minué, Sergio
Bermúdez-Tamayo, Clara
Fernández, Alberto
Martín-Martín, José Jesús
Benítez, Vivian
Melguizo, Miguel
Caro, Araceli
Orgaz, María José
Prados, Miguel Angel
Díaz, José Enrique
Montoro, Rafael
metadata.dc.contributor.authoraffiliation: [Minué,S; Bermúdez-Tamayo,C; Fernández,A; Benítez,V; Caro,A] Andalusian School of Public Health, Granada, Spain. [Bermúdez-Tamayo,C] Institute de recherche en santé publique. Université de Montréal, Montréal, Canada. [Bermúdez-Tamayo,C] CIBERESP. CIBER de Epidemiología y Salud Pública, Madrid, Spain. [Martín-Martín,JJ] Facultad de Ciencias Económicas y Empresariales, Universidad de Granada, Granada, Spain. [Melguizo,M; Orgaz, MJ] Centro de salud Almanjayar. Servicio Andaluz de Salud, Granada, Spain. [Prados,MA] Centro de salud Cartuja. Servicio Andaluz de Salud, Granada, Spain. [Díaz,JE] Centro de salud Gran Capitán. Servicio Andaluz de Salud, Granada, España. [Montoro,R] Distrito de Atención Primaria de Granada -Metropolitano. Servicio Andaluz de Salud, Granada, Spain. [Bermúdez-Tamayo,c] Département d’administration de la Santé, École de santé publique, Montréal, Québec, Canada.
Keywords: Primary care;Diagnostic errors;Decision-making;Diagnóstico Diferencial;Errores Diagnósticos;Disnea;Femenino;Investigación sobre Servicios de Salud;Humanos;Masculino;Atención Primaria de Salud;Estudios Prospectivos;Cuestionarios;Proyectos de Investigación;España
metadata.dc.subject.mesh: Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnosis, Differential
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Errors
Medical Subject Headings::Diseases::Respiratory Tract Diseases::Respiration Disorders::Dyspnea
Medical Subject Headings::Check Tags::Female
Medical Subject Headings::Disciplines and Occupations::Natural Science Disciplines::Science::Research::Biomedical Research::Health Services Research
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Check Tags::Male
Medical Subject Headings::Health Care::Health Services Administration::Patient Care Management::Comprehensive Health Care::Primary Health Care
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Questionnaires
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Methods::Research Design
Medical Subject Headings::Geographicals::Geographic Locations::Europe::Spain
Issue Date: 12-May-2014
Publisher: BioMed Central
Citation: Minué S, Bermúdez-Tamayo C, Fernández A, Martín-Martín JJ, Benítez V, Melguizo M, et al. Identification of factors associated with diagnostic error in primary care. BMC Fam Pract 2014; 15:92
Abstract: BACKGROUND Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care (PC) physicians diagnose dyspnoea. It examines the possible links between the use of heuristics, suboptimal cognitive acts and diagnostic errors, using Reason's taxonomy of human error (slips, lapses, mistakes and violations). The influence of situational factors (professional experience, perceived overwork and fatigue) is also analysed. METHODS Cohort study of new episodes of dyspnoea in patients receiving care from family physicians and residents at PC centres in Granada (Spain). With an initial expected diagnostic error rate of 20%, and a sampling error of 3%, 384 episodes of dyspnoea are calculated to be required. In addition to filling out the electronic medical record of the patients attended, each physician fills out 2 specially designed questionnaires about the diagnostic process performed in each case of dyspnoea. The first questionnaire includes questions on the physician's initial diagnostic impression, the 3 most likely diagnoses (in order of likelihood), and the diagnosis reached after the initial medical history and physical examination. It also includes items on the physicians' perceived overwork and fatigue during patient care. The second questionnaire records the confirmed diagnosis once it is reached. The complete diagnostic process is peer-reviewed to identify and classify the diagnostic errors. The possible use of heuristics of representativeness, availability, and anchoring and adjustment in each diagnostic process is also analysed. Each audit is reviewed with the physician responsible for the diagnostic process. Finally, logistic regression models are used to determine if there are differences in the diagnostic error variables based on the heuristics identified. DISCUSSION This work sets out a new approach to studying the diagnostic decision-making process in PC, taking advantage of new technologies which allow immediate recording of the decision-making process.
Description: Journal Article; Research Support, Non-U.S. Gov't;
metadata.dc.identifier.doi: 10.1186/1471-2296-15-92
ISSN: 1471-2296 (Online)
Appears in Collections:01- Artículos - DAP Granada
01- Artículos - DAP Metropolitano de Granada
01- Artículos - EASP. Escuela Andaluza de Salud Pública

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