A Federal Agency’s Role in Improving Diagnosis

What follows is an interview with Jeff Brady, MD, MPH, Director of the Agency for Healthcare Research and Quality’s (AHRQ) Center for Quality Improvement and Patient Safety (CQuIPS). CQuIPS works to improve the quality and safety of the healthcare system through research and implementation of evidence. AHRQ is a federal liaison to the Coalition to Improve Diagnosis.

 

First, tell us a bit about what AHRQ and CQuIPS do to improve diagnosis.

“AHRQ’s Director, Mr. Gopal Khanna, often describes the agency’s role in improving the health of the nation by highlighting a distinction between ‘care’ and ‘cures,’” said Dr. Jeff Brady, MD, MPH. “Science has produced myriad ‘cures,’ but a failure to address the issues with ‘care’ limits the ability to consistently and reliably deliver these ‘cures’ to patients.” AHRQ addresses the safety and quality of the healthcare system to ensure ‘cures’ actually reach patients.

“Receipt of the right treatment often depends on a correct diagnosis, so this is one way we address both ‘cures’ and ‘care,’” said Dr. Brady. “At CQuIPS, we believe successful approaches to improving diagnostic safety will draw from the important knowledge gained from targeted research to develop proven patient safety strategies.”

CQuIPS conducts and supports user-driven research on patient safety and healthcare quality measurement, reporting, and improvement. “A major portion of our research effort has been aimed at better understanding of the frequency and impact of diagnostic errors, how they happen, and what can be done to prevent them,” said Dr. Brady.

 

How did AHRQ come to the decision of making diagnostic quality an organizational priority?

“AHRQ recognizes that diagnostic errors are a significant and under-recognized threat to patient safety,” said Dr. Brady. In fact, AHRQ Director Khanna recently cited reducing diagnostic errors as one of today’s three urgent challenges in healthcare that the agency is addressing.

Dr. Brady and others in the field believe large gains can be made by focusing research on the “Big Three” disease categories that account for half of all diagnostic errors that cause serious harm: vascular events, cancer, and infections.

Even Congress recognizes the impact that diagnostic errors have on Americans. They authorized $2 million in fiscal year 2019 for AHRQ to increase funding for research that will enhance the ability to understand and solve the problem.

“With these funds, we are supporting research to quantify the incidence of diagnostic errors, understand what contributes to these errors, and learn more about the link between diagnostic errors and outcomes, including adverse events that harm patients,” said Dr. Brady.

 

What tools or products has AHRQ developed to improve the diagnostic process and safety within healthcare systems? How did you implement them?

“AHRQ’s research efforts have led to the development of several practical tools and resources that can improve diagnosis by enhancing communication among clinicians and between clinicians and their patients,” said Dr. Brady. Examples are provided in the resources section below.

“By creating tools that are intentionally broad-based to address foundational issues (e.g., organizational culture and teamwork, patient-clinician communication) in combination with tools to address specific problems such as harm due to adverse drug events, falls, healthcare-associated infections, and diagnostic error, we can substantially improve patient safety,” said Dr. Brady.

AHRQ routinely includes patients and family members in the development of its products. The agency’s focus on broad strategies and its ongoing relationships with patients, clinicians, and researchers has led to widespread implementation of its products. The agency has hundreds of Impact Case Studies that detail what has been achieved with the use of its tools, resources, and data.

 

What were some barriers you needed to overcome in order to advance this work? What advice might you have for other Coalition members who are engaging in their own efforts to improve diagnosis?

“Thankfully, mainstream appreciation of patient safety and quality concerns is increasing, although we still have a long way to go to raise awareness to a level that is commensurate with the scope of the problems and the potential we have to solve them,” said Dr. Brady. “The research and practice improvement innovators that AHRQ fosters and supports help overcome some barriers to change by demonstrating the ability to improve and showing what can be done and how to do it.”

Dr. Brady commented that the relationship between patient safety and high-value care should be a compelling motivator to many stakeholders. “We know patients want—and providers want to deliver—safe care,” said Dr. Brady. “No one wants to suffer from or be associated with a diagnostic error or any event that harms a patient. Safer care also saves money by avoiding additional care to address harm from a patient safety event.”

Dr. Brady emphasized the importance of stakeholder engagement and buy in. “We have always recognized that patient safety and quality improvement is a team sport. Working with other stakeholders to identify, promote, and efficiently implement evidence-based approaches to diagnosis is the key to success.”

 

Resources

• Guide to Patient and Family Engagement in Hospital Quality and Safety: This guide encourages hospital patients and family members to be involved in their care. It focuses on four primary strategies for promoting patient/family engagement in hospital safety and quality of care.
• Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families: This guide offers four interventions and four case studies designed to improve patient safety by meaningfully engaging patients and families in their care.
• Improving Your Laboratory Testing Process: A Step-by-Step Guide for Rapid-Cycle Patient Safety and Quality Improvement: This toolkit helps ensure that diagnostic lab tests are accurately managed and shared with patients and clinicians in a timely manner.
• Questions Are the Answer: These resources provide tips for communicating with clinicians and demonstrate how patients asking questions can improve care.
• Reducing Diagnostic Errors in Primary Care Pediatrics: This toolkit helps primary care practice teams with a systematic approach to reduce diagnostic errors among children in three important areas: elevated blood pressure, adolescent depression, and actionable pediatric diagnostic tests.
• TeamSTEPPS®: This evidence-based program is aimed at optimizing performance among teams of healthcare professionals, enabling them to respond quickly and communicate effectively in a variety of clinical situations.
• QuestionBuilder app: This puts a technology-based solution in the hands of patients, helping them prepare and organize questions before a medical visit.