Syracuse University Magazine

Using Public Deliberation to Define Patient Roles in Reducing Diagnostic Error


Investigator: Tina Nabatchi

Department: Public Administration and International Affairs, Program for the Advancement of Research on Conflict and Collaboration, Maxwell School

Sponsor: Agency for Healthcare Research and Quality/U.S. Department of Health and Human Services

Amount Awarded: $365,430 (September 2014-September 2016)

Background: Diagnostic error, or diagnoses that are wrong, missed, or delayed, is a serious problem in both inpatient and outpatient settings in the United States: It occurs in 5 to 15 percent of all cases and causes 40,000 to 80,000 deaths annually. Unfortunately, diagnostic error is under-recognized, under-studied, and seldom integrated into quality assurance measures or activities. Moreover, most proposals to reduce diagnostic error focus on physicians and health care systems; few seek to enlist health care consumers in helping to reduce the risk of harm from diagnostic error. Thus, health care consumers represent a large, untapped, and critically important resource for influencing and improving the quality of diagnoses, and may be the key to making rapid and significant gains in diagnostic safety. Simply put, the health field requires patient-focused strategies to reduce diagnostic error, improve patient safety and health care delivery, and ultimately ensure better quality health outcomes.

Impact: This project is engaging health care consumers here in Onondaga County, New York, to develop informed and practical patient-focused strategies for reducing diagnostic error. Its goals are twofold: first, to assess the value of public deliberation in creating health policy; and second, to develop a set of recommendations that any health care consumer can use to help improve diagnostic quality. The project uses a randomized and controlled experimental design that involves a diverse and demographically representative set of participants who were randomly assigned into a control group, an education-only group, or one of two deliberation groups. The first deliberative group is working to address three interrelated questions: (1) What roles are patients willing and able to play in preventing, identifying, and reporting diagnostic error? (2) What strategies should be pursued to enable patients to play those roles? (3) What systems and structures should be in place to allow patients to assume these roles? This group will develop a set of patient-centered recommendations, which will be tested with a second deliberation group that will rank and prioritize the recommendations and assess their value to average health care consumers. Once the recommendations are finalized, the Society to Improve Diagnosis in Medicine—a nonprofit organization whose membership includes patients, clinicians, researchers, educators, insurers, and health care professionals—will use them to develop strategic plans, policy statements, and research agendas about patient engagement in reducing diagnostic error, as well as to create a patient engagement “toolkit” for health care systems, providers, and consumers that more closely reflects the patient experience. Thus, the project will address an important problem in patient-centered care and has the potential to significantly impact diagnostic quality, patient safety, health care delivery, and health outcomes.