Tejal K. Gandhi, MD, MPH; Allen Kachalia, MD, JD; Eric J. Thomas, MD, MPH; Ann Louise Puopolo, BSN, RN; Catherine Yoon, MS; Troyen A. Brennan, MD, JD; David M. Studdert, LLB, ScD
Note: Drs. Gandhi, Kachalia, and Studdert had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Grant Support: This study was supported by grants from the Agency for Healthcare Research and Quality (HS011886-03) and the Harvard Risk Management Foundation. Dr. Studdert was also supported by the Agency for Healthcare Research and Quality (KO2HS11285).
Potential Financial Conflicts of Interest: Employment: T.A. Brennan (Aetna); Stock ownership or options (other than mutual funds): T.A. Brennan (Aetna); Expert testimony: T.A. Brennan.
Requests for Single Reprints: David M. Studdert, LLB, ScD, Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115; e-mail, email@example.com.
Current Author Addresses: Drs. Gandhi and Kachalia and Ms. Yoon: Division of General Internal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02114.
Dr. Thomas: University of Texas Medical School at Houston, 6431 Fannin, MSB 1.122, Houston, TX 77030.
Ms. Puopolo: CRICO/RMF, 101 Main Street, Cambridge, MA 02142.
Dr. Brennan: 151 Farmington Avenue, RC5A, Hartford, CT 06156.
Dr. Studdert: Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115.
Author Contributions: Conception and design: T.K. Gandhi, E.J. Thomas, T.A. Brennan, D.M. Studdert.
Analysis and interpretation of the data: T.K. Gandhi, A. Kachalia, C. Yoon, D.M. Studdert.
Drafting of the article: T.K. Gandhi, A. Kachalia, T.A. Brennan D.M. Studdert.
Critical revision of the article for important intellectual content: T.K. Gandhi, A. Kachalia, E.J. Thomas, T.A. Brennan D.M. Studdert.
Final approval of the article: T.K. Gandhi, A. Kachalia, E.J. Thomas, D.M. Studdert.
Provision of study materials or patients: A.L. Puopolo.
Statistical expertise: D.M. Studdert.
Obtaining of funding: D.M. Studdert.
Administrative, technical, or logistic support: A. Kachalia, A.L. Puopolo, D.M. Studdert.
Collection and assembly of data: A. Kachalia, A.L. Puopolo, D.M. Studdert.
Gandhi TK, Kachalia A, Thomas EJ, Puopolo AL, Yoon C, Brennan TA, et al. Missed and Delayed Diagnoses in the Ambulatory Setting: A Study of Closed Malpractice Claims. Ann Intern Med. 2006;145:488-496. doi: 10.7326/0003-4819-145-7-200610030-00006
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Published: Ann Intern Med. 2006;145(7):488-496.
Missed and delayed diagnoses in the ambulatory setting are an important patient safety problem. The current diagnostic process in health care is complex, chaotic, and vulnerable to failures and breakdowns. For example, one third of women with abnormal results on mammography or Papanicolaou smears do not receive follow-up care that is consistent with well-established guidelines (1-2), and primary care providers often report delays in reviewing test results (3). Recognition of systemic problems in this area has prompted urgent calls for improvements (4).
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