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Improving Diagnosis in Health Care: Highlights of a Report From the National Academies of Sciences, Engineering, and Medicine

John R. Ball, MD, JD; and Erin Balogh, MPH
[+] Article, Author, and Disclosure Information

This article was published online first at www.annals.org on 29 September 2015.


From the National Academies of Sciences, Engineering, and Medicine, Washington, DC.

Disclaimer: The authors are responsible for the content of this article, which does not necessarily represent the views of the National Academies of Sciences, Engineering, and Medicine.

Acknowledgment: The authors thank the members of the Committee on Diagnostic Error in Health Care: John Ball (Chair), Elizabeth Belmont, Robert Berenson, Pascale Carayon, Christine Cassel, Carolyn Clancy, Michael Cohen, Patrick Croskerry, Thomas Gallagher, Christine Goeschel, Mark Graber, Hedvig Hricak, Anupam Jena, Ashish Jha, Michael Laposata, Kathryn McDonald, Elizabeth McGlynn, Michelle Rogers, Urmimala Sarkar, George Thibault, and John Wong, as well as members of the Academies staff, directed by Erin Balogh.

Financial Support: Dr. Ball received no funding for his participation in the study, which was funded by 10 sponsors (the Agency for Healthcare Research and Quality, American College of Radiology, American Society for Clinical Pathology, Cautious Patient Foundation, Centers for Disease Control and Prevention, College of American Pathologists, The Doctors Company Foundation, Janet and Barry Lang, Kaiser Permanente National Community Benefit Fund at the East Bay Community Foundation, and Robert Wood Johnson Foundation) or in the preparation of this manuscript. Ms. Balogh was supported by the Academies, through funding provided by the sponsors.

Disclosures: The authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2256.

Requests for Single Reprints: Erin Balogh, MPH, Board on Health Care Services, Institute of Medicine, 500 Fifth Street NW, Washington, DC 20001; e-mail, ebalogh@nas.edu.

Current Author Addresses: Dr. Ball: 26 Snow Shoe Drive; Asheville, NC 28803.

Ms. Balogh: Board on Health Care Services, Institute of Medicine, 500 Fifth Street NW, Washington, DC 20001.

Author Contributions: Conception and design: J. Ball, E. Balogh.

Analysis and interpretation of the data: J. Ball, E. Balogh.

Drafting of the article: J. Ball, E. Balogh.

Critical revision of the article for important intellectual content: J. Ball.

Final approval of the article: J. Ball, E. Balogh.

Administrative, technical, or logistic support: J. Ball.

Collection and assembly of data: J. Ball, E. Balogh.


Ann Intern Med. 2016;164(1):59-61. doi:10.7326/M15-2256
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To date, efforts to improve patient safety in health care have not focused on reduction of diagnostic error. The Institute of Medicine assembled a panel to evaluate the existing knowledge about diagnostic error and propose solutions. This commentary highlights key points from the resulting report, “Improving Diagnosis in Health Care,” published in September 2015.

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The committee's visualization of the diagnostic process illustrates its complexity and the need for collaboration among clinicians, patients, and their families to achieve accurate, timely diagnosis.

The committee identifies 4 types of information-gathering activities in the diagnostic process: clinical history and interview, physical examination, diagnostic testing, and referral and consultation. Throughout the process, there is an iterative cycle of information gathering, information integration and interpretation, and developing a working diagnosis. A key responsibility is communication—throughout the diagnostic process, patients need an explanation of their health problem, along with an understanding of the degree of uncertainty involved, communicated each time the working diagnosis is revised. Treatment can often inform the diagnostic process and refine the diagnosis; in addition, clinicians need to identify treatment-related health problems. Outcomes from the diagnostic process can inform efforts to strengthen the diagnostic process and improve outcomes for patients and their families.

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