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Center for Improving Diagnosis in Healthcare

The Center for Improving Diagnosis in Healthcare

The Institute’s Center for Improving Diagnosis in Healthcare is developing and implementing a multi-pronged approach to achieve the goals set forth in the Improving Diagnosis in Health Care report published by the National Academies of Medicine in September 2015. According to the report, “diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.”

At the Center for Improving Diagnosis in Healthcare, we address challenges in the diagnostic process by:

  • Convening clinician, patient, family and community stakeholders as key contributors to our work
  • Collaborating to identify and prioritize diagnostic challenges
  • Creating and Implementing goal directed strategies, tools, training, and effective improvement interventions
  • Communicating with the larger community through workshops, publications, enhanced training and expanded research

The Center is led by Dr. Christine Goeschel, ScD, MPA, MPS, RN, FAAN. Dr. Goeschel is a fellow of the American Academy of Nursing. She was founder and first executive for the Keystone Center for Patient Safety and Quality at the Michigan Health & Hospital Association and was the Michigan principal investigator on groundbreaking research to reduce bloodstream infections in intensive care units. A quality and patient safety researcher, she has led large scale, national and international healthcare improvement projects.  Dr. Goeschel served on the board of directors of the Maryland Patient Safety Center and was a member of the National Academy of Medicine’s committee that produced the seminal report Improving Diagnosis in Healthcare in 2015.  She was appointed by the Secretary of Health and Human Services in July, 2019, to serve a three-year term on the National Advisory Council for Healthcare Research and Quality.

Center Projects

The Center is currently leading several innovative, multi-year research and education projects that include:

  • Diagnostic Safety Capacity Building: MedStar Health was awarded a contract to support the AHRQ in developing capacity related to understanding and improving diagnostic safety. The project will engage subject matter experts from across the country to help develop new approaches and resources to improve diagnostic safety.  Select resources will include a TeamSTEPPS® module to enhance communication among providers related to diagnosis, a resource to engage patients and families in the diagnostic process, and tools to guide clinicians and frontline quality and safety professionals in their diagnostic improvement efforts.
  • Patient Safety Learning Lab to Improve the Diagnosis and Treatment of Cardiovascular Disease in Women: Cardiovascular disease (CVD) is our nation’s costliest chronic disease. Errors in the diagnosis, treatment, and communication of CVD disproportionately impact women. Women are nearly twice as likely as men to receive the wrong initial diagnosis following a heart attack and 30% more likely to have stroke symptoms misdiagnosed in the emergency department (ED). The MedStar Health Learning Lab will apply a systems engineering approach to understand the factors contributing to diagnostic error in women with CVD. Collaboratively with our partners, we will design and test methods to prevent or mitigate these errors. The Lab will focus on the ambulatory care setting and involve patients, physicians, nurses and other providers working in partnership with the research team. The overall aims are to improve the diagnosis and treatment of women with CVD thereby improving patient outcomes and reducing costs of care.
  • Improving Diagnostic Accuracy for Hepatitis C with a Validated Teach/Improve Model: "HCV ECHO" Chronic hepatitis C viral infection (HCV) has been dubbed the ‘silent killer’ due to its largely asymptomatic nature until progression results in noticeable, often irreversible impact on the patient’s health.  The MedStar project seeks to improve accurate and timely diagnosis of HCV and facilitation of comprehensive treatment within the primary care setting.  The work aligns with goals contained in the Maryland Department of Health Hepatitis C Strategic Plan, which includes a 4-pronged approach that encompasses prevention and education, testing, treatment and strengthening the disease surveillance system.

In addition to above, the Center aims to create a pragmatic curriculum for diagnosis improvement, and several patient-centered resources and toolkits. The Institute is proud to serve as an ECHO Model™ Hub Site which allows us to use interactive video technology to connect groups of learners and providers in real-time to facilitate case-based learning, mentorship and skill transfer.  To learn more about ongoing research and education projects across the Institute click here.

Suggested Publicly Available Resources

  • “Improving Diagnosis: A Vital Patient Safety Frontier” AHRQ Director Gopal Khanna, M.B.A., and Jeff Brady, M.D., director of AHRQ’s Center for Quality Improvement and Patient Safety, highlight AHRQ’s commitment to improving diagnostic safety in a new AHRQ Views blog post. The post highlights work that AHRQ has already begun in this important area, including funding a Patient Safety Learning Laboratory opportunity and a Health Services Research project that emphasize diagnostic excellence. Improving diagnostic safety, establishing a data and analytics platform to support healthcare decision-making, and improving care for patients with multiple chronic conditions have been identified as three areas that will guide the Agency’s future activities.
  • $4.5 Million Grant Program to Accelerate Innovation in Diagnostic Quality and Safety: The Society to Improve Diagnosis in Medicine (SIDM) was recently awarded a $4.5 million grant from the Gordon and Betty Moore Foundation to initiate the DxQI Seed Grant Program. The seed grant program will engage healthcare organizations in the identification, development and testing of interventions aimed at improving diagnostic quality and reducing harm. Organizations interested in the DxQI Seed Grant Program may sign up on the SIDM website to receive notifications when the request for proposal is issued. Read the full press release.
  • “Emergency Department Risks: Through the Lens of Liability Claims”: This report highlights the root causes of claims occurring in the emergency department (ED) based on an analysis of ED-related closed medical professional liability claims across a five-year period. The goal is to provide emergency medicine providers and healthcare leaders with data-driven insights, and strategies to meet the needs of patients seeking emergency .
  • "Improving Diagnosis in Primary Care”: This is an AHRQ-sponsored webcast that features Gordon Schiff, M.D., quality and safety director for the Harvard Medical School Center for Primary Care. Dr. Schiff is an AHRQ grantee and leading expert in diagnostics and malpractice prevention. Access the no-cost webcast (when asked at login for the “Bureau/Office,” enter “Guest”). Access more information about AHRQ’s efforts to improve diagnostic safety. 
  • After 20 Years of Improving America’s Healthcare, AHRQ Makes Bold Plans for Future Successes: In this AHRQ blog post, Director Gopal Khanna, M.B.A., notes that two seminal events helped set the nation’s healthcare agenda and define the quality improvement mission that drives AHRQ’s work today.
  • "Be Aware - Women and Heart Disease": This video features commentary about Cardio Vascular Disease (CVD) from Drs. Harjit Chahal and Ezequiel Molina, both with the MedStar Heart & Vascular Institute. In the video, Drs. Chahal and Molina share important information women should know about CVD, the #1 killer of women in the U.S.

For additional quality improvement tools and resources visit the Institute Resource Library here.