How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care
Objectives The quest to measure and improve diagnosis has proven challenging; new approaches are needed to better understand and measure key elements of the diagnostic process in clinical encounters. The aim of this study was to develop a tool assessing key elements of the diagnostic assessment proc...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-05-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/5/e071241.full |
| _version_ | 1797832820581728256 |
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| author | Gordon D Schiff Mark Linzer Erin E Sullivan Maram Khazen Sophia Arabadjis Jason Ramos Maria Mirica Andrew Olson |
| author_facet | Gordon D Schiff Mark Linzer Erin E Sullivan Maram Khazen Sophia Arabadjis Jason Ramos Maria Mirica Andrew Olson |
| author_sort | Gordon D Schiff |
| collection | DOAJ |
| description | Objectives The quest to measure and improve diagnosis has proven challenging; new approaches are needed to better understand and measure key elements of the diagnostic process in clinical encounters. The aim of this study was to develop a tool assessing key elements of the diagnostic assessment process and apply it to a series of diagnostic encounters examining clinical notes and encounters’ recorded transcripts. Additionally, we aimed to correlate and contextualise these findings with measures of encounter time and physician burnout.Design We audio-recorded encounters, reviewed their transcripts and associated them with their clinical notes and findings were correlated with concurrent Mini Z Worklife measures and physician burnout.Setting Three primary urgent-care settings.Participants We conducted in-depth evaluations of 28 clinical encounters delivered by seven physicians.Results Comparing encounter transcripts with clinical notes, in 24 of 28 (86%) there was high note/transcript concordance for the diagnostic elements on our tool. Reliably included elements were red flags (92% of notes/encounters), aetiologies (88%), likelihood/uncertainties (71%) and follow-up contingencies (71%), whereas psychosocial/contextual information (35%) and mentioning common pitfalls (7%) were often missing. In 22% of encounters, follow-up contingencies were in the note, but absent from the recorded encounter. There was a trend for higher burnout scores being associated with physicians less likely to address key diagnosis items, such as psychosocial history/context.Conclusions A new tool shows promise as a means of assessing key elements of diagnostic quality in clinical encounters. Work conditions and physician reactions appear to correlate with diagnostic behaviours. Future research should continue to assess relationships between time pressure and diagnostic quality. |
| first_indexed | 2024-04-09T14:13:51Z |
| format | Article |
| id | doaj.art-27c01b354332471994f19e06021f3bf3 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-09T14:13:51Z |
| publishDate | 2023-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-27c01b354332471994f19e06021f3bf32023-05-05T21:30:06ZengBMJ Publishing GroupBMJ Open2044-60552023-05-0113510.1136/bmjopen-2022-071241How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary careGordon D Schiff0Mark Linzer1Erin E Sullivan2Maram Khazen3Sophia Arabadjis4Jason Ramos5Maria Mirica6Andrew Olson72General Medicine, Brigham and Women`s Hospital, Boston, Massachusetts, USAGeneral Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USASawyer School of Business, Suffolk University, Boston, Massachusetts, USAHarvard Medical School, Center for Primary Care, Boston, Massachusetts, USAUniversity of California Santa Barbara, Santa Barbara, California, USAEmory University School of Medicine, Atlanta, Georgia, USABrigham and Women’s Hospital, Boston, Massachusetts, USAUniversity of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USAObjectives The quest to measure and improve diagnosis has proven challenging; new approaches are needed to better understand and measure key elements of the diagnostic process in clinical encounters. The aim of this study was to develop a tool assessing key elements of the diagnostic assessment process and apply it to a series of diagnostic encounters examining clinical notes and encounters’ recorded transcripts. Additionally, we aimed to correlate and contextualise these findings with measures of encounter time and physician burnout.Design We audio-recorded encounters, reviewed their transcripts and associated them with their clinical notes and findings were correlated with concurrent Mini Z Worklife measures and physician burnout.Setting Three primary urgent-care settings.Participants We conducted in-depth evaluations of 28 clinical encounters delivered by seven physicians.Results Comparing encounter transcripts with clinical notes, in 24 of 28 (86%) there was high note/transcript concordance for the diagnostic elements on our tool. Reliably included elements were red flags (92% of notes/encounters), aetiologies (88%), likelihood/uncertainties (71%) and follow-up contingencies (71%), whereas psychosocial/contextual information (35%) and mentioning common pitfalls (7%) were often missing. In 22% of encounters, follow-up contingencies were in the note, but absent from the recorded encounter. There was a trend for higher burnout scores being associated with physicians less likely to address key diagnosis items, such as psychosocial history/context.Conclusions A new tool shows promise as a means of assessing key elements of diagnostic quality in clinical encounters. Work conditions and physician reactions appear to correlate with diagnostic behaviours. Future research should continue to assess relationships between time pressure and diagnostic quality.https://bmjopen.bmj.com/content/13/5/e071241.full |
| spellingShingle | Gordon D Schiff Mark Linzer Erin E Sullivan Maram Khazen Sophia Arabadjis Jason Ramos Maria Mirica Andrew Olson How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care BMJ Open |
| title | How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care |
| title_full | How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care |
| title_fullStr | How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care |
| title_full_unstemmed | How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care |
| title_short | How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care |
| title_sort | how does work environment relate to diagnostic quality a prospective mixed methods study in primary care |
| url | https://bmjopen.bmj.com/content/13/5/e071241.full |
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