Issues With Electronic Health Records Contribute to Diagnostic Errors

AHRQ Stats: Maternal Deaths by Race

Non-Hispanic Black and non-Hispanic Asian Pacific Islander mothers experienced 9.4 and 9.3 deaths per 100,000 delivery hospitalizations respectively in 2019, nearly three times the 3.5 deaths per 100,000 delivery hospitalizations among Non-Hispanic White mothers. (Source: AHRQ 2023 Patient Safety Chartbook [PDF, 4 MB].)

Today's Headlines:

• Issues With Electronic Health Records Contribute to Diagnostic Errors.
• Pandemic’s Impact on Health Insurance Not as Severe as Expected.
• Registration Open for May 15 Webinar on Mitigating Bias in Healthcare Algorithms.
• Highlights From AHRQ’s Patient Safety Network.
• Register for May 31 Webinar: Learning From Patient Narratives Through Innovative Feedback Reporting Methods.
• Explore Careers at AHRQ.
• AHRQ in the Professional Literature.

Issues With Electronic Health Records Contribute to Diagnostic Errors

A majority of diagnostic errors are at least partially caused by problems with electronic health records (EHRs), according to an AHRQ-funded study published in JAMA Network Open. The authors analyzed closed malpractice claims from January 2015 to September 2021 for ambulatory care that were diagnosis- and EHR-related. Of 199 diagnosis-related claims, EHRs were considered a potential contributor to diagnostic errors in 61 percent of claims. About 92 percent involved the testing stage, and the most prevalent outcome for claims (71 percent) was missed or delayed diagnoses. The authors concluded that the study findings illustrated the central role of EHRs for supporting the diagnostic process, and the potential for issues such as suboptimal design or clinician use to facilitate diagnostic errors. Access the abstract.

Pandemic’s Impact on Health Insurance Not as Severe as Expected

Despite the COVID-19 pandemic, employer-sponsored health insurance remained stable between 2019 and 2020, a new AHRQ study has found. Researchers’ analysis, published in Health Affairs and based on AHRQ Medical Expenditure Panel Survey data, found increased stability of Medicaid coverage for children and nonelderly adults during the first year of the pandemic and that fewer people who had Medicaid in 2019 became uninsured in 2020 (4.3 percent) than in 2018–19 (7.8 percent). In 2020, the Families First Coronavirus Response Act (FFCRA) began providing states increased federal funding if they maintained their Medicaid enrollment, and all states chose to do so. The increased stability of Medicaid coverage over the 2019–20 period suggests that policies intended to broaden Medicaid coverage, such as the FFCRA of 2020, may have helped stem losses in coverage in 2020. Access the abstract.

Registration Open for May 15 Webinar on Mitigating Bias in Healthcare Algorithms

Register now for a webinar on May 15 from noon to 2 p.m. ET to provide feedback on draft guiding principles to prevent or mitigate bias related to healthcare algorithms that affect racial and ethnic disparities in healthcare. While healthcare algorithms can offer value in diagnostics and treatments, they can also create and perpetuate inequities in healthcare. At a March 2 meeting, AHRQ and the National Institute on Minority Health and Health Disparities presented a draft of an AHRQ evidence report on published studies about the impacts of healthcare algorithms. The meeting informed an expert panel’s development of draft guiding principles to prevent or mitigate bias related to algorithms. Register for the May 15 meeting to hear a presentation of the draft principles and provide feedback.

Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:

• Listen to the whispers before they become screams: addressing black maternal morbidity and mortality in the United States.
• Medicines related problems (MRPs) originating in primary care settings in older adults - a systematic review.
• Nurse staffing and inpatient mortality in the English National Health Service: a retrospective longitudinal study.

Review additional new publications in PSNet’s current issue or access recent cases and commentaries in AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web).

Register for May 31 Webinar: Learning From Patient Narratives Through Innovative Feedback Reporting Methods

Registration is open for “Learning from Patient Narratives Through Innovative Feedback Reporting Methods,” an AHRQ webinar on May 31 from 1 to 2 p.m. ET. Speakers will provide an overview of AHRQ’s Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys and patient narratives and describe the New York-Presbyterian Hospital (NYP) patient narrative reporting project. The impact of the project on staff and patient experience and NYP leadership perspectives will be discussed.

Explore Careers at AHRQ

Join the team that strives to improve healthcare for all Americans by investing in health systems research, creating strategies to support practice improvement and providing data and analytics to identify opportunities for improvement. Current vacancies include:

• Health Scientist Administrator-Scientific Review Officer, Office of Extramural Research, Education and Priority Populations. Application deadline: May 9.
• Junior Staff Service Fellow. Application deadline: May 10.
• Management Analyst, Office of the Director. Application deadline: May 12.
• Program Analyst, Office of Extramural Research, Education and Priority Populations/Division of Scientific Review. Application deadline: May 19.
• Health Scientist Administrator-Digital Healthcare Research, Center for Evidence and Practice Improvement/Division of Digital Healthcare Research. Application deadline: May 19.

AHRQ in the Professional Literature

The need to expand the infection prevention workforce in home infusion therapy. Oladapo-Shittu O, Hannum SM, Salinas AB, et al. Am J Infect Control 2023 May;51(5):594-6. Epub 2023 Jan 12. Access the abstract on PubMed®.

Association of community walkability and glycemic control among pregnant individuals with pregestational diabetes mellitus. Field C, Lynch CD, Fareed N, et al. Am J Obstet Gynecol MFM 2023 May;5(5):100898. Epub 2023 Feb 12. Access the abstract on PubMed®.

Care quality for patients with chronic obstructive pulmonary disease in the readmission penalty era. Rojas JC, Chokkara S, Zhu M, et al. Am J Respir Crit Care Med 2023 Jan;207(1):29-37. Access the abstract on PubMed®.

Development of a natural language processing system for extracting rheumatoid arthritis outcomes from clinical notes using the national rheumatology informatics system for effectiveness registry. Humbert-Droz M, Izadi Z, Schmajuk G, et al. Arthritis Care Res 2023 Mar;75(3):608-15. Epub 2022 Oct 31. Access the abstract on PubMed®.

New psychotropic medication use among Medicare beneficiaries with dementia after hospital discharge. Growdon ME, Gan S, Yaffe K, et al. J Am Geriatr Soc 2023 Apr;71(4):1134-44. Epub 2022 Dec 13. Access the abstract on PubMed®.

User-centered design of a clinical tool for shared decision-making about diet in primary care. Tierney WM, Henning JM, Altillo BS, et al. J Gen Intern Med 2023 Feb;38(3):715-26. Epub 2022 Sep 20. Access the abstract on PubMed®.

The safety of performing surgery at ambulatory surgery centers versus hospital outpatient departments in older patients with or without multimorbidity. Silber JH, Rosenbaum PR, Reiter JG, et al. Med Care 2023 May;61(5):328-37. Epub 2023 Mar 17. Access the abstract on PubMed®.

Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019. Kim KC, Khouja T, Burgette JM, et al. Pharmacoepidemiol Drug Saf 2023 Jun;32(6):625-34. Epub 2023 Jan 16. Access the abstract on PubMed®.