Dr. Peabody's Feature Article in FOCUS from the American College of Medical Quality

Humbling Excitement: What We Have Not Thought About in Quality

There are many aspects of clinical care variation that can be measured: beta blocker use in MI’s; referrals to the ophthalmologist in a diabetic; blood cultures, lactate, fluids, and antibiotics in sepsis. Research has shown that when we measure these and report individual performance back to providers, they get better. 1,2 Each one of these metrics, however, depends upon making the right diagnosis.

In quality improvement (QI) work, we start with the assumption of a correct diagnosis to evaluate the quality of care but that is a faulty paradigm for QI. There is a growing body of research, including our own, showing misdiagnosis rates vary between 15-30% for a new clinical presentation. 3,4 We all have been there: heart attacks masquerading as GI disease, diabetes recognized late, or sepsis only uncovered after it has become life-threatening.

It is unstated that when we see a patient, we do our best to... read the full article