Association Between Primary Care Physician Diagnostic Knowledge and Death, Hospitalization and ED Visits Following Outpatient Visit

BMJ Open (04/01/2021) Vol. 11, No. 4 Gray, Bradley M.; Vandergrift, Jonathan L.; McCoy, Rozalina G.; et al.

Researchers sought to quantify associations between diagnostic knowledge and adverse outcomes after outpatient visits to primary care physicians that were at risk for diagnostic errors. The analysis involved 1,410 U.S. general internists who took their American Board of Internal Medicine Maintenance of Certification (ABIM-IM-MOC) exam. They treated 42,407 Medicare beneficiaries who had 48,632 index outpatient visits for new problems at risk for diagnostic error because the presenting problem was connected to prespecified diagnostic error-sensitive conditions. Physician performance on ABIM-IM-MOC diagnostic exam questions was correlated with patient outcomes during the 90-day post-index visit period. Rates of 90-day adverse outcomes for every 1,000 index visits were seven for death, 11 for hospitalizations, and 14 for emergency department (ED) visits. Physician consultations in the top versus bottom third of diagnostic knowledge during an index visit for a new problem at risk for diagnostic error corresponded with 2.9 fewer all-cause deaths, 4.1 fewer hospitalizations, and 4.9 fewer ED visits per 1,000 visits. The authors conclude that "gaps in diagnostic knowledge among first contact primary care physicians are associated with serious diagnostic error sensitive outcomes." Should future research validate these findings, the authors recommend that interventions focus on diagnostic knowledge to reduce errors.

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