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Planting design seeds to fill diagnostic holes at low-income clinics

Health policy researcher Kathryn McDonald, PhD, recently asked a group of physicians who work with low-income patients in San Francisco what keeps them up at night.

They told her that making an error, such as one that could lead to a missed cancer diagnosis, is their greatest fear.

After all, missed cancer diagnoses are the leading cause for paid medical malpractice claims in the outpatient setting, with one in 20 patients experiencing potentially preventable diagnostic errors each year.

"For example, a patient who has a positive fecal blood test, but no follow-up colonoscopy within a reasonable period may experience a missed opportunity to detect and successfully treat colon cancer," McDonald told me.

To prevent these mistakes, she and her research team at Stanford — where she is executive director of the Center for Health Policy and the Center for Primary Care and Outcomes Research — and the University of California, San Francisco turned to a tried-and-true Silicon Valley solution: design learning.

The team spent two years working with a network of San Francisco public health clinics to investigate missed diagnoses and prevention activities during outpatient care, then came up with design solutions.

A Stanford Health Policy article describes their approach:

They constructed maps for each pathway used by doctors to monitor patients with sinister findings, starting with the initial diagnostic assessment during an initial clinic visit and continuing through ongoing follow-up visits.

'Whenever participants in the study verbalized elements of the pathway that were particularly vulnerable to error or poor monitoring, we marked the activity with a bullseye target, also referred to by clinicians as a 'pain point,'' the authors wrote. 'To our knowledge, this technique has seldom been applied to the ambulatory setting, and has not been targeted to clinic workflow efficiency or patient safety intervention development.'

Their research was recently published in the journal Implementation Science.

Previously: Keeping patients safe: A Stanford researcher weighs in on medical mistakes and Diagnostic errors: "A complex problem that requires a many-pronged, multi-level attack"
Photo by Steve Fisch

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