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July 28, 2010

Reducing Diagnostic Error Through Medical Home-Based Primary Care Reform

Author Affiliations

Author Affiliations: Houston VA Health Services Research and Development Service Center of Excellence, and the Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas (Dr Singh); Northport VA Medical Center, Northport, New York (Dr Graber); and Department of Medicine, SUNY Stony Brook, Stony Brook, New York (Dr Graber).

JAMA. 2010;304(4):463-464. doi:10.1001/jama.2010.1035

If implemented correctly, the patient-centered medical home (PCMH) can potentially address many current safety concerns in primary care. One highly relevant but underemphasized safety concern is diagnostic error (ie, missed, delayed, or incorrect diagnosis),1 possibly the leading type of error in primary care. Diagnostic errors are the single largest contributor to ambulatory malpractice claims (40% in some studies) and cost approximately $300 000 per claim on average.2 The joint principles endorsed by major US primary care organizations envision practice changes to improve coordination, communication, and continuity of care, deficits of which are associated with diagnostic errors. Also integral to the PCMH concept are electronic health records (EHRs), which, despite their current limitations, can enhance access to data and advanced decision support to reduce diagnostic error.3 However, PCMH models as currently envisioned do not address other fundamental and deeply rooted systems and cognitive problems that cause diagnostic error.4 For instance, the US Department of Veterans Affairs (VA) uses an advanced EHR and has a relatively unique integrated model of care that resembles PCMH, yet diagnostic errors persist in this system.5,6

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