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. 2016 Dec 15:9:32672.
doi: 10.3402/gha.v9.32672. eCollection 2016.

Misdiagnosis of obstetrical cases and the clinical and cost consequences to patients: a cross-sectional study of urban providers in the Philippines

Riti Shimkhada  1 , Orville Solon  2 , Diana Tamondong-Lachica  1 , John W Peabody  1   3
Affiliations

Misdiagnosis of obstetrical cases and the clinical and cost consequences to patients: a cross-sectional study of urban providers in the Philippines

Riti Shimkhada et al. Glob Health Action. .

Abstract

Background: Misdiagnosis may be a significant and under-recognized quality of care problem. In birthing facilities located in anurban Philippine setting, we investigated the diagnostic accuracy for three obstetric conditions: cephalopelvic disproportion (CPD), post-partum hemorrhage (PPH), and pre-eclampsia.

Design: Identical simulated cases were used to measure diagnostic accuracy for every provider (n=103). We linked misdiagnosis - identified by the simulated cases - to obstetrical complications of the patients at the participating facilities. Patient-level data on health outcomes and costs were obtained from medical records and follow-home in-person interviews.

Results: The prevalence of misdiagnosis among obstetric providers was 29.8% overall, 25% for CPD, 33% for PPH, and 31% for pre-eclampsia. Linking provider decision-making to patients, we found those who misdiagnosed the simulated cases were more likely to have patients with a complication (OR 2.96; 95% CI 1.39-3.77) compared with those who did not misdiagnose. Complicated patients were significantly less likely to be referred to a hospital immediately, were more likely to be readmitted to a hospital after delivery, had significantly higher medical costs, and lost more income than non-complicated patients.

Conclusion: Diagnosis is arguably the most important task a clinician performs because it determines the subsequent course of evaluation and treatment, with the direct and indirect costs of diagnostic error, placing large financial burdens on the patient.

Keywords: Philippines; health costs; health outcomes; misdiagnosis; obstetrics; practice variability; quality of care.

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Conflict of interest statement

Conflict of interest and fundingQURE Healthcare uses their proprietary technology, Clinical Performance and Value (CPV®) vignettes, to measure quality of healthcare providers. Dr. Peabody is the owner of QURE Healthcare and Dr. Shimkhada and Dr. Tamondong-Lachica were paid employees of QURE Healthcare at the time of this study.This work was partially funded by the Bill & Melinda Gates Foundation under the Disease Control Priorities Network grant to the Department of Global Health, University of Washington.

Figures

Fig. 1
Fig. 1
Framework for conceptualizing misdiagnosis.
Fig. 2
Fig. 2
Distribution of CPV scores (n=309), overall and domain for 103 providers (physicians and midwives).
See this image and copyright information in PMC

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