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. 2018 Sep;33(9):1447-1453.
doi: 10.1007/s11606-018-4491-x. Epub 2018 May 29.

Diagnostic Discordance, Health Information Exchange, and Inter-Hospital Transfer Outcomes: a Population Study

Michael Usher  1 , Nishant Sahni  2 , Dana Herrigel  3 , Gyorgy Simon  2   4 , Genevieve B Melton  4   5 , Anne Joseph  2 , Andrew Olson  6
Affiliations

Diagnostic Discordance, Health Information Exchange, and Inter-Hospital Transfer Outcomes: a Population Study

Michael Usher et al. J Gen Intern Med. 2018 Sep.

Abstract

Background: Studying diagnostic error at the population level requires an understanding of how diagnoses change over time.

Objective: To use inter-hospital transfers to examine the frequency and impact of changes in diagnosis on patient risk, and whether health information exchange can improve patient safety by enhancing diagnostic accuracy.

Design: Diagnosis coding before and after hospital transfer was merged with responses from the American Hospital Association Annual Survey for a cohort of patients transferred between hospitals to identify predictors of mortality.

Participants: Patients (180,337) 18 years or older transferred between 473 acute care hospitals from NY, FL, IA, UT, and VT from 2011 to 2013.

Main measures: We identified discordant Elixhauser comorbidities before and after transfer to determine the frequency and developed a weighted score of diagnostic discordance to predict mortality. This was included in a multivariate model with inpatient mortality as the dependent variable. We investigated whether health information exchange (HIE) functionality adoption as reported by hospitals improved diagnostic discordance and inpatient mortality.

Key results: Discordance in diagnoses occurred in 85.5% of all patients. Seventy-three percent of patients gained a new diagnosis following transfer while 47% of patients lost a diagnosis. Diagnostic discordance was associated with increased adjusted inpatient mortality (OR 1.11 95% CI 1.10-1.11, p < 0.001) and allowed for improved mortality prediction. Bilateral hospital HIE participation was associated with reduced diagnostic discordance index (3.69 vs. 1.87%, p < 0.001) and decreased inpatient mortality (OR 0.88, 95% CI 0.89-0.99, p < 0.001).

Conclusions: Diagnostic discordance commonly occurred during inter-hospital transfers and was associated with increased inpatient mortality. Health information exchange adoption was associated with decreased discordance and improved patient outcomes.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Population distribution (left axis) of diagnostic discordance index and association with observed mortality (right axis) in the validation cohort
See this image and copyright information in PMC

Comment in

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