Diagnostic Concordance by Berger

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American Academy on Communication in Healthcare (AACH)

I don’t know why I’m in the hospital! Patient-doctor diagnostic concordance Zackary Berger, MD, PhD Assistant Professor Johns Hopkins General Internal Medicine

Doctor-patient diagnostic concordance ,[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Ripped from the Bellevue Hospital casefiles: The real story of Ms. D ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Doctor-patient communication in the hospital ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Diagnostic concordance: a previous study (Tisnado 2006) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Diagnostic discordance among medicine inpatients: specific aims ,[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Diagnostic discordance among medicine inpatients: hypotheses ,[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Study design, setting, and population ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Patient interview ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Medical record abstraction ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

How do we define EMR-patient diagnostic concordance? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Patient characteristics (N=46) ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

“ No sé porque estoy en hospital” ,[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Diagnostic discordance ,[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Discordance is greater among older patients Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH Concordant (N, %) Discordant (N, %) Age >= 60 Age < 60 5 (17%) 18 (83%) 11 (48%) 12 (52%) 30 (65%) Total 16 (35%)

Discordant patients are less educated Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH Concordant Discordant Mean years of schooling (SD) 10.6 (4.4) 8.9 (4.7)

Summary ,[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Limitations ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Future questions ,[object Object],[object Object],[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

How do we address the problem of diagnostic discordance? ,[object Object],[object Object],Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH

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About AACH

Diagnostic Concordance by Berger

1. I don’t know why I’m in the hospital! Patient-doctor diagnostic concordance Zackary Berger, MD, PhD Assistant Professor Johns Hopkins General Internal Medicine

2. Doctors and patients think differently.

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16. Discordance is greater among older patients Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH Concordant (N, %) Discordant (N, %) Age >= 60 Age < 60 5 (17%) 18 (83%) 11 (48%) 12 (52%) 30 (65%) Total 16 (35%)

17. Discordant patients are less educated Why am I in the hospital? Z. Berger, Hopkins GIM, ICCH Concordant Discordant Mean years of schooling (SD) 10.6 (4.4) 8.9 (4.7)

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23. Make way for Diagnostic Reconciliation!