I don’t know why I’m in the hospital! Patient-Doctor Diagnostic Concordance by Berger

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American Academy on Communication in Healthcare (AACH)

The document reports on a study of diagnostic concordance between patients and doctors at a large public hospital in New York City. The study found that over half of patients' reported reasons for admission did not match the reasons documented in their medical records. Discordance was higher in older patients and those with fewer years of education. Around 10% of patients could not provide any reason for their admission. The study had a small sample size and was single-site, limiting conclusions. It suggests diagnostic reconciliation discussions and record audits to improve doctor-patient concordance.

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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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