Patient-reported measurement opportunities of diagnostic excellence: From whom,what,when,and where

Abstract

Background

Diagnostic excellence is an emerging construct that could be further operationalized by capturing relevant domains of experiences and outcomes reported by patients and care partners. Characterization of when, where, and how these domains can be assessed while considering populations most vulnerable to diagnostic disparities, is critical.

Objective

We aimed to devise a framework for patient-reported measurement opportunities to center patients and health equity in diagnostic excellence.

Methods

Adapting an existing set of patient diagnostic error journeys, we used human-centered design to illustrate additional journeys and identify opportunities for patient reporting on their experiences and outcomes throughout. We mapped previously identified diagnostically relevant patient-reported domains into the journeys exploring specifications of these domains from diagnostic error to diagnostic excellence. We relied on internal expert consultations and a five-session international expert convening.

Results

We grouped patient journeys into seven pairs of diagnostic error and counterfactual excellence scenarios including journeys of those who are “invisible” to the health system. We organized the journeys into a taxonomy based on their timing, setting, and diagnostic care utilization. The domains were specified under diagnostic excellence and aggregated into a 21-domain map. We identified up to four measurement opportunities throughout diagnostic journeys: Pre-encounter, within-encounter, immediate post-encounter, and subsequent cross-sectional. We synthesized the taxonomy, domain map, and measurement opportunities into a multi-part framework for patient-reported measurement of diagnostic excellence.

Conclusions

The presented framework informs patient-reported measurement for the emerging construct of diagnostic excellence and anticipates needs for a suite of patient-reported measures for various settings and timings.

Keywords

Diagnostic excellence patient reporting disparities measurement framework

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