In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 15_suppl ( 2012-05-20), p. 6072-6072
Abstract:
6072 Background: Diagnostic error is postulated to represent a significant source of preventable mortality, morbidity, and cost. A primary pathologic diagnosis of cancer has a relatively high error rate necessitating cost effective solutions to mitigate diagnostic related harm. Methods: A review of 773 consecutive inbound transfers to Stanford, with review of prior pathology material, was performed to measure diagnostic discrepancy. Information was collected about the originating practice size and type, subspecialty area, additional testing, and a description of the disagreement. For a subset of cases, itemized payment data was collected to explore the financial impact of slide review. Results: We found that 9% of cases have diagnostic discrepancies when comparing the incoming working diagnosis with the result of the pathology slide review. Major diagnostic discrepancies, likely to alter treatment, were identified in 3% of cases. Discrepancy rates differed significantly between subspecialty areas (p 〈 0.01) although few areas were spared major error. Disagreements about classification were common as were over/under calling malignancy, grading errors, and incorrect ordering or interpretation of ancillary testing. The subset of cases (n=107) with billing information demonstrated ~42,800 unique charge events associated with these episodes of care. The mean charge for patients was $292,813 (median $130,467). Typical of charge data the dollar amounts exhibited strong right-skew. Average reimbursement was $76,017 (median $23,999) and the median charge:reimbursement ratio was 3.3. When analyzing cases by service line, only 1.4% of charges related to the diagnostic review of the prior pathology material, demonstrating a remarkably small impact on the overall cost. While additional testing was performed on 10% of cases, there was no evidence that cases with a discrepancy were associated with increased overall costs. Conclusions: Diagnostic slide review on prior material is relatively inexpensive in terms of the cost of overall care and permits the detection of significant errors that may affect treatment planning. Pathology slide review represents a clinically impactful and low cost way to prevent errors in diagnosis from becoming errors in management.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/jco.2012.30.15_suppl.6072
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2012
detail.hit.zdb_id:
2005181-5
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