Language
English
Publication Date
8-1-2024
Journal
Applied Clinical Informatics
DOI
10.1055/s-0044-1788330
PMID
39293648
PMCID
PMC11410438
PubMedCentral® Posted Date
9-18-2024
PubMedCentral® Full Text Version
Post-print
Abstract
Objectives: This study aimed to pilot an application-based patient diagnostic questionnaire (PDQ) and assess the concordance of the admission diagnosis reported by the patient and entered by the clinician.
Methods: Eligible patients completed the PDQ assessing patients' understanding of and confidence in the diagnosis 24 hours into hospitalization either independently or with assistance. Demographic data, the hospital principal problem upon admission, and International Classification of Diseases 10th Revision (ICD-10) codes were retrieved from the electronic health record (EHR). Two physicians independently rated concordance between patient-reported diagnosis and clinician-entered principal problem as full, partial, or no. Discrepancies were resolved by consensus. Descriptive statistics were used to report demographics for concordant (full) and nonconcordant (partial or no) outcome groups. Multivariable logistic regressions of PDQ questions and a priori selected EHR data as independent variables were conducted to predict nonconcordance.
Results: A total of 157 (77.7%) questionnaires were completed by 202 participants; 77 (49.0%), 46 (29.3%), and 34 (21.7%) were rated fully concordant, partially concordant, and not concordant, respectively. Cohen's kappa for agreement on preconsensus ratings by independent reviewers was 0.81 (0.74, 0.88). In multivariable analyses, patient-reported lack of confidence and undifferentiated symptoms (ICD-10 "R-code") for the principal problem were significantly associated with nonconcordance (partial or no concordance ratings) after adjusting for other PDQ questions (3.43 [1.30, 10.39], p = 0.02) and in a model using selected variables (4.02 [1.80, 9.55], p < 0.01), respectively.
Conclusion: About one-half of patient-reported diagnoses were concordant with the clinician-entered diagnosis on admission. An ICD-10 "R-code" entered as the principal problem and patient-reported lack of confidence may predict patient-clinician nonconcordance early during hospitalization via this approach.
Keywords
Humans, Female, Male, Surveys and Questionnaires, Middle Aged, Adult, Patient Admission, Diagnosis, Hospitalization, Electronic Health Records, Aged, diagnostic error, diagnostic safety, acute care
Published Open-Access
yes
Recommended Citation
Lam, Alyssa; Plombon, Savanna; Garber, Alison; et al., "Patient-Clinician Diagnostic Concordance upon Hospital Admission" (2024). Faculty, Staff and Students Publications. 8469.
https://digitalcommons.library.tmc.edu/baylor_docs/8469