Diagnostic Error in Medicine
Notice bibliographique
Résumé
Background: Delays in cancer diagnosis can result from lack of timely follow-up of positive fecal occult blood tests (FOBT) and iron-deficiency anemia (IDA) for colorectal cancer (CRC) and elevated serum alpha-fetoprotein (AFP) levels for hepatocellular carcinoma (HCC). The VA implemented the patient-centered medical home (PCMH) model in 2010-2011 to provide patient-driven, team-based care with goals of improving healthcare outcomes. We hypothesized that PCMH will improve timely follow up of FOBT, IDA and AFP tests nationally in the VA. Methods: To identify patients with delayed follow-up after abnormal results, we applied previously validated electronic "trigger" algorithms to VA's national repository of electronic health record data. The trigger included patients with newly abnormal test results, excluding patients for whom follow-up was not required or action had been completed within 60 days of result. Positive predictive values of 57.0%, 55.1% and 82.3% for FOBT, IDA and AFP respectively, were higher than other known measures of diagnostic safety. We applied each trigger to all patients from 130 VA facilities across 18 national VA networks from 2006-2015. We derived yearly counts of trigger-positive patients based on VA facility and VA network to assess annual percent changes beginning in 2006. Negative binomial regression models were applied to assess overall and yearly changes in number of trigger-positive patients while accounting for clustering by VA network, over-dispersion and correlation due to repeated measures. An offset was created using expected number of trigger-positive patients by facility that adjusted for year and number of patients with primary care provider (PCP) visits that year. Final models were adjusted for VA network and PCP visits that year. Results: After excluding patients not meeting inclusion criteria, 5,887,006 and 37,762,419 patients had tests for FOBT and IDA from 2006-2015, respectively. Of patients who received FOBT tests, 245,776 patients met trigger-positive criteria and of those who received IDA tests, 303,323 met trigger-positive criteria. Similarly, 888,033 patients received AFP tests, with 12,098 patients meeting trigger-positive criteria. The trigger-positive count means for FOBT, IDA and AFP tests increased immediately following PCMH implementation, however the trigger-positive count means in subsequent years fluctuated between and among tests. Variability was also found by VA network, most likely due to facility size and complexity. Conclusion: Primary care medical home implementation does not appear to improve follow-up of abnormal test results that warrant cancer evaluation. Further contextual evaluation to explore lack of impact from this teamwork-based intervention is warranted.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,163 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».