Relevant bibliographies by topics / Climatericprimary health care; nursing care

Academic literature on the topic 'Climatericprimary health care; nursing care'

Author: Grafiati
Published: 10 December 2022
Last updated: 28 January 2023

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Journal articles on the topic "Climatericprimary health care; nursing care"

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McCormack, Brendan. "Nursing care is health care." Elderly Care 8, no. 2 (February 1988): 41. http://dx.doi.org/10.7748/eldc.8.2.41.s22.

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McCormack, Brendan. "Nursing care is health care." Nursing Older People 8, no. 2 (April 1, 1996): 41. http://dx.doi.org/10.7748/nop.8.2.41.s21.

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&NA;. "Home Health Care Nursing." AJN, American Journal of Nursing 86, no. 6 (June 1986): 770–71. http://dx.doi.org/10.1097/00000446-198606000-00036.

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&NA;. "Home Health Care Nursing." AJN, American Journal of Nursing 86, no. 6 (June 1986): 770–71. http://dx.doi.org/10.1097/00000446-198686060-00036.

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Martin, Constance. "Community Health Care Nursing." Nursing Older People 10, no. 5 (October 1, 1998): 47. http://dx.doi.org/10.7748/nop.10.5.47.s38.

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Fortunato, Nancy M. "Home Health Care Nursing." AORN Journal 52, no. 2 (August 1990): 420. http://dx.doi.org/10.1016/s0001-2092(07)68180-0.

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Booth, Katie. "Community health care nursing." International Journal of Nursing Studies 34, no. 1 (February 1997): 86. http://dx.doi.org/10.1016/s0020-7489(97)84249-6.

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Graham, Barbara A. "Home Health Care Nursing." Family & Community Health 14, no. 1 (April 1991): 80–81. http://dx.doi.org/10.1097/00003727-199104000-00014.

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Dunkin, Jeri. "Nursing and Health Care." Online Journal of Rural Nursing and Health Care 10, no. 2 (December 2010): 1–2. http://dx.doi.org/10.14574/ojrnhc.v10i2.30.

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Shuster, George F., and Patricia A. Cloonan. "Home Health Nursing Care." Home Health Care Services Quarterly 12, no. 1 (May 6, 1991): 23–36. http://dx.doi.org/10.1300/j027v12n01_04.

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Dissertations / Theses on the topic "Climatericprimary health care; nursing care"

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Hemphill, Jean Croce. "Homeless Health Care: A Nursing Initiative." Digital Commons @ East Tennessee State University, 1994. https://dc.etsu.edu/etsu-works/7569.

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Howard, Shevon Naomi. "Health literacy program proposal for health care workers." Thesis, Walden University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10145339.

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Health information literacy influences patient health outcomes, yet almost 90% of adults struggle to understand health information. This study explored the impact of an education course in health literacy on healthcare professionals’ methods of providing information to patients in order to increase effective communication and improve patient outcomes. This study drew from an integrated theoretical framework that suggests development and validation of tools to measure health literacy. Access to and understanding of reliable, high-quality health care information equalizes many other variables that impact health outcomes, including age, economic class, and cultural background. This study analyzed survey data collected from 2 doctors, 2 nurse practitioners, and 1 staff nurse selected based on their expertise and experience working with patients. They completed a learner- centered course, in which learners interact and instructors provide feedback. Based on survey responses, the participants strongly supported implementing the proposed education module. Four of the 5 experts agreed that a course in health literacy will help health care workers recognize and address patients with low health literacy. Limited health literacy is associated with poor health outcomes and higher health care costs. This type of literacy requires a complex group of reading, listening, analytical, and decision- making skills, and the ability to apply these skills to health situations. The results of this study may guide educators to effectively communicate with patients, increase health literacy, and improve patient outcomes.

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Damberg, Jonas. "Availability of primary care physicians in nursing homes and home care nursing services and associations with emergency care consumption." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-61585.

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Updike, Meghan. "Health Care for Hawaiian Foster Children." Diss., The University of Arizona, 2012. http://hdl.handle.net/10150/265365.

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Foster children represent a vulnerable pediatric population with complex health needs including both acute and chronic conditions that require comprehensive health care management. However, years of research has continually demonstrated a poor provision of health care services to this at risk population including gaps in preventative care and poor follow-up with specialty services. Current literature reveals that the health care management for foster children continues to be fragmented and subpar. Several health care delivery models, standards of care, and interventions have been recommended in an effort to improve the outcomes among foster children. However the perspective of foster parents, key caregivers, has been missing in current evidence. This investigation serves as a descriptive study utilizing grounded theory methodology to explore health care management from the Hawaii foster parent's perspective. The purpose of the investigation was two-fold: 1) to describe foster parents' experience obtaining health care for their foster children and 2) to elicit foster parents' opinions about whether or not a health education program designed for foster parents would be helpful. After completing seven individual interviews, which were analyzed using constant comparative analysis, 19 categories were developed describing the foster parent experience related to policy and services, social environment, physical environment, biology, and behavior. The concept of a medical home model was identified as unfeasible for Hawaii foster families, and large variations in health education preparation among foster parents was observed while a significant interest in further education on health-related topics was identified as a necessity. Implications for practice and recommendations for further research were also generated.
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Hemphill, Jean Croce. "Health Care for the Homeless Population." Digital Commons @ East Tennessee State University, 1994. https://dc.etsu.edu/etsu-works/7592.

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Florini, Marita A. "Primary care providers' perception of care coordination needs and strategies in adult primary care practice." Thesis, State University of New York at Binghamton, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3630859.

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Problem: Medical and nursing literature poorly identify primary care providers' (PCP) relationship to care coordination (CC). Primary care providers' education, experience, and perspective, contribute to: (a) assessments of patient's care coordination needs, and (b) variability in behavior to address needs. Dissimilar approaches to CC by PCPs affect work relationships and office flow.

Purpose: To pre-pilot a new tool describing PCPs' knowledge, perception, and behavior regarding CC. Methods: Primary care physicians, nurse practitioners, and physician assistants were surveyed.

Analysis: Frequencies and percentages provided sample characteristics. Descriptive statistics analyzed provider responses within and between groups. Narratives were analyzed for themes. Tool refinement is suggested however, the tool does describe PCPs and CC activities.

Significance: A tool was developed to evaluate areas of CC activity performed by PCPs. Information from surveys of PCPs can illuminate behaviors that lead to improved work flow, efficiency, and patient outcomes. Doctors of Nursing Practice who are PCPs contribute to primary care CC through leadership, experience, and descriptive evidence.

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Kaye, Debra Anne. "Women's perceptions of telephone nursing care within an antenatal home care program." Thesis, University of Ottawa (Canada), 2006. http://hdl.handle.net/10393/26308.

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Purpose/problem. Telephone nursing care (TNC) has replaced some home visits to increase efficiency of The Ottawa Hospital Antenatal Home Care Program (AHCP). There is limited published research addressing TNC in similar settings to guide program development. Therefore, chose an evaluation strategy to explore the clients' the researchers and organization perceptions of TNC. Objectives. (1) Perform a systematic literature review of TNC in the high risk antenatal population. (2) Profile high risk antenatal population receiving telephone nursing care. (3) Describe clients' perceptions of telephone nursing care. (4) Explore the feasibility of this methodology for continuous program evaluation and informing development and improvement. Method. A mixed methods approach was used. Two surveys and a semi-structured interview were completed by 13 participants. Data were analyzed using descriptive statistics and constant comparative analysis. Results. Sample was similar to the population in diagnosis, maternal and fetal outcomes. Anxiety scores were high and women identified the highest needs related to high risk pregnancy, psychological and information domains. Four main themes emerged: the experience of being at home, perceptions of the telephone care, perceived benefits, and perceived health systems issues.
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Flores, Cristina. "The quality of care in residential care facilities for the elderly." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2007. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3261238.

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Goldsborough, Jennifer. "Palliative Care Integration in the Intensive Care Unit." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4787.

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Palliative health care is offered to any patient experiencing a life limiting or life changing illness. The palliative approach includes goals of care, expert symptom management, and advance care planning in order to reduce patient suffering. Complex care can be provided by palliative care specialists while primary palliative care can be given by educated staff nurses. However, according to the literature, intensive care unit (ICU) nurses have demonstrated a lack of knowledge in the provision of primary care as well as experiencing moral distress from that lack of knowledge. In this doctor of nursing practice staff education project, the problem of ICU nurses' lack of knowledge was addressed. Framed within Rosswurm and Larrabee's model for evidence-based practice, the purpose of this project was to develop an evidence-based staff education plan. The outcomes included a literature review matrix, an educational curriculum plan, and a pretest and posttest of questions based on the evidence in the curriculum plan. A physician and a master's prepared social worker, both certified in palliative care, and a hospital nurse educator served as content experts. They evaluated the curriculum plan using a dichotomous 6-item format and concluded that the items met the intent of the objectives. They also conducted content validation on each of the pretest/posttest items using a Likert-type scale ranging from 1 (not relevant) to 4 (very relevant). The content validation index was 0.82 indicating that test items were relevant to the educational curriculum objectives. Primary palliative care by educated ICU nurses can result in positive social change by facilitating empowerment of patients and their families in personal goal-directed care and reduction of suffering.
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MacDonald, Ashley Patricia. "The Experience of Health Care Providers Who Care for the Refugee Population." ScholarWorks @ UVM, 2016. http://scholarworks.uvm.edu/graddis/570.

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Refugees resettling in the United States face many challenges; especially within the health care setting. The purpose of this research was to add to the increasing body of knowledge about improving health care for the refugee population through investigating providers' lived experience caring for them. This study utilized qualitative research methods with a descriptive phenomenological approach. Five healthcare providers, one Nurse Practitioner, three Pediatricians and one Family Medicine Attending, were interviewed face to face through semi-structured interviews, utilizing twelve questions about their lived experience caring for the refugee population. The data from the five participants interviewed revealed three themes that described their experience: Facing Challenges; Experiencing Satisfaction; and Reframing the System. Although each provider found satisfaction within his or her current positions, there is a critical need for improved allocation of resources for housing, social support, and increased funding to help support refugee families that arrive in the United States.
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Books on the topic "Climatericprimary health care; nursing care"

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1936-, Martinson Ida Marie, and Widmer Ann, eds. Home health care nursing. Philadelphia: W.B. Saunders, 1989.

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David, Sines, Appleby Frances M, and Frost Marion, eds. Community health care nursing. 3rd ed. Oxford, UK: Blackwell Pub., 2005.

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David, Sines, Saunders Mary 1955-, and Forbes-Burford Janice, eds. Community health care nursing. 4th ed. Chichester, West Sussex, U.K: John Wiley & Sons, 2009.

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David, Sines, ed. Community health care nursing. Oxford: Blackwell Science, 1995.

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Eby, Linda. Mental health nursing care. Upper Saddle River, N.J: Pearson, 2005.

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Eby, Linda. Mental health: Nursing care. 2nd ed. Upper Saddle River, NJ: Pearson/Prentice Hall, 2009.

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Eby, Linda. Mental health: Nursing care. 2nd ed. Upper Saddle River, NJ: Pearson/Prentice Hall, 2009.

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Sines, David, Mary Saunders, and Janice Forbes-Burford, eds. Community Health Care Nursing. Oxford, UK: Wiley-Blackwell, 2009. http://dx.doi.org/10.1002/9781444316247.

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David, Sines, Appleby Frances M, and Raymond Elizabeth, eds. Community health care nursing. 2nd ed. Oxford: Blackwell Science, 2001.

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Royal College of Nursing. Dynamic Quality Improvement Programme., ed. Standards of care for critical care nursing. London: Royal College of Nursing, 1994.

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Book chapters on the topic "Climatericprimary health care; nursing care"

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Jones, Terry L. "Nursing Care Processes." In Nurses Contributions to Quality Health Outcomes, 157–76. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-69063-2_9.

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Johnston, Claire, and Kate Brown. "Politics, policies and trends in community nursing." In Community Health Care, 63–76. London: Macmillan Education UK, 1991. http://dx.doi.org/10.1007/978-1-349-14009-1_6.

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Levett-Jones, Tracy. "Person-Centred Care (In Nursing)." In Health Practice Relationships, 111–18. Rotterdam: SensePublishers, 2014. http://dx.doi.org/10.1007/978-94-6209-788-9_13.

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Savage, Peter. "Ethics and Health Care." In Principles of Professional Studies in Nursing, 80–95. London: Macmillan Education UK, 2007. http://dx.doi.org/10.1007/978-0-230-20882-7_5.

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Kristofersson, Gisli Kort, and Merrie J. Kaas. "Integrative Care Planning." In Advanced Practice in Mental Health Nursing, 123–46. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-05536-2_6.

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Hannah, Kathryn J., Marion J. Ball, and Margaret J. A. Edwards. "History of Health Care Computing." In Introduction to Nursing Informatics, 30–42. New York, NY: Springer New York, 1994. http://dx.doi.org/10.1007/978-1-4757-2246-8_4.

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Fraser, Mary. "Neuman’s health care systems model." In Conceptual Nursing in Practice, 256–75. Boston, MA: Springer US, 1996. http://dx.doi.org/10.1007/978-1-4899-3340-9_8.

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Moore, Susan. "The Politics of Health Care." In Foundations of Nursing Practice, 345–69. London: Macmillan Education UK, 1999. http://dx.doi.org/10.1007/978-1-349-14608-6_12.

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Wilkinson, Carol, and Sam Maurimootoo. "Promoting mental health in primary care." In Nursing in Primary Care, 237–62. London: Macmillan Education UK, 2001. http://dx.doi.org/10.1007/978-0-230-21366-1_11.

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While, Alison. "Community Child Health Care." In Achieving Quality in Community Health Care Nursing, 123–37. London: Macmillan Education UK, 1997. http://dx.doi.org/10.1007/978-1-349-13904-0_7.

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Conference papers on the topic "Climatericprimary health care; nursing care"

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Park, Soo-chul, and Chang-suk Kim. "Research on Oral Health and Health Behaviors of Some Senior CitizenS." In Health Care and Nursing 2015. Science & Engineering Research Support soCiety, 2015. http://dx.doi.org/10.14257/astl.2015.88.10.

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Yang, Jong-Hyun. "Factors Affecting the Customer Satisfaction of Cancer Patient." In Health Care and Nursing 2015. Science & Engineering Research Support soCiety, 2015. http://dx.doi.org/10.14257/astl.2015.88.37.

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Jee, Young-Ju. "Predictors of Youth Drug Use; using the 2014 Youth Risk Behavior Web-based Survey." In Health Care and Nursing 2015. Science & Engineering Research Support soCiety, 2015. http://dx.doi.org/10.14257/astl.2015.88.01.

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Kim, YoungHee. "An Analysis of Barrier Factors of Physical Activity among Old Adults." In Health Care and Nursing 2015. Science & Engineering Research Support soCiety, 2015. http://dx.doi.org/10.14257/astl.2015.88.26.

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Kim, YoungHee. "A study of Clinical Nurses’ knowledge about Critical Practice Guideline for Diabetes Mellitus." In Health Care and Nursing 2015. Science & Engineering Research Support soCiety, 2015. http://dx.doi.org/10.14257/astl.2015.88.27.

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Hee, Lee Sung, Hong Sung Jung, and Hwa Sun Kim. "Development of a Smartphone Application for Evidence-Based Practice Guideline Education Program." In Health Care and Nursing 2015. Science & Engineering Research Support soCiety, 2015. http://dx.doi.org/10.14257/astl.2015.88.02.

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Jee, Young-Ju. "Influencing Factors on Sexual Experience among Korean Adolescents." In Health Care and Nursing 2015. Science & Engineering Research Support soCiety, 2015. http://dx.doi.org/10.14257/astl.2015.88.03.

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Noh RN PhD, Jun Hee, and Eun Ju Lim RN PhD. "Ego-resilience and Health Locus of Control in Nursing Students." In Health Care and Nursing 2015. Science & Engineering Research Support soCiety, 2015. http://dx.doi.org/10.14257/astl.2015.88.04.

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Lim RN PhD, Eun Ju, and Jun Hee Noh RN PhD. "Correlations between Physical and Cognitive Functions and Depression Symptoms in the Dysmobility Syndrome Group." In Health Care and Nursing 2015. Science & Engineering Research Support soCiety, 2015. http://dx.doi.org/10.14257/astl.2015.88.05.

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Lim RN PhD, Eun Ju, Jun Hee Noh RN PhD, and Eun Young Kim RN PhD. "A study on the Health-Promoting Behaviors of the Young-Elderly Population in Urban and Rural Communities." In Health Care and Nursing 2015. Science & Engineering Research Support soCiety, 2015. http://dx.doi.org/10.14257/astl.2015.88.06.

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Reports on the topic "Climatericprimary health care; nursing care"

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Ashby-Mitchell, Kimberly, Kayon Donaldson-Davis, Julian McKoy-Davis, Douladel Willie-Tyndale, and Denise Eldemire-Shearer. Open configuration options Aging and Long-Term Care in Jamaica. Inter-American Development Bank, May 2022. http://dx.doi.org/10.18235/0004221.

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Recent estimates show that almost 15% of the Jamaican population is 60 years old or more. About 7% of this population need help with at least one activity of daily living. The demand for long-term care services is expected to rise as the countrys population grows older. In a context in which family sizes are shrinking and older adults are experiencing poor health and critical socioeconomic vulnerability, the means to meet care needs privatelyeither by relying on unpaid care, provided by their families or close networks, or by purchasing services in the marketare scarce. The regulation and provision of long-term care services in the country is highly fragmented and focuses mostly on those that are economically and socially vulnerable, as part of poverty-relief programs. Residential care is the main long-term care service available in Jamaica. Public institutions target the poor, while the private sector also offers various levels of institutional care, from residential to nursing care. The nongovernmental sector is also heavily involved in the provision of residential care in Jamaica, especially through churches. All things considered, women in the family are still the main providers of care. The main conclusion of the report is that long-term care in Jamaica is still an unmet need that requires the development of comprehensive policies and programs.
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Schnabel, Filipina, and Danielle Aldridge. Effectiveness of EHR-Depression Screening Among Adult Diabetics in an Urban Primary Care Clinic. University of Tennessee Health Science Center, April 2021. http://dx.doi.org/10.21007/con.dnp.2021.0003.

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Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR). Methods We conducted a retrospective chart review on patients aged 18 years and above with a diagnosis of DM2 and no initial diagnosis of depression or other mental illnesses. Chart reviews included those from 2018 or prior for before integration data and 2020 to present for after integration. Sixty subjects were randomly selected from a pool of 33,695 patients in the clinic with DM2 from the year 2013-2021. Thirty of the patients were prior to the integration of depression screening tools PHQ2 and PHQ9 into the EHR, while the other half were post-integration. The study population ranged from 18-83 years old. Results All subjects (100%) were screened using PHQ2 before integration and after integration. Twenty percent of patients screened had a positive PHQ2 among subjects before integration, while 10% had a positive PHQ2 after integration. Twenty percent of patients were screened with a PHQ9 pre-integration which accounted for 100% of those subjects with a positive PHQ2. However, of the 10% of patients with a positive PHQ2 post-integration, only 6.7 % of subjects were screened, which means not all patients with a positive PHQ2 were adequately screened post-integration. Interestingly, 10% of patients were treated with antidepressants before integration, while none were treated with medications in the post-integration group. There were no referrals made to the behavior team in either group. Conclusion There is no difference between the prevalence of depression screening before or after integration of depression screening tools in the EHR. The study noted that there is a decrease in the treatment using antidepressants after integration. However, other undetermined conditions could have influenced this. Furthermore, not all patients with positive PHQ2 in the after-integration group were screened with PHQ9. The authors are unsure if the integration of the depression screens influenced this change. In both groups, there is no difference between referrals to the behavior team. Implications to Nursing Practice This quality improvement study shows that providers are good at screening their DM2 patients for depression whether the screening tools were incorporated in the EHR or not. However, future studies regarding providers, support staff, and patient convenience relating to accessibility and availability of the tool should be made. Additional issues to consider are documentation reliability, hours of work to scan documents in the chart, risk of documentation getting lost, and the use of paper that requires shredding to comply with privacy.
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Wiener, Joshua M., Mary E. Knowles, and Erin E. White. Financing Long-Term Services and Supports: Continuity and Change. RTI Press, September 2017. http://dx.doi.org/10.3768/rtipress.2017.op.0042.1709.

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This article provides an overview of financing for long-term services and supports (LTSS) in the United States, paying special attention to how it has changed and not changed over the last 30 years. Although LTSS expenditures have increased greatly (like the rest of health care), the broad outline of the financing system has remained remarkably constant. Medicaid—a means-tested program—continues to dominate LTSS financing, while private long-term care insurance plays a minor role. High out-of-pocket costs and spend-down to Medicaid because of those high costs continue to be hallmarks of the system. Although many major LTSS financing reform proposals were introduced over this period, none was enacted—except the Community Living Assistance Services and Supports Act, which was repealed before implementation because of concerns about adverse selection. The one major change during this time period has been the very large increase in Medicare spending for post-acute services, such as short-term skilled nursing facility and home health care. With the aging of the population, demand for LTSS is likely to increase, placing strain on the existing system.
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Keane, Claire, Sean Lyons, Mark Regan, and Brendan Walsh. HOME SUPPORT SERVICES IN IRELAND: EXCHEQUER AND DISTRIBUTIONAL IMPACTS OF FUNDING OPTIONS. ESRI, February 2022. http://dx.doi.org/10.26504/sustat111.

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A new statutory scheme for the provision of home support services is currently being developed by the Department of Health. Research has shown that access to home support services varies across the country. The new scheme aims to tackle this issue to ensure equitable access to home support services nationwide and is part of wider reform of Ireland’s health and social care systems as envisaged in the Sláintecare report and Department of Health action plans. Publicly funded home support services in Ireland are currently provided free of charge for recipients, unlike long-term residential or nursing home care, which involves a contribution from residents. In 2019, the HSE’s Older Persons’ Services provided care to 53,000 people at a cost of €440 million. It is anticipated that demand for home support services may increase under the new scheme, for example if unmet demand is met or if the new scheme results in more people being able to remain in their own home, substituting away from long-term residential care. Any increased demand would result in an increased cost, which may also rise as the population ages. This report examines the possible introduction of co-payments for home support services. We focus on the likely Exchequer impact of a range of different funding scenarios along with the distributional, poverty and inequality impacts of such charges. Due to data limitations, and the fact that the majority of home support services are provided to older age groups, we focus on those aged 65 years and over. Regarding co-payments we examine the impact of flat-rate charges for users, regardless of means, as well as co-payments for home support recipients above a variety of income levels. The tapering of payments is also examined to ensure that individuals just over a specific income threshold would see co-payments gradually increasing as their income rises. We also consider the capping of co-payments so that those needing a high number of home support hours would not potentially face very high costs.
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Batt, Rosemary, Eileen Applebaum, and Tamar Katz. The Role of Public REITs in Financialization and Industry Restructuring. Institute for New Economic Thinking Working Paper Series, July 2022. http://dx.doi.org/10.36687/inetwp189.

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Real Estate Investment Trusts (REITs) are important but little studied financial actors that control over $3.5 trillion in gross assets and over 500,000 properties in the U.S. Yet they have been largely ignored because tax rules define them as ‘passive investors.’ The evidence in this report shows that they are actually financial actors that aggressively buy up property assets and manage them to extract wealth at taxpayers’ expense. This study identifies the powerful impact that REITs, as owners of the real estate that houses productive enterprises, have had on operating companies and on the US economy more generally. It draws on case study evidence from markets where REITs have a major presence – nursing homes, hospitals, and hotels. The tax treatment of REITs has facilitated a growing and worrying influence on health care markets in particular at taxpayer expense.
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Newman-Toker, David E., Susan M. Peterson, Shervin Badihian, Ahmed Hassoon, Najlla Nassery, Donna Parizadeh, Lisa M. Wilson, et al. Diagnostic Errors in the Emergency Department: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), December 2022. http://dx.doi.org/10.23970/ahrqepccer258.

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Abstract:
Objectives. Diagnostic errors are a known patient safety concern across all clinical settings, including the emergency department (ED). We conducted a systematic review to determine the most frequent diseases and clinical presentations associated with diagnostic errors (and resulting harms) in the ED, measure error and harm frequency, as well as assess causal factors. Methods. We searched PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL®), and Embase® from January 2000 through September 2021. We included research studies and targeted grey literature reporting diagnostic errors or misdiagnosis-related harms in EDs in the United States or other developed countries with ED care deemed comparable by a technical expert panel. We applied standard definitions for diagnostic errors, misdiagnosis-related harms (adverse events), and serious harms (permanent disability or death). Preventability was determined by original study authors or differences in harms across groups. Two reviewers independently screened search results for eligibility; serially extracted data regarding common diseases, error/harm rates, and causes/risk factors; and independently assessed risk of bias of included studies. We synthesized results for each question and extrapolated U.S. estimates. We present 95 percent confidence intervals (CIs) or plausible range (PR) bounds, as appropriate. Results. We identified 19,127 citations and included 279 studies. The top 15 clinical conditions associated with serious misdiagnosis-related harms (accounting for 68% [95% CI 66 to 71] of serious harms) were (1) stroke, (2) myocardial infarction, (3) aortic aneurysm and dissection, (4) spinal cord compression and injury, (5) venous thromboembolism, (6/7 – tie) meningitis and encephalitis, (6/7 – tie) sepsis, (8) lung cancer, (9) traumatic brain injury and traumatic intracranial hemorrhage, (10) arterial thromboembolism, (11) spinal and intracranial abscess, (12) cardiac arrhythmia, (13) pneumonia, (14) gastrointestinal perforation and rupture, and (15) intestinal obstruction. Average disease-specific error rates ranged from 1.5 percent (myocardial infarction) to 56 percent (spinal abscess), with additional variation by clinical presentation (e.g., missed stroke average 17%, but 4% for weakness and 40% for dizziness/vertigo). There was also wide, superimposed variation by hospital (e.g., missed myocardial infarction 0% to 29% across hospitals within a single study). An estimated 5.7 percent (95% CI 4.4 to 7.1) of all ED visits had at least one diagnostic error. Estimated preventable adverse event rates were as follows: any harm severity (2.0%, 95% CI 1.0 to 3.6), any serious harms (0.3%, PR 0.1 to 0.7), and deaths (0.2%, PR 0.1 to 0.4). While most disease-specific error rates derived from mainly U.S.-based studies, overall error and harm rates were derived from three prospective studies conducted outside the United States (in Canada, Spain, and Switzerland, with combined n=1,758). If overall rates are generalizable to all U.S. ED visits (130 million, 95% CI 116 to 144), this would translate to 7.4 million (PR 5.1 to 10.2) ED diagnostic errors annually; 2.6 million (PR 1.1 to 5.2) diagnostic adverse events with preventable harms; and 371,000 (PR 142,000 to 909,000) serious misdiagnosis-related harms, including more than 100,000 permanent, high-severity disabilities and 250,000 deaths. Although errors were often multifactorial, 89 percent (95% CI 88 to 90) of diagnostic error malpractice claims involved failures of clinical decision-making or judgment, regardless of the underlying disease present. Key process failures were errors in diagnostic assessment, test ordering, and test interpretation. Most often these were attributed to inadequate knowledge, skills, or reasoning, particularly in “atypical” or otherwise subtle case presentations. Limitations included use of malpractice claims and incident reports for distribution of diseases leading to serious harms, reliance on a small number of non-U.S. studies for overall (disease-agnostic) diagnostic error and harm rates, and methodologic variability across studies in measuring disease-specific rates, determining preventability, and assessing causal factors. Conclusions. Although estimated ED error rates are low (and comparable to those found in other clinical settings), the number of patients potentially impacted is large. Not all diagnostic errors or harms are preventable, but wide variability in diagnostic error rates across diseases, symptoms, and hospitals suggests improvement is possible. With 130 million U.S. ED visits, estimated rates for diagnostic error (5.7%), misdiagnosis-related harms (2.0%), and serious misdiagnosis-related harms (0.3%) could translate to more than 7 million errors, 2.5 million harms, and 350,000 patients suffering potentially preventable permanent disability or death. Over two-thirds of serious harms are attributable to just 15 diseases and linked to cognitive errors, particularly in cases with “atypical” manifestations. Scalable solutions to enhance bedside diagnostic processes are needed, and these should target the most commonly misdiagnosed clinical presentations of key diseases causing serious harms. New studies should confirm overall rates are representative of current U.S.-based ED practice and focus on identified evidence gaps (errors among common diseases with lower-severity harms, pediatric ED errors and harms, dynamic systems factors such as overcrowding, and false positives). Policy changes to consider based on this review include: (1) standardizing measurement and research results reporting to maximize comparability of measures of diagnostic error and misdiagnosis-related harms; (2) creating a National Diagnostic Performance Dashboard to track performance; and (3) using multiple policy levers (e.g., research funding, public accountability, payment reforms) to facilitate the rapid development and deployment of solutions to address this critically important patient safety concern.
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