While diagnostic performance is a crucial part of quality patient care, it remains understudied and should be prioritized as an area for innovation and improvement. Diagnostic errors have largely been ignored in patient safety efforts and health care quality initiatives for many years. This has contributed to potentially preventable patient harm, including disability and death. There is growing evidence that our diagnostic processes are highly variable, and harmful diagnostic errors are common; it is estimated that each of us will experience a preventable diagnostic error in our lifetime. 

The Moore Foundation’s Diagnostic Excellence Initiative works to improve the diagnostic process by measuring performance, growing the field, and assessing new technologies. In 2022, the initiative team partnered with editors at the Journal of the American Medical Association (JAMA) to create a JAMA Viewpoint series focused on various aspects of diagnostic excellence, publishing 21 articles over nine months..  

Aimed at spreading knowledge about diagnostic errors across the health care space, the series featured work from over 20 different health care leaders, and members of foundation’s Patient Care Program team – Harvey V. Fineberg, M.D., Ph.D., Daniel Yang, M.D., Karen Cosby, M.D., Susan Song, M.P.H., and Tommy Wang, Ph.D. – co-authored four articles in the series, writing about areas such as the use of artificial intelligence and measuring performance. Fineberg, Song and Wang co-authored the series’ final entry, moving beyond the focus on the present-day challenges and progress to examine the future of the diagnostic excellence field. 

Looking ahead, improving diagnostic performance remains an ongoing and complex process, requiring continuous work from all parties in the healthcare space – researchers, policymakers, practitioners and others. With JAMA’s position as the most widely circulated medicine journal in the world, the articles in the Viewpoint series have been viewed thousands of times, reaching a wide healthcare audience and serving as a collection of knowledge that will help improve patient outcomes.  

A full list of the Viewpoint series is below:

 

Diagnostic Excellence

Daniel Yang, M.D., Harvey V. Fineberg, M.D., Ph.D., Karen Cosby, M.D.

Diagnosis and the Illness Experience: Ways of Knowing

Amrapali Maitra, M.D., Ph.D., Abraham Verghese, M.D.

Diagnostic Excellence Through the Lens of Patient-Centeredness

Donald M. Berwick, M.D., M.P.P.

Next-Generation Artificial Intelligence for Diagnosis: From Predicting Diagnostic Labels to “Wayfinding”

Julia Adler-Milstein, Ph.D., Jonathan H. Chen, M.D., Ph.D., Gurpreet Dhaliwal, M.D.

Achieving Diagnostic Excellence for Sepsis

Derek C. Angus, M.D., M.P.H., Andrew B. Bindman, M.D.

The Rational Diagnostician and Achieving Diagnostic Excellence

Pat Croskerry, M.D. Ph.D.

At-home Diagnostics and Diagnostic Excellence: Devices vs. General Wellness Products

David A. Simon, J.D., L.L.M., Ph.D., Carmel Shachar, J.D., M.P.H., I. Glenn Cohen, J.D.

Achieving Diagnostic Excellence for Older Patients

Christine Cassel, M.D., Terry Fulmer, Ph.D., R.N.

Understanding and Communicating Uncertainty in Achieving Diagnostic Excellence

Maria R. Dahm, M.A., Ph.D.; Carmel Crock, M.B.B.S., BLitt

Evaluating the Effectiveness of Diagnostic Tests

Ashley Graham Kennedy, Ph.D.

Aligning Incentives for Improving Diagnostic Excellence

Bob Kocher, M.D., Ezekiel J. Emanuel, M.D., Ph.D.

Improving Efficiency in Medical Diagnosis 

Leila Agha, Ph.D.; Jonathan Skinner, Ph.D.; David Chan, M.D., Ph.D.

Measuring Performance of the Diagnostic Process 

Helen Burstin, M.D., M.P.H.; Karen Cosby, M.D.

Learning the Art and Science of Diagnosis 

Allan S. Detsky, M.D., Ph.D.

Achieving Equity in Diagnostic Excellence 

Kathryn M. McDonald, M.M., Ph.D.

Diagnostic Excellence and Patient Safety: Strategies and Opportunities 

Nirav R. Shah, M.D., MPH.; Tejal K. Gandhi, M.D., MPH; David W. Bates, M.D., M.S.

Rethinking Algorithm Performance Metrics for Artificial Intelligence in Diagnostic Medicine

Matthew A. Reyna, Ph.D., M.S.; Elaine O. Nsoesie, Ph.D.; Gari D. Clifford, DPhil, M.A., MSc

Achieving Diagnostic Excellence for Cancer: Symptom Detection as a Partner to Screening 

Elizabeth A. Sarma, Ph.D., MPH; Fiona M. Walter, M.A., M.D.; Sarah C. Kobrin, Ph.D., MPH

Decoding Artificial Intelligence to Achieve Diagnostic Excellence: Learning from Experts, Examples and Experience

Jonathan H. Chen, M.D., Ph.D.; Gurpreet Dhaliwal, M.D.; Daniel Yang, M.D. 

Achieving Diagnostic Equity in Cardiovascular Disease 

Urmimala Sarkar M.D., MPH; Kirsten Bibbins-Domingo, Ph.D., M.D., MAS

The Future of Diagnostic Excellence 

Harvey V. Fineberg, M.D., Ph.D.; Susan Song, MPH; Tommy Wang, Ph.D.

 

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