The Epidemiology of Missed and Delayed Medical Diagnosis: Implications for Health Equity and Public Health

Preventing diagnostic errors including missed and delayed diagnosis improves patient safety and saves lives. While epidemiological research on patient safety has increased since the US National Academies Institute of Medicine (now NASEM) published 2000 To Err Is Human: Building a Safer Health System, progress toward understanding the nexus of conditions and factors that cause or contribute to diagnostic error has been measured. Impeding progress are perceptions that diagnostic errors primarily arise from inadequate medical training, overworked and stressed providers, and innocent mistakes, and subsequently, that interventions should focus on training and clinical management. However, additional aspects that potentially affect diagnostic accuracy, have been identified: effective communication and patient engagement – especially in multilingual and multicultural groups where perceptions and beliefs may not be shared or understood; medical conditions with ambiguous signs and or vague symptoms; settings with limited access to advanced technologies; social, cultural and economic structures; and organization and management of care delivery. Recent epidemiological studies indicate that diagnostic errors vary considerably across sociodemographic cultural and socioeconomic groups, suggesting that underlying determinants range well beyond the clinical encounters and settings.

Epidemiological research on diagnostic errors holds great promise, as the basic concepts and methods used to identify risk factors and causes of disease in populations have been developed and generally apply when diagnostic errors are the outcome of interest. These methods facilitate the simultaneous identification and quantification of the possible role of several co-factors. However, before such methods effectively can be applied to uncover preventable causes of diagnostic error, several foundational blocks need to be set. The most basic of these is the need to standardize a taxonomy that helps define specific forms of diagnostic error – including failing to diagnose or incorrectly diagnosing a condition that is present, diagnosing a condition that is not present, delayed, partial, or over-diagnosis. Even if diagnostic errors can be defined precisely, documentation and reporting of these may not be comprehensive or uniform, even within a single provider setting or system. Superimposed on these are language challenges, belief structures, and level of medical vocabulary and awareness can impede patient communication and engagement. As in other epidemiological research contexts, the source of data on the outcome – and various individual, situational, and contextual risk factors – will influence the relationships observed in the data, including various forms of reporting error (or bias) and confounding (i.e., correlation with other causes or strong risk factors).

The Research Topic aims to build a platform on which epidemiological research, evaluation, and commentary on diagnostic error can showcase progress in and methods for understanding and diagnostic error, including health equity and public health aspects informing policies and practices to maximize patient safety. Submissions to this collection will form a core of innovative and valuable scientific findings and ideas that improve patient safety, engage a broader range of stakeholders, stimulate exchange of ideas and perspectives that cross boundaries and inspire additional scientific research investment into the causes and contributors to diagnostic errors.

The following article types will be considered for this collection: Brief Research Report, General Commentary, Hypothesis & Theory, Methods, Mini Review, Opinion, Original Research, Perspective, Policy Brief, Policy and Practice Reviews, Review, and Systematic Review.