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Developing a framework for understanding diagnostic reconciliation based on evidence review, stakeholder engagement, and practice evaluation

  • Sandra Algarin Perneth , Gilberto Perez Rodriguez Garcia , Juan P. Brito , Tejal Gandhi , Carma L. Bylund , Ian G. Hargraves and Naykky Singh Ospina EMAIL logo
Published/Copyright: December 10, 2024
Diagnosis
From the journal Diagnosis Volume 12 Issue 1

Abstract

Objectives

Diagnostic reconciliation is the collaborative process between patients and clinicians to create and reconcile evidence-based, feasible, and desirable care plans. However, the specific components of this process remain unclear. The objective of this study was to develop the first comprehensive framework to elucidate the diagnostic reconciliation process.

Methods

We followed a multi-step and iterative approach to develop the framework, including a focused systematic review of diagnostic conversations, quantitative evaluation of recordings of real-life clinical visits recordings, and stakeholder engagement (e.g., patients, clinicians, researchers).

Results

We identified 17 potential components to the process of diagnostic reconciliation through literature review and stakeholder engagement. After review of 56 clinical visits and further stakeholder engagement, we developed a final framework including four categories: 1) understanding the need for a test/referral, 2) logistics of test/referral scheduling, 3) test/referral information, and 4) test/referral results.

Conclusions

The proposed framework lays the foundation for evaluation and improvement of diagnostic conversations in practice. Clinicians can enhance patient-centered diagnosis by co-creating diagnostic plans of care in practice and using the components described in the novel diagnostic reconciliation framework.

Keywords: diagnostic conversation; diagnostic error; diagnosis excellence; diagnostic reconciliation
Corresponding author: Naykky Singh Ospina, MD, MS, Division of Endocrinology, Department of Medicine, University of Florida, 1600 SW Archer Road, Room H2, Gainesville, FL 32606, USA, E-mail:
Sandra Algarin Perneth and Gilberto Perez Rodriguez Garcia contributed equally to this work and share first authorship.

Funding source: National Cancer Institute

Award Identifier / Grant number: K08CA248972

  1. Research ethics: The University of Florida Institutional Review Board approved the study.

  2. Informed consent: Informed consent was obtained from all individuals included in this study.

  3. Author contributions: NSO, JBP, IH conceptualized and designed the study. NSO, GPR, SAP reviewed clinical videos. NSO led the stakeholder panel meetings. GPR, SAP, and NSO wrote the first draft of the manuscript. All authors assisted in the interpretation of research findings, provided critical feedback on the manuscript, and approved the revised version. The authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: This project was supported by the National Academy of Medicine Excellence in Diagnosis Scholar Program. NSO was supported by the National Cancer Institute of the National Institutes of Health under Award Number K08CA248972. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  7. Data availability: Not applicable.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/dx-2024-0132).

Received: 2024-07-29
Accepted: 2024-11-01
Published Online: 2024-12-10

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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  17. Quality control of ultrasonography markers for Down’s syndrome screening: a retrospective study by the laboratory
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  20. Bayesian intelligence for medical diagnosis: a pilot study on patient disposition for emergency medicine chest pain
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  23. Letters to the Editor
  24. Mpox (monkeypox) diagnostic kits – September 2024
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  26. Superwarfarin poisoning: a challenging diagnosis
  27. Reviewer Acknowledgment
  28. Reviewer Acknowledgment
https://doi.org/10.1515/dx-2024-0132
Keywords for this article
diagnostic conversation; diagnostic error; diagnosis excellence; diagnostic reconciliation

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Systematic review and meta-analysis of observational studies evaluating glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCHL1) as blood biomarkers of mild acute traumatic brain injury (mTBI) or sport-related concussion (SRC) in adult subjects
  4. Opinion Papers
  5. From stable teamwork to dynamic teaming in the ambulatory care diagnostic process
  6. Bringing team science to the ambulatory diagnostic process: how do patients and clinicians develop shared mental models?
  7. Vitamin D assay and supplementation: still debatable issues
  8. Original Articles
  9. Developing a framework for understanding diagnostic reconciliation based on evidence review, stakeholder engagement, and practice evaluation
  10. Validity and reliability of Brier scoring for assessment of probabilistic diagnostic reasoning
  11. Impact of disclosing a working diagnosis during simulated patient handoff presentation in the emergency department: correctness matters
  12. Implementation of a bundle to improve diagnosis in hospitalized patients: lessons learned
  13. Time pressure in diagnosing written clinical cases: an experimental study on time constraints and perceived time pressure
  14. A decision support system to increase the compliance of diagnostic imaging examinations with imaging guidelines: focused on cerebrovascular diseases
  15. Bridging the divide: addressing discrepancies between clinical guidelines, policy guidelines, and biomarker utilization
  16. Unnecessary repetitions of C-reactive protein and leukocyte count at the emergency department observation unit contribute to higher hospital admission rates
  17. Quality control of ultrasonography markers for Down’s syndrome screening: a retrospective study by the laboratory
  18. Short Communications
  19. Unclassified green dots on nucleated red blood cells (nRBC) plot in DxH900 from a patient with hyperviscosity syndrome
  20. Bayesian intelligence for medical diagnosis: a pilot study on patient disposition for emergency medicine chest pain
  21. Case Report – Lessons in Clinical Reasoning
  22. A delayed diagnosis of hyperthyroidism in a patient with persistent vomiting in the presence of Chiari type 1 malformation
  23. Letters to the Editor
  24. Mpox (monkeypox) diagnostic kits – September 2024
  25. Barriers to diagnostic error reduction in Japan
  26. Superwarfarin poisoning: a challenging diagnosis
  27. Reviewer Acknowledgment
  28. Reviewer Acknowledgment
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