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Article ; Online: A Patient-Centered Approach to Writing Ambulatory Visit Notes in the Cures Act Era.

Lam, Barbara D / Dupee, David / Gerard, Macda / Bell, Sigall K

Applied clinical informatics

2023 Volume 14, Issue 1, Page(s) 199–204

MeSH term(s)	Humans ; Electronic Health Records ; Patients ; Writing ; Patient-Centered Care
Language	English
Publishing date	2023-03-08
Publishing country	Germany
Document type	Journal Article
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0043-1761436
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety.

Blease, Charlotte R / Bell, Sigall K

Diagnosis (Berlin, Germany)

2019 Volume 6, Issue 3, Page(s) 213–221

Abstract: Error resulting from missed, delayed, or wrong diagnoses is estimated to occur in 10-15% of ambulatory and inpatient encounters, leading to serious harm in around half of such cases. When it comes to conceptualizing diagnostic error, most research has ... ...

Abstract	Error resulting from missed, delayed, or wrong diagnoses is estimated to occur in 10-15% of ambulatory and inpatient encounters, leading to serious harm in around half of such cases. When it comes to conceptualizing diagnostic error, most research has focused on factors pertaining to: (a) physician cognition and (b) ergonomic or systems factors related to the physician's working environment. A third factor - the role of patients in diagnostic processes - remains relatively under-investigated. Yet, as a growing number of researchers acknowledge, patients hold unique knowledge about themselves and their healthcare experience, and may be the most underutilized resource for mitigating diagnostic error. This opinion article examines recent findings from patient surveys about sharing visit notes with patients online. Drawing on these survey results, we suggest three ways in which sharing visit notes with patients might enhance diagnostic processes: (1) avoid delays and missed diagnoses by enhancing timely follow up of recommended tests, results, and referrals; (2) identify documentation errors that may undermine diagnostic accuracy; and (3) strengthen patient-clinician relationships thereby creating stronger bidirectional diagnostic partnerships. We also consider the potential pitfalls or unintended consequences of note transparency, and highlight areas in need of further research.
MeSH term(s)	Ambulatory Care Facilities ; Delayed Diagnosis ; Diagnostic Errors/prevention & control ; Electronic Health Records/standards ; Humans ; Male ; Patient Participation ; Patient Portals ; Patient Safety ; Surveys and Questionnaires
Language	English
Publishing date	2019-04-26
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2194-802X
ISSN (online)	2194-802X
DOI	10.1515/dx-2018-0106
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: A Patient-Centered Approach to Writing Ambulatory Visit Notes in the Cures Act Era

Lam, Barbara D. / Dupee, David / Gerard, Macda / Bell, Sigall K.

Applied Clinical Informatics

2023 Volume 14, Issue 01, Page(s) 199–204

Language	English
Publishing date	2023-01-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0043-1761436
Database	Thieme publisher's database

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Article ; Online: Every patient should be enabled to stop the line.

Bell, Sigall K / Martinez, William

BMJ quality & safety

2018 Volume 28, Issue 3, Page(s) 172–176

MeSH term(s)	Communication ; Humans ; Patient Comfort ; Patient Safety
Language	English
Publishing date	2018-11-22
Publishing country	England
Document type	Editorial ; Research Support, N.I.H., Extramural ; Comment
ZDB-ID	2592912-4
ISSN	2044-5423 ; 2044-5415
ISSN (online)	2044-5423
ISSN	2044-5415
DOI	10.1136/bmjqs-2018-008714
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Article ; Online: Diagnostic error experiences of patients and families with limited English-language health literacy or disadvantaged socioeconomic position in a cross-sectional US population-based survey.

Bell, Sigall K / Dong, Joe / Ngo, Long / McGaffigan, Patricia / Thomas, Eric J / Bourgeois, Fabienne

BMJ quality & safety

2022 Volume 32, Issue 11, Page(s) 644–654

Abstract: Background: Language barrier, reduced self-advocacy, lower health literacy or biased care may hinder the diagnostic process. Data on how patients/families with limited English-language health literacy (LEHL) or disadvantaged socioeconomic position (dSEP) ...

Abstract	Background: Language barrier, reduced self-advocacy, lower health literacy or biased care may hinder the diagnostic process. Data on how patients/families with limited English-language health literacy (LEHL) or disadvantaged socioeconomic position (dSEP) experience diagnostic errors are sparse. Method: We compared patient-reported diagnostic errors, contributing factors and impacts between respondents with LEHL or dSEP and their counterparts in the 2017 Institute for Healthcare Improvement US population-based survey, using contingency analysis and multivariable logistic regression models for the analyses. Results: 596 respondents reported a diagnostic error; among these, 381 reported LEHL or dSEP. After adjusting for sex, race/ethnicity and physical health, individuals with LEHL/dSEP were more likely than their counterparts to report unique contributing factors: "(No) qualified translator or healthcare provider that spoke (the patient's) language" (OR and 95% CI 4.4 (1.3 to 14.9)); "not understanding the follow-up plan" (1.9 (1.1 to 3.1)); "too many providers… but no clear leader" (1.8 (1.2 to 2.7)); "not able to keep follow-up appointments" (1.9 (1.1 to 3.2)); "not being able to pay for necessary medical care" (2.5 (1.4 to 4.4)) and "out-of-date or incorrect medical records" (2.6 (1.4 to 4.8)). Participants with LEHL/dSEP were more likely to report long-term emotional, financial and relational impacts, compared with their counterparts. Subgroup analysis (LEHL-only and dSEP-only participants) showed similar results. Conclusions: Individuals with LEHL or dSEP identified unique and actionable contributing factors to diagnostic errors. Interpreter access should be viewed as a diagnostic safety imperative, social determinants affecting care access/affordability should be routinely addressed as part of the diagnostic process and patients/families should be encouraged to access and update their medical records. The frequent and disproportionate long-term impacts from self-reported diagnostic error among LEHL/dSEP patients/families raises urgency for greater prevention and supportive efforts.
MeSH term(s)	Humans ; Health Literacy ; Cross-Sectional Studies ; Language ; Patient Care ; Socioeconomic Factors
Language	English
Publishing date	2022-02-04
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, Non-U.S. Gov't
ZDB-ID	2592909-4
ISSN	2044-5423 ; 2044-5415
ISSN (online)	2044-5423
ISSN	2044-5415
DOI	10.1136/bmjqs-2021-013937
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Zs.A 3754: Show issues

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Article ; Online: Partnering with Patients and Families to Improve Diagnostic Safety through the OurDX Tool: Effects of Race, Ethnicity, and Language Preference.

Bourgeois, Fabienne C / Hart, Nicholas J / Dong, Zhiyong / Ngo, Long H / DesRoches, Catherine M / Thomas, Eric J / Bell, Sigall K

Applied clinical informatics

2023 Volume 14, Issue 5, Page(s) 903–912

Abstract: Background: Patients and families at risk for health disparities may also be at higher risk for diagnostic errors but less likely to report them.: Objectives: This study aimed to explore differences in race, ethnicity, and language preference ... ...

Abstract	Background: Patients and families at risk for health disparities may also be at higher risk for diagnostic errors but less likely to report them. Objectives: This study aimed to explore differences in race, ethnicity, and language preference associated with patient and family contributions and concerns using an electronic previsit tool designed to engage patients and families in the diagnostic process (DxP). Methods: Cross-sectional study of 5,731 patients and families presenting to three subspecialty clinics at an urban pediatric hospital May to December 2021 who completed a previsit tool, codeveloped and tested with patients and families. Prior to each visit, patients/families were invited to share visit priorities, recent histories, and potential diagnostic concerns. We used logistic regression to determine factors associated with patient-reported diagnostic concerns. We conducted chart review on a random subset of visits to review concerns and determine whether patient/family contributions were included in the visit note. Results: Participants provided a similar mean number of contributions regardless of patient race, ethnicity, or language preference. Compared with patients self-identifying as White, those self-identifying as Black (odds ratio [OR]: 1.70; 95% confidence interval [CI]: [1.18, 2.43]) or "other" race (OR: 1.48; 95% CI: [1.08, 2.03]) were more likely to report a diagnostic concern. Participants who preferred a language other than English were more likely to report a diagnostic concern than English-preferring patients (OR: 2.53; 95% CI: [1.78, 3.59]. There were no significant differences in physician-verified diagnostic concerns or in integration of patient contributions into the note based on race, ethnicity, or language preference. Conclusion: Participants self-identifying as Black or "other" race, or those who prefer a language other than English were 1.5 to 2.5 times more likely than their counterparts to report potential diagnostic concerns when proactively asked to provide this information prior to a visit. Actively engaging patients and families in the DxP may uncover opportunities to reduce the risk of diagnostic errors and potential safety disparities.
MeSH term(s)	Humans ; Child ; Ethnicity ; Cross-Sectional Studies ; Language
Language	English
Publishing date	2023-11-15
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0043-1776055
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: What's going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process.

Liu, Stephen K / Bourgeois, Fabienne / Dong, Joe / Harcourt, Kendall / Lowe, Elizabeth / Salmi, Liz / Thomas, Eric J / Riblet, Natalie / Bell, Sigall K

Diagnosis (Berlin, Germany)

2023 Volume 11, Issue 1, Page(s) 63–72

Abstract: Objectives: Accurate and timely diagnosis relies on close collaboration between patients/families and clinicians. Just as patients have unique insights into diagnostic breakdowns, positive patient feedback may also generate broader perspectives on what ... ...

Abstract	Objectives: Accurate and timely diagnosis relies on close collaboration between patients/families and clinicians. Just as patients have unique insights into diagnostic breakdowns, positive patient feedback may also generate broader perspectives on what constitutes a "good" diagnostic process (DxP). Methods: We evaluated patient/family feedback on "what's going well" as part of an online pre-visit survey designed to engage patients/families in the DxP. Patients/families living with chronic conditions with visits in three urban pediatric subspecialty clinics (site 1) and one rural adult primary care clinic (site 2) were invited to complete the survey between December 2020 and March 2022. We adapted the Healthcare Complaints Analysis Tool (HCAT) to conduct a qualitative analysis on a subset of patient/family responses with ≥20 words. Results: In total, 7,075 surveys were completed before 18,129 visits (39 %) at site 1, and 460 surveys were completed prior to 706 (65 %) visits at site 2. Of all participants, 1,578 volunteered positive feedback, ranging from 1-79 words. Qualitative analysis of 272 comments with ≥20 words described: Relationships (60 %), Clinical Care (36 %), and Environment (4 %). Compared to primary care, subspecialty comments showed the same overall rankings. Within Relationships, patients/families most commonly noted: thorough and competent attention (46 %), clear communication and listening (41 %) and emotional support and human connection (39 %). Within Clinical Care, patients highlighted: timeliness (31 %), effective clinical management (30 %), and coordination of care (25 %). Conclusions: Patients/families valued relationships with clinicians above all else in the DxP, emphasizing the importance of supporting clinicians to nurture effective relationships and relationship-centered care in the DxP.
MeSH term(s)	Adult ; Child ; Humans ; Feedback ; Patients ; Delivery of Health Care ; Ambulatory Care Facilities ; Communication
Language	English
Publishing date	2023-12-20
Publishing country	Germany
Document type	Journal Article
ISSN	2194-802X
ISSN (online)	2194-802X
DOI	10.1515/dx-2023-0075
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Patients Managing Medications and Reading Their Visit Notes.

DesRoches, Catherine M / Delbanco, Tom / Bell, Sigall K

Annals of internal medicine

2019 Volume 171, Issue 10, Page(s) 774

MeSH term(s)	Humans ; Patient Access to Records ; Reading ; Surveys and Questionnaires
Language	English
Publishing date	2019-11-07
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/L19-0599
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Article ; Online: Third Things as Inspiration and Artifact: A Multi-Stakeholder Qualitative Approach to Understand Patient and Family Emotions after Harmful Events.

Gaufberg, Elizabeth / Olmsted, Molly Ward / Bell, Sigall K

The Journal of medical humanities

2019 Volume 40, Issue 4, Page(s) 489–504

Abstract: Patient and family emotional harm after medical errors may be profound. At an Agency for Healthcare Research and Quality (AHRQ) conference to establish a research agenda on this topic, the authors used visual images as a gateway to personal reflections ... ...

Abstract	Patient and family emotional harm after medical errors may be profound. At an Agency for Healthcare Research and Quality (AHRQ) conference to establish a research agenda on this topic, the authors used visual images as a gateway to personal reflections among diverse stakeholders. Themes identified included chaos and turmoil, profound isolation, organizational denial, moral injury and betrayal, negative effects on families and communities, importance of relational skills, and healing effects of human connection. The exercise invited storytelling, enabled psychological safety, and fostered further collaborative discussion. The authors discuss implications for quality/safety, educational innovation, and qualitative research.
MeSH term(s)	Artifacts ; Emotions ; Family/psychology ; Humans ; Medical Errors/psychology ; Patients/psychology ; Qualitative Research
Language	English
Publishing date	2019-07-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2017000-2
ISSN	1573-3645 ; 1041-3545
ISSN (online)	1573-3645
ISSN	1041-3545
DOI	10.1007/s10912-019-09563-z
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Article ; Online: Speaking up about patient-perceived serious visit note errors: Patient and family experiences and recommendations.

Lam, Barbara D / Bourgeois, Fabienne / Dong, Zhiyong J / Bell, Sigall K

Journal of the American Medical Informatics Association : JAMIA

2020 Volume 28, Issue 4, Page(s) 685–694

Abstract: Background: Open notes invite patients and families to read ambulatory visit notes through the patient portal. Little is known about the extent to which they identify and speak up about perceived errors. Understanding the barriers to speaking up can ... ...

Abstract	Background: Open notes invite patients and families to read ambulatory visit notes through the patient portal. Little is known about the extent to which they identify and speak up about perceived errors. Understanding the barriers to speaking up can inform quality improvements. Objective: To describe patient and family attitudes, experiences, and barriers related to speaking up about perceived serious note errors. Methods: Mixed method analysis of a 2016 electronic survey of patients and families at 2 northeast US academic medical centers. Participants had active patient portal accounts and at least 1 note available in the preceding 12 months. Results: 6913 adult patients (response rate 28%) and 3672 pediatric families (response rate 17%) completed the survey. In total, 8724/9392 (93%) agreed that reporting mistakes improves patient safety. Among 8648 participants who read a note, 1434 (17%) perceived ≥1 mistake. 627/1434 (44%) reported the mistake was serious and 342/627 (56%) contacted their provider. Participants who self-identified as Black or African American, Asian, "other," or "multiple" race(s) (OR 0.50; 95% CI (0.26,0.97)) or those who reported poorer health (OR 0.58; 95% CI (0.37,0.90)) were each less likely to speak up than white or healthier respondents, respectively. The most common barriers to speaking up were not knowing how to report a mistake (61%) and avoiding perception as a "troublemaker" (34%). Qualitative analysis of 476 free-text suggestions revealed practical recommendations and proposed innovations for partnering with patients and families. Conclusions: About half of patients and families who perceived a serious mistake in their notes reported it. Identified barriers demonstrate modifiable issues such as establishing clear mechanisms for reporting and more challenging issues such as creating a supportive culture. Respondents offered new ideas for engaging patients and families in improving note accuracy.
MeSH term(s)	Adult ; Attitude to Health ; Child ; Data Accuracy ; Electronic Health Records ; Ethnicity ; Humans ; Patient Access to Records ; Patient Participation ; Patient Portals ; Professional-Family Relations ; Surveys and Questionnaires
Language	English
Publishing date	2020-12-23
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1205156-1
ISSN	1527-974X ; 1067-5027
ISSN (online)	1527-974X
ISSN	1067-5027
DOI	10.1093/jamia/ocaa293
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Zs.A 4128: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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