CHPR News | July 2020
Romano Publishes Primer on COVID-19 and Diagnostic Errors
A summary of the current state of the global literature on potential diagnostic errors related to COVID-19 was recently published on the website of the Patient Safety Network (PSNet) of the U.S. Agency for Healthcare Research and Quality (AHRQ). Patrick Romano, M.D., M.P.H., Co-Editor-in-Chief of AHRQ’s PSNet with Debra Bakerjian, Ph.D., A.P.R.N. of the UC Davis Betty Irene Moore School of Nursing, authored the Patient Safety Primer “Coronavirus Disease 2019 (COVID-19) and Diagnostic Error” on behalf of the AHRQ PSNet team, which is based in part at the UC Davis Center for Healthcare Policy and Research (CHPR). The latest evidence on both test-related and clinician-related contributors to diagnostic errors is reviewed in the document.
Current diagnostic tests are described as analytically sensitive and highly specific for SARS-CoV-2, the virus that causes COVID-19, for example, but test accuracy can be substantially lower in actual clinical practice due to variation in how specimens from patients are obtained and handled, and the stage of a patient’s illness when the testing is performed. False-negative rates can be so high, in fact, that symptomatic individuals with an intermediate or high clinical suspicion of having COVID-19 should be retested when an initial test comes back negative.
Dr. Romano also describes the various kinds of biases that may contribute to errors in diagnosing COVID-19 and other conditions with which COVID-19 is confused. For example, implicit biases—those outside conscious awareness that lead to negative evaluations of people based on characteristics such as race and ethnicity, nationality, disability, and socio-economic status—may be contributing to the disproportionate impact of COVID-19 on African-American and Hispanic communities in the U.S. This Primer highlights the importance of conscious efforts to identify and address these implicit biases, as well as other biases, that can interfere with the diagnostic process.
“COVID-19 and Diagnostic Errors” outlines approaches healthcare providers can take to minimize the impact of biases, summarizes current guidance for improving the fidelity of diagnostic testing, and references additional resources on this important topic. It will be updated over time to incorporate new information and evidence in this rapidly evolving field.