Diagnostische Fehler in der Primärversorgung - eine randomisierte kontrollierte Studie
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Abstract
Research Questions
Diagnostic uncertainty is an important factor in primary care that leads to high risk for diagnostic error. The Pseudoerror Method is a heuristic developed by Norbert Donner-Ban-zhoff to identify diagnostic errors. Aim of this study was to compare the retrospective reflection on diagnostic decisions of physicians using the Pseudoerror Method with the usual approach. We investigated whether using the Pseudoerror Method facilitates the recognition of diagnostic errors, whether using the method makes it easier for reviewers to make a decision and whether it results in greater agreement in the assessments of reviewers.
Methods
To answer these questions, we conducted a randomized controlled trial with primary care physicians in Germany. In an online survey they were presented eight case vignettes in which a diagnostic error may have occurred. Participants were asked to decide whether the physician in the case has made a true diagnostic error or not. In addition, they were asked, how difficult it was to make a decision. Participants in the intervention group were provided educational material on the Pseudoerror Method. There was written material, an educational video explaining the method and they were invited to take part in a webinar. 57 primary care physicians completed the survey, 27 in the intervention group and 30 in the control group. Data regarding the accuracy of judgement and the difficulty were analysed using a multilevel logistic regression model. For the reliability of judgement, we cal-culated and compared Fleiss Kappa for more than two raters.
Results
There was no difference between the two groups in accuracy of judgement. The introduc-tion of physicians in using the Pseudoerror Method did not facilitate the correct recogni-tion of diagnostic errors. It felt harder to decide for physicians in the intervention group. In both groups agreement between the physicians was fair. The education on the method did not lead to an improvement in interrater agreement.
Conclusions
In the way that it was introduced in this study the Pseudoerror Method did not help to identify diagnostic errors correctly or to make it easier for physicians to make a decision. The significance of the results with regard to the benefit of the Pseudoerror Method itself is limited, as they may be influenced by a didactic insufficient introduction to the method.
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Except where otherwise noted, this item's license is described as Attribution-NonCommercial 4.0 International