JAMA network open · 2026
Classification of Emergency Diagnosis-Sensitive Conditions Among Medicare Beneficiaries.
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Burke Laura G, Burke Ryan C, Orav E John, Sabbatini Amber K, Haimovich Adrian D, Edlow Jonathan A, Figueroa Jose F, Lin Michelle P
Аннотация
IMPORTANCE: Diagnostic accuracy is a key driver of emergency department (ED) quality, yet little consensus exists on which conditions to target.
OBJECTIVE: To develop a list of emergency diagnosis-sensitive conditions (EDSCs) for measuring diagnostic error in the ED.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study examined a national sample of claims for fee-for-service Medicare beneficiaries 65 years or older with nonelective hospitalizations from January 1, 2022, to December 31, 2024.
EXPOSURE: Potential diagnostic errors in the ED.
MAIN OUTCOMES AND MEASURES: A panel of 5 clinician investigators reviewed principal discharge International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes and determined whether each met criteria for an EDSC-a disease that is emergency care sensitive, at risk of diagnostic error, and should be diagnosed in the ED or on admission. The percentage of each EDSC's admissions preceded within 9 days by a potential diagnostic error (ED discharge) was characterized. To account for background ED utilization, an adjusted potential diagnostic error percentage was calculated by subtracting the percentage of a comparison cohort with at least 1 ED visit in the 9 days preceding a randomly selected date. The incidence of potential diagnostic errors per 10 000 ED discharges was calculated. Thirty-day morbidity (number of healthy days at home [HDAH]) and mortality were characterized. High-priority EDSCs were those in the top half of diagnostic errors per 10 000 ED discharges and in the top quartile of either mortality or HDAH lost. For high-priority conditions, the 20 most frequent diagnoses on preceding ED discharges were tabulated.
RESULTS: Of 19 973 diagnosis codes identified, 1802 were aggregated into 76 EDSC categories. Of 14 671 540 admissions, 2 852 901 (19.4%) were for EDSCs. Of these EDSC admissions, 713 601 (25.0%) occurred among adults 85 years or older, and 1 493 822 (52.4%) were among women. The EDSCs with the highest and lowest adjusted percentages of admissions preceded by a potential ED diagnostic error were Guillain-Barré syndrome (16.6%; 95% CI, 15.4%-17.9%) and acute appendicitis (1.4%; 95% CI, 1.3%-1.5%), respectively. Pneumonia had the highest adjusted incidence of potential diagnostic errors per 10 000 ED discharges (9.30; 95% CI, 9.18-9.42) despite a moderate adjusted potential diagnostic error percentage per 10 000 ED discharges (4.4%; 95% CI, 4.3%-4.5%). Symptom-based diagnoses were frequent on ED discharges preceding EDSC admissions.
CONCLUSIONS AND RELEVANCE: In this retrospective observational study of Medicare beneficiaries, EDSCs were used to characterize the population burden of potential diagnostic errors in emergency care and associated clinical presentations.
OBJECTIVE: To develop a list of emergency diagnosis-sensitive conditions (EDSCs) for measuring diagnostic error in the ED.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study examined a national sample of claims for fee-for-service Medicare beneficiaries 65 years or older with nonelective hospitalizations from January 1, 2022, to December 31, 2024.
EXPOSURE: Potential diagnostic errors in the ED.
MAIN OUTCOMES AND MEASURES: A panel of 5 clinician investigators reviewed principal discharge International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes and determined whether each met criteria for an EDSC-a disease that is emergency care sensitive, at risk of diagnostic error, and should be diagnosed in the ED or on admission. The percentage of each EDSC's admissions preceded within 9 days by a potential diagnostic error (ED discharge) was characterized. To account for background ED utilization, an adjusted potential diagnostic error percentage was calculated by subtracting the percentage of a comparison cohort with at least 1 ED visit in the 9 days preceding a randomly selected date. The incidence of potential diagnostic errors per 10 000 ED discharges was calculated. Thirty-day morbidity (number of healthy days at home [HDAH]) and mortality were characterized. High-priority EDSCs were those in the top half of diagnostic errors per 10 000 ED discharges and in the top quartile of either mortality or HDAH lost. For high-priority conditions, the 20 most frequent diagnoses on preceding ED discharges were tabulated.
RESULTS: Of 19 973 diagnosis codes identified, 1802 were aggregated into 76 EDSC categories. Of 14 671 540 admissions, 2 852 901 (19.4%) were for EDSCs. Of these EDSC admissions, 713 601 (25.0%) occurred among adults 85 years or older, and 1 493 822 (52.4%) were among women. The EDSCs with the highest and lowest adjusted percentages of admissions preceded by a potential ED diagnostic error were Guillain-Barré syndrome (16.6%; 95% CI, 15.4%-17.9%) and acute appendicitis (1.4%; 95% CI, 1.3%-1.5%), respectively. Pneumonia had the highest adjusted incidence of potential diagnostic errors per 10 000 ED discharges (9.30; 95% CI, 9.18-9.42) despite a moderate adjusted potential diagnostic error percentage per 10 000 ED discharges (4.4%; 95% CI, 4.3%-4.5%). Symptom-based diagnoses were frequent on ED discharges preceding EDSC admissions.
CONCLUSIONS AND RELEVANCE: In this retrospective observational study of Medicare beneficiaries, EDSCs were used to characterize the population burden of potential diagnostic errors in emergency care and associated clinical presentations.