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.
Keywords
error management and prevention - vulnerable populations - patient safety - patient–provider
communication
