CC BY-NC-ND 4.0 · Appl Clin Inform 2023; 14(05): 903-912
DOI: 10.1055/s-0043-1776055
Research Article

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

Fabienne C. Bourgeois
1   Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
2   Harvard Medical School, Boston, Massachusetts, United States
Nicholas J. Hart
1   Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
Zhiyong Dong
3   Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Long H. Ngo
3   Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
4   Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
Catherine M. DesRoches
2   Harvard Medical School, Boston, Massachusetts, United States
3   Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Eric J. Thomas
5   Department of Medicine, University of Texas at Houston Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, United States
6   McGovern Medical School at the University of Texas Health Science Center Houston, Houston, Texas, United States
2   Harvard Medical School, Boston, Massachusetts, United States
3   Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
› Author Affiliations
Funding This work was generously supported by the Agency for Healthcare Research and Quality; Grant Number: 5R01HS27367-03 and the Society to Improve Diagnosis in Medicine; Grant number: 165.


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.

Protection of Human and Animal Subjects

The study was approved by Boston Children's Hospital Institutional Review Board.

Supplementary Material

Publication History

Received: 02 March 2023

Accepted: 24 July 2023

Article published online:
15 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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