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Patient Safety Culture, Health Information Technology Implementation, and Medical Office Problems That Could Lead to Diagnostic Error

Campione, Joanne R. PhD*; Mardon, Russell E. PhD; McDonald, Kathryn M. PhD

doi: 10.1097/PTS.0000000000000531
Original Articles

Background Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment or by leading to unnecessary or harmful treatment.

Objectives The aim of the study was to investigate the relationship between patient safety culture, health information technology (IT) implementation, and the frequency of problems that could lead to diagnostic errors in the medical office setting, such as unavailable test results, unavailable medical records, or unpursued abnormal results.

Methods We used survey data from 925 medical offices nationwide that voluntarily submitted results to the 2012 Agency for Healthcare Research and Quality Medical Office Surveys on Patient Safety Culture database. At the office level, we ran a multivariate regression model to estimate the effect of culture on problem frequency while controlling for office-reported implementation levels of health IT, office characteristics such as the number of locations, and survey characteristics such as the percent of respondents that were physicians.

Results The most frequent problem was “results from a lab or imaging test were not available when needed”; across 925 offices, the average was 15% reporting that it happened daily or weekly. Higher overall culture scores were significantly associated with fewer occurrences of each problem assessed. Compared with offices with completed health IT implementation, offices in the process of health IT implementation had higher frequency of problems.

Conclusions This study offers insight into how patient safety culture and health IT implementation in medical offices can influence the frequency of breakdowns in processes of care, thereby identifying potential vulnerabilities that can increase diagnostic errors.

From the *Westat, Durham, North Carolina

Westat, Rockville, Mayland

Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California.

Correspondence: Joanne Campione, PhD, MSPH, Westat, 1009 Slater Rd, Suite 110, Durham, NC 27703 (e-mail:

The authors disclose no conflict of interest.

This work was partially funded from the Agency for Healthcare Research and Quality (AHRQ) under IDIQ Prime Contract #HHSA290201200003I, Task Order #3. The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the US Department of Health and Human Services.

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