High Rate of Failure Found In Colorectal Cancer Diagnoses

Oak Brook, IL — A study in the January issue of The Joint Commission Journal on Quality and Patient Safety examined how the quality of primary care clinicians’ workup, procedures or tests performed to arrive at diagnosis can delay diagnoses of colorectal cancer.

Diagnostic errors affect millions of patients each year, resulting in significant illness or death. Missed or delayed colorectal cancer diagnoses represent a major share of medical malpractice claims. Yet, little is know about how often primary care clinicians followed recommended practice guidelines for patients experiencing rectal bleeding – a potential sign of colon cancer – including obtaining a family history, performing a physical exam and ordering laboratory tests.

For the study, Saul N. Weingart, MD, MPP, Ph.D., chief medical officer of Tufts Medical Center, and his co-authors used billing codes to identify 438 patients with rectal bleeding, hemorrhoids, and blood in the stool at 10 adult primary care practices in Boston. Physician reviewers then assessed processes of care, overall quality of care, and measures that could have reduced or prevented a delayed workup.

In 77 percent of the cases, the reviewers judged the care’s quality as good or excellent, but 71 percent of the patients experienced at least one process-of-care failure in the workup of rectal bleeding. Clinicians did not obtain adequate family histories in 38 percent of cases, did not conduct a proper physical in 23 percent and did not order lab tests in 16 percent.

In all, the reviewers estimated that 128 delays in workup could have been reduced or prevented through educating practitioners and creating office-based systems to ensure adequate history taking, physical examination and processes for ordering, performing and interpreting diagnostic tests.

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