{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:58:30Z","timestamp":1791341910122,"version":"4.3.1"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>There is limited evidence regarding the frequency of diagnostic errors and outcomes associated with them in emergency care in the US.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine rates of potential diagnostic errors and associated clinical outcomes among Medicare beneficiaries with emergency hospitalizations.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study examined a national sample of fee-for-service Medicare beneficiaries aged 65 years or older with emergency hospitalizations for 10 high-risk conditions from 2016 to 2019. Data were analyzed from December 20, 2022, to April 16, 2025.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Potential diagnostic errors in the emergency department (ED).<\/jats:p><\/jats:sec>Main Outcome and Measures<\/jats:title>The percentage of hospitalizations with an ED discharge (potential diagnostic error) in the preceding 9 days was calculated. From this observed ED visit rate, an adjusted rate of potential diagnostic errors was calculated by subtracting the rate of background ED discharges among a comparison cohort of beneficiaries with similar baseline risk. To examine the association between potential diagnostic error and outcomes, multivariable linear regression models were specified for the outcomes: 30-day mortality and healthy days at home (HDAH). Potential diagnostic error was the exposure, and the models were adjusted for diagnosis, patient demographics, and chronic conditions.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 302\u202f837 emergency hospitalizations, 13\u202f550 (4.5%) were preceded by an ED discharge (ie, potential diagnostic error) within 9 days. For the comparison group with similar baseline risk, 1.2% (95% CI, 1.2%-1.3%) had an ED discharge in a random 9-day period. After accounting for this background use, the adjusted potential diagnostic error rate was 3.2% (95% CI, 3.1%-3.3%) for all conditions in aggregate but ranged from 2.1% (95% CI, 1.9%-2.4%) for spontaneous intracranial hemorrhage to 15.6% (95% CI, 11.9%-19.3%) for spinal abscess. Having a potential diagnostic error was associated with higher adjusted 30-day mortality for emergency admissions (15.7% vs 14.9%; point absolute difference, 0.8 percentage points, 95% CI, 0.2 to 1.4 percentage points; P<\/jats:italic>\u2009=\u2009.007) as well as fewer 30-day HDAH (13.5 days vs 15.0 days; difference, \u22121.4 days; 95% CI, \u22121.6 to \u22121.3 days; P<\/jats:italic>\u2009&amp;lt;\u2009.001), although associations varied among conditions.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of Medicare beneficiaries aged 65 years and older with emergency hospitalizations, the adjusted potential diagnostic error rate was modest overall but varied by condition. Potential diagnostic errors were associated with worse outcomes for emergency conditions overall, with associations again varying among individual conditions.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.16400","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T15:00:30Z","timestamp":1750172430000},"page":"e2516400","source":"Crossref","is-referenced-by-count":10,"title":["Potential Diagnostic Error for Emergency Conditions, Mortality, and Healthy Days at Home"],"prefix":"10.1001","volume":"8","author":[{"given":"Michelle P.","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Stanford University, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan C.","family":"Burke","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts"},{"name":"Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber K.","family":"Sabbatini","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Latsko","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A.","family":"Edlow","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts"},{"name":"Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. John","family":"Orav","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura G.","family":"Burke","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts"},{"name":"Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"issue":"9","key":"zoi250516r2","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1136\/bmjqs-2013-002627","article-title":"The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations.","volume":"23","author":"Singh","year":"2014","journal-title":"BMJ Qual Saf"},{"issue":"2","key":"zoi250516r4","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1136\/qshc.2005.016618","article-title":"Unscheduled returns to the emergency department: an outcome of medical errors?","volume":"15","author":"Nu\u00f1ez","year":"2006","journal-title":"Qual Saf Health Care"},{"issue":"1","key":"zoi250516r5","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s13049-019-0629-z","article-title":"Diagnostic error increases mortality and length of hospital stay in patients presenting through the emergency room.","volume":"27","author":"Hautz","year":"2019","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"5","key":"zoi250516r6","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1017\/S1481803500012574","article-title":"Adverse events among patients registered in high-acuity areas of the emergency department: a prospective cohort study.","volume":"12","author":"Calder","year":"2010","journal-title":"CJEM"},{"issue":"1","key":"zoi250516r7","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s12873-019-0289-3","article-title":"Diagnostic error in the emergency department: learning from national patient safety incident report analysis.","volume":"19","author":"Hussain","year":"2019","journal-title":"BMC Emerg Med"},{"issue":"7","key":"zoi250516r8","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmjqs-2017-007032","article-title":"Symptom-Disease Pair Analysis of Diagnostic Error (SPADE): a conceptual framework and methodological approach for unearthing misdiagnosis-related harms using big data.","volume":"27","author":"Liberman","year":"2018","journal-title":"BMJ Qual Saf"},{"issue":"5","key":"zoi250516r9","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1016\/j.annemergmed.2024.06.014","article-title":"Characterizing acute pulmonary embolism cases diagnosed at an emergency department revisit using a statewide clinical registry.","volume":"84","author":"Janke","year":"2024","journal-title":"Ann Emerg Med"},{"issue":"1","key":"zoi250516r10","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/MLR.0000000000001216","article-title":"Validity of race and ethnicity codes in Medicare administrative data compared with gold-standard self-reported race collected during routine home health care visits.","volume":"58","author":"Jarr\u00edn","year":"2020","journal-title":"Med Care"},{"issue":"3","key":"zoi250516r11","first-page":"191","article-title":"Risk adjustment for Medicare beneficiaries with Alzheimer\u2019s disease and related dementias.","volume":"16","author":"Lin","year":"2010","journal-title":"Am J Manag Care"},{"key":"zoi250516r12","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1186\/1472-6963-10-245","article-title":"Comparison of the performance of the CMS Hierarchical Condition Category (CMS-HCC) risk adjuster with the Charlson and Elixhauser comorbidity measures in predicting mortality.","volume":"10","author":"Li","year":"2010","journal-title":"BMC Health Serv Res"},{"issue":"12","key":"zoi250516r13","doi-asserted-by":"publisher","first-page":"2306","DOI":"10.1111\/j.1532-5415.2009.02558.x","article-title":"Do hierarchical condition category model scores predict hospitalization risk in newly enrolled Medicare advantage participants as well as probability of repeated admission scores?","volume":"57","author":"Mosley","year":"2009","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"zoi250516r14","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1001\/jamainternmed.2024.6214","article-title":"Implementation of electronic triggers to identify diagnostic errors in emergency departments.","volume":"185","author":"Vaghani","year":"2025","journal-title":"JAMA Intern Med"},{"issue":"1","key":"zoi250516r15","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1515\/dx-2013-0027","article-title":"A unified conceptual model for diagnostic errors: underdiagnosis, overdiagnosis, and misdiagnosis.","volume":"1","author":"Newman-Toker","year":"2014","journal-title":"Diagnosis (Berl)"},{"issue":"8","key":"zoi250516r16","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1111\/acem.12442","article-title":"Patient returns to the emergency department: the time-to-return curve.","volume":"21","author":"Rising","year":"2014","journal-title":"Acad Emerg Med"},{"issue":"4","key":"zoi250516r17","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1111\/acem.13140","article-title":"Identification of emergency department visits in Medicare Administrative claims: approaches and implications.","volume":"24","author":"Venkatesh","year":"2017","journal-title":"Acad Emerg Med"},{"issue":"2","key":"zoi250516r18","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1001\/jamainternmed.2016.7875","article-title":"Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians.","volume":"177","author":"Tsugawa","year":"2017","journal-title":"JAMA Intern Med"},{"issue":"4","key":"zoi250516r19","doi-asserted-by":"publisher","first-page":"480","DOI":"10.7326\/M22-3165","article-title":"Effect of Medicare advantage on hospital readmission and mortality rankings.","volume":"176","author":"Oseran","year":"2023","journal-title":"Ann Intern Med"},{"issue":"1","key":"zoi250516r20","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1001\/jamasurg.2024.4574","article-title":"Failure to rescue female patients undergoing high-risk surgery.","volume":"160","author":"Wagner","year":"2025","journal-title":"JAMA Surg"},{"issue":"1","key":"zoi250516r21","doi-asserted-by":"publisher","DOI":"10.1016\/j.hjdsi.2019.100378","article-title":"Healthy days at home: a novel population-based outcome measure.","volume":"8","author":"Burke","year":"2020","journal-title":"Healthc (Amst)"},{"issue":"2","key":"zoi250516r22","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.54559","article-title":"Association of Academic Medical Center presence with clinical outcomes at neighboring community hospitals among Medicare beneficiaries.","volume":"6","author":"Burke","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"10","key":"zoi250516r23","doi-asserted-by":"publisher","first-page":"3122","DOI":"10.1111\/jgs.18464","article-title":"Trends in healthy days at home for Medicare beneficiaries using the emergency department.","volume":"71","author":"Burke","year":"2023","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"zoi250516r24","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1515\/dx-2013-0038","article-title":"Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample.","volume":"1","author":"Newman-Toker","year":"2014","journal-title":"Diagnosis (Berl)"},{"issue":"9","key":"zoi250516r25","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1111\/j.1553-2712.2010.00840.x","article-title":"What are the unintended consequences of changing the diagnostic paradigm for subarachnoid hemorrhage after brain computed tomography to computed tomographic angiography in place of lumbar puncture?","volume":"17","author":"Edlow","year":"2010","journal-title":"Acad Emerg Med"},{"issue":"9","key":"zoi250516r26","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1001\/jamainternmed.2019.1739","article-title":"Prevalence and cost of care cascades after low-value preoperative electrocardiogram for cataract surgery in fee-for-service Medicare beneficiaries.","volume":"179","author":"Ganguli","year":"2019","journal-title":"JAMA Intern Med"},{"key":"zoi250516r27","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e3502","article-title":"Preventing overdiagnosis: how to stop harming the healthy.","volume":"344","author":"Moynihan","year":"2012","journal-title":"BMJ"},{"issue":"3","key":"zoi250516r28","doi-asserted-by":"publisher","first-page":"572","DOI":"10.2214\/AJR.17.18586","article-title":"Trends and variation in the utilization and diagnostic yield of chest imaging for Medicare patients with suspected pulmonary embolism in the emergency department.","volume":"210","author":"Venkatesh","year":"2018","journal-title":"AJR Am J Roentgenol"},{"issue":"4","key":"zoi250516r29","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/j.jacr.2019.11.021","article-title":"Higher imaging yield when clinical decision support is used.","volume":"17","author":"Richardson","year":"2020","journal-title":"J Am Coll Radiol"},{"key":"zoi250516r30","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/1472-6947-5-26","article-title":"Pretest probability assessment derived from attribute matching.","volume":"5","author":"Kline","year":"2005","journal-title":"BMC Med Inform Decis Mak"},{"issue":"5","key":"zoi250516r31","doi-asserted-by":"publisher","first-page":"e65","DOI":"10.1016\/j.annemergmed.2018.07.045","article-title":"Clinical policy: critical issues in the evaluation and management of emergency department patients with suspected non-ST-elevation acute coronary syndromes.","volume":"72","author":"Tomaszewski","year":"2018","journal-title":"Ann Emerg Med"},{"issue":"5","key":"zoi250516r32","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1111\/j.1538-7836.2008.02944.x","article-title":"Prospective multicenter evaluation of the pulmonary embolism rule-out criteria.","volume":"6","author":"Kline","year":"2008","journal-title":"J Thromb Haemost"},{"issue":"10","key":"zoi250516r33","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1111\/acem.14765","article-title":"Implementation of an emergency department back pain clinical management tool on the early diagnosis and testing of spinal epidural abscess.","volume":"30","author":"Cai","year":"2023","journal-title":"Acad Emerg Med"},{"issue":"8","key":"zoi250516r34","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1001\/jama.2023.0577","article-title":"Misdiagnosis in the emergency department: time for a system solution.","volume":"329","author":"Edlow","year":"2023","journal-title":"JAMA"},{"issue":"14","key":"zoi250516r35","doi-asserted-by":"publisher","first-page":"1748","DOI":"10.1001\/jama.286.14.1748","article-title":"Has misdiagnosis of appendicitis decreased over time: a population-based analysis.","volume":"286","author":"Flum","year":"2001","journal-title":"JAMA"},{"issue":"4","key":"zoi250516r36","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.7373","article-title":"Shifts in diagnostic testing for headache in the emergency department, 2015 to 2021.","volume":"7","author":"Mark","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"2","key":"zoi250516r37","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1093\/qje\/qjab046","article-title":"Diagnosing physician error: a machine learning approach to low-value health care.","volume":"137","author":"Mullainathan","year":"2022","journal-title":"Q J Econ"},{"issue":"10","key":"zoi250516r38","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.40969","article-title":"Large language model influence on diagnostic reasoning: a randomized clinical trial.","volume":"7","author":"Goh","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"4","key":"zoi250516r39","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1001\/jamainternmed.2017.8628","article-title":"Unrecognized cardiovascular emergencies among Medicare patients.","volume":"178","author":"Waxman","year":"2018","journal-title":"JAMA Intern Med"},{"issue":"3","key":"zoi250516r40","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1161\/STROKEAHA.115.010613","article-title":"Missed ischemic stroke diagnosis in the emergency department by emergency medicine and neurology services.","volume":"47","author":"Arch","year":"2016","journal-title":"Stroke"},{"issue":"5","key":"zoi250516r41","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1016\/j.annemergmed.2022.07.010","article-title":"The man who mistook a hat for his wife: case report of aortic dissection presenting with acute hyperfamiliarity for faces.","volume":"81","author":"Park","year":"2023","journal-title":"Ann Emerg Med"},{"issue":"5","key":"zoi250516r42","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2020-234831","article-title":"Painless type A aortic dissection.","volume":"13","author":"Becerra-Gonzales","year":"2020","journal-title":"BMJ Case Rep"},{"issue":"4","key":"zoi250516r43","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1161\/01.STR.0000259661.05525.9a","article-title":"Missed diagnosis of subarachnoid hemorrhage in the emergency department.","volume":"38","author":"Vermeulen","year":"2007","journal-title":"Stroke"},{"issue":"7","key":"zoi250516r44","doi-asserted-by":"publisher","first-page":"866","DOI":"10.1001\/jama.291.7.866","article-title":"Initial misdiagnosis and outcome after subarachnoid hemorrhage.","volume":"291","author":"Kowalski","year":"2004","journal-title":"JAMA"},{"issue":"11","key":"zoi250516r45","doi-asserted-by":"publisher","first-page":"3072","DOI":"10.1161\/STROKEAHA.119.025520","article-title":"Misdiagnosis worsens prognosis in subarachnoid hemorrhage with good hunt and Hess score.","volume":"50","author":"Ois","year":"2019","journal-title":"Stroke"},{"key":"zoi250516r1","first-page":"472","volume-title":"Improving Diagnosis in Health Care","author":"Institute of Medicine, National Academies of Sciences Engineering, Medicine","year":"2015"},{"key":"zoi250516r3","doi-asserted-by":"crossref","DOI":"10.23970\/AHRQEPCCER258","volume-title":"Diagnostic Errors in the Emergency Department: A Systematic Review","author":"Newman-Toker","year":"2022"},{"key":"zoi250516r46","unstructured":"Moore? BJ, Liang? L. Statistical briefs #268: costs of emergency department visits in the United States, 2017. Healthcare Cost and Utilization Project (HCUP). Accessed May 28, 2025. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK566654\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2835402\/lin_2025_oi_250516_1749568845.40388.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T15:00:31Z","timestamp":1750172431000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2835402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,17]]},"references-count":46,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.16400","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,17]]}}}