{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T12:29:24Z","timestamp":1766492964724,"version":"3.37.3"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T00:00:00Z","timestamp":1648512000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000936","name":"Gordon and Betty Moore Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000936","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Houston Veterans Administration (VA) Health Services Research and Development"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The 21st Century Cures Act mandates patients\u2019 access to their electronic health record (EHR) notes. To our knowledge, no previous work has systematically invited patients to proactively report diagnostic concerns while documenting and tracking their diagnostic experiences through EHR-based clinician note review.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To test if patients can identify concerns about their diagnosis through structured evaluation of their online visit notes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In a large integrated health system, patients aged 18\u201385 years actively using the patient portal and seen between October 2019 and February 2020 were invited to respond to an online questionnaire if an EHR algorithm detected any recent unexpected return visit following an initial primary care consultation (\u201cat-risk\u201d visit). We developed and tested an instrument (Safer Dx Patient Instrument) to help patients identify concerns related to several dimensions of the diagnostic process based on notes review and recall of recent \u201cat-risk\u201d visits. Additional questions assessed patients\u2019 trust in their providers and their general feelings about the visit. The primary outcome was a self-reported diagnostic concern. Multivariate logistic regression tested whether the primary outcome was predicted by instrument variables.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 293\u2009566 visits, the algorithm identified 1282 eligible patients, of whom 486 responded. After applying exclusion criteria, 418 patients were included in the analysis. Fifty-one patients (12.2%) identified a diagnostic concern. Patients were more likely to report a concern if they disagreed with statements \u201cthe care plan the provider developed for me addressed all my medical concerns\u201d [odds ratio (OR), 2.65; 95% confidence interval [CI], 1.45\u20134.87) and \u201cI trust the provider that I saw during my visit\u201d (OR, 2.10; 95% CI, 1.19\u20133.71) and agreed with the statement \u201cI did not have a good feeling about my visit\u201d (OR, 1.48; 95% CI, 1.09\u20132.01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Patients can identify diagnostic concerns based on a proactive online structured evaluation of visit notes. This surveillance strategy could potentially improve transparency in the diagnostic process.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocac036","type":"journal-article","created":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T04:14:26Z","timestamp":1646799266000},"page":"1091-1100","source":"Crossref","is-referenced-by-count":21,"title":["Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes"],"prefix":"10.1093","volume":"29","author":[{"given":"Traber D","family":"Giardina","sequence":"first","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, and Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debra T","family":"Choi","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, and Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Divvy K","family":"Upadhyay","sequence":"additional","affiliation":[{"name":"Geisinger, Danville, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saritha","family":"Korukonda","sequence":"additional","affiliation":[{"name":"Geisinger, Danville, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taylor M","family":"Scott","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, and Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christiane","family":"Spitzmueller","sequence":"additional","affiliation":[{"name":"University of Houston, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Conrad","family":"Schuerch","sequence":"additional","affiliation":[{"name":"Geisinger, Danville, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis","family":"Torretti","sequence":"additional","affiliation":[{"name":"Geisinger, Danville, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4419-8974","authenticated-orcid":false,"given":"Hardeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. 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