{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T14:23:34Z","timestamp":1750170214476,"version":"3.37.3"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"6","funder":[{"name":"Effectiveness and Safety","award":["CIN13-413"],"award-info":[{"award-number":["CIN13-413"]}]},{"DOI":"10.13039\/100000738","name":"Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007915","name":"Baylor College of Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007915","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Fiscal Year 2018 Michael E. DeBakey Veterans Affairs Medical Center Seed Award"},{"name":"Houston VA HSR&D Center for Innovations in Quality"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,20]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Diagnostic errors in psychiatry are understudied partly because they are difficult to measure. The current study aimed to adapt and test the Safer Dx Instrument, a structured tool to review electronic health records (EHR) for errors in medical diagnoses, to evaluate errors in anxiety diagnoses to improve measurement of psychiatric diagnostic errors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>The iterative adaptation process included a review of the revised Safer Dx-Mental Health Instrument by mental health providers to ensure content and face validity and review by a psychometrician to ensure methodologic validity and pilot testing of the revised instrument.<\/jats:p><\/jats:sec><jats:sec><jats:title>Settings<\/jats:title><jats:p>None.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Pilot testing was conducted on 128 records of patients diagnosed with anxiety in integrated primary care mental health clinics. Cases with anxiety diagnoses documented in progress notes but not included as a diagnosis for the encounter (n\u00a0=\u00a025) were excluded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention(s)<\/jats:title><jats:p>None.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measure(s)<\/jats:title><jats:p>None.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 103 records meeting the inclusion criteria, 62 likely involved a diagnostic error (42 from use of unspecified anxiety diagnosis when a specific anxiety diagnosis was warranted; 20 from use of unspecified anxiety diagnosis when anxiety symptoms were either undocumented or documented but not severe enough to warrant diagnosis). Reviewer agreement on presence\/absence of errors was 88% (\u03ba\u00a0=\u00a00.71).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The revised Safer Dx-Mental Health Instrument has a high reliability for detecting anxiety-related diagnostic errors and deserves testing in additional psychiatric populations and clinical settings.<\/jats:p><\/jats:sec>","DOI":"10.1093\/intqhc\/mzaa066","type":"journal-article","created":{"date-parts":[[2020,7,13]],"date-time":"2020-07-13T19:12:04Z","timestamp":1594667524000},"page":"405-411","source":"Crossref","is-referenced-by-count":6,"title":["Identifying psychiatric diagnostic errors with the Safer Dx Instrument"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0854-4216","authenticated-orcid":false,"given":"Terri L","family":"Fletcher","sequence":"first","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA"},{"name":"Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"},{"name":"VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley","family":"Helm","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"},{"name":"VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viralkumar","family":"Vaghani","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA"},{"name":"Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark E","family":"Kunik","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA"},{"name":"Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"},{"name":"VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melinda A","family":"Stanley","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA"},{"name":"Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"},{"name":"VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hardeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030, USA"},{"name":"Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,7,16]]},"reference":[{"key":"2020072001463241900_ref1","first-page":"S1","volume-title":"Improving Diagnosis in Health Care","author":"National Academies of Sciences, Engineering and Medicine","year":"2015"},{"key":"2020072001463241900_ref2","doi-asserted-by":"crossref","first-page":"2493","DOI":"10.1056\/NEJMp1512241","article-title":"Improving diagnosis in health care - the next imperative for patient safety","volume":"373","author":"Singh","year":"2015","journal-title":"New Eng J Med"},{"key":"2020072001463241900_ref3","doi-asserted-by":"crossref","first-page":"2501","DOI":"10.1001\/jama.2015.13453","article-title":"Measurement is essential for improving diagnosis and reducing diagnostic error: a report from the Institute of Medicine","volume":"314","author":"McGlynn","year":"2015","journal-title":"JAMA"},{"key":"2020072001463241900_ref4","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1186\/s12888-016-0963-x","article-title":"Can mental health diagnoses in administrative data be used for research? A systematic review of the accuracy of routinely collected diagnoses","volume":"16","author":"Davis","year":"2016","journal-title":"BMC Psychiatry"},{"key":"2020072001463241900_ref5","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1002\/wps.20486","article-title":"Increasing equity in access to mental health care: a critical first step in improving service quality","volume":"17","author":"Alegria","year":"2018","journal-title":"World Psychiatry"},{"key":"2020072001463241900_ref6","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.psychres.2015.08.028","article-title":"Minimally adequate mental health care and latent classes of PTSD symptoms in female Iraq and Afghanistan veterans","volume":"230","author":"Hebenstreit","year":"2015","journal-title":"Psychiatry Res"},{"key":"2020072001463241900_ref7","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1176\/appi.ps.201400537","article-title":"The quality of medication treatment for mental disorders in the Department of Veterans Affairs and in private-sector plans","volume":"67","author":"Watkins","year":"2016","journal-title":"Psychiatr Serv"},{"key":"2020072001463241900_ref8","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1097\/NMD.0000000000001018","article-title":"Predictors of disagreement between diagnoses from consult requesters and consultation-liaison psychiatry","volume":"207","author":"Otani","year":"2019","journal-title":"J Nerv Ment Dis"},{"key":"2020072001463241900_ref9","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1515\/dx-2013-0032","article-title":"Detecting diagnostic error in psychiatry","volume":"1","author":"Phillips","year":"2014","journal-title":"Diagnosis"},{"key":"2020072001463241900_ref10","doi-asserted-by":"crossref","first-page":"861","DOI":"10.2217\/bmm-2016-0076","article-title":"Seeking an objective diagnosis of depression","volume":"10","author":"Bilello","year":"2016","journal-title":"Biomark Med"},{"key":"2020072001463241900_ref11","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders (DSM-5\u00ae)","author":"American Psychiatric Association","year":"2013"},{"key":"2020072001463241900_ref12","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1001\/archinternmed.2010.146","article-title":"Patient record review of the incidence, consequences, and causes of diagnostic adverse events","volume":"170","author":"Zwaan","year":"2010","journal-title":"Arch Intern Med"},{"key":"2020072001463241900_ref13","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1136\/emermed-2015-204754","article-title":"Diagnostic errors related to acute abdominal pain in the emergency department","volume":"33","author":"Medford-Davis","year":"2016","journal-title":"Emerg Med J"},{"key":"2020072001463241900_ref14","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1007\/s11606-016-3601-x","article-title":"Accuracy of the Safer Dx Instrument to identify diagnostic errors in primary care","volume":"31","author":"Al-Mutairi","year":"2016","journal-title":"J Gen Intern Med"},{"key":"2020072001463241900_ref15","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1097\/PCC.0000000000001059","article-title":"Finding diagnostic errors in children admitted to the PICU","volume":"18","author":"Davalos","year":"2017","journal-title":"Ped Crit Care Med"},{"key":"2020072001463241900_ref16","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1136\/bmjqs-2014-003675","article-title":"Advancing the science of measurement of diagnostic errors in healthcare: the Safer dx framework","volume":"24","author":"Singh","year":"2015","journal-title":"BMJ Qual Saf"},{"key":"2020072001463241900_ref17","doi-asserted-by":"publisher","DOI":"10.1515\/dx-2019-0012","article-title":"Recommendations for using the revised Safer Dx Instrument to help measure and improve diagnostic safety","author":"Singh","year":"2019","journal-title":"Diagnosis (Berl)"},{"key":"2020072001463241900_ref18","doi-asserted-by":"crossref","first-page":"327","DOI":"10.31887\/DCNS.2015.17.3\/bbandelow","article-title":"Epidemiology of anxiety disorders in the 21st century","volume":"17","author":"Bandelow","year":"2015","journal-title":"Dialogues Clin Neurosci"},{"key":"2020072001463241900_ref19","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.genhosppsych.2013.10.013","article-title":"Diagnostic specificity and mental health service utilization among veterans with newly diagnosed anxiety disorders","volume":"36","author":"Barrera","year":"2014","journal-title":"Gen Hosp Psychiatry"},{"key":"2020072001463241900_ref20","doi-asserted-by":"crossref","first-page":"e41670","DOI":"10.1371\/journal.pone.0041670","article-title":"Recent trends in the incidence of anxiety diagnoses and symptoms in primary care","volume":"7","author":"Walters","year":"2012","journal-title":"PLOS One"},{"key":"2020072001463241900_ref21","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1097\/PRA.0000000000000408","article-title":"Accuracy of anxiety disorder not otherwise specified diagnosis in older veterans","volume":"25","author":"Fletcher","year":"2019","journal-title":"J Psychiatr Pract"},{"key":"2020072001463241900_ref22","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.genhosppsych.2017.05.004","article-title":"Recognition of anxiety, depression, and PTSD in patients with COPD and CHF: who gets missed?","volume":"47","author":"Ratcliff","year":"2017","journal-title":"Gen Hosp Psychiatry"},{"key":"2020072001463241900_ref23","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1348\/014466509X476567","article-title":"What does a Transdiagnostic approach have to offer the treatment of anxiety disorders?","volume":"49","author":"McManus","year":"2010","journal-title":"Brit J Clin Psychol"},{"key":"2020072001463241900_ref24","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1176\/appi.ps.201500045","article-title":"National trends in psychiatric not otherwise specified (NOS) diagnosis and medication use among adults in outpatient treatment","volume":"67","author":"Rajakannan","year":"2016","journal-title":"Psychiatr Serv"},{"key":"2020072001463241900_ref25","doi-asserted-by":"crossref","first-page":"76","DOI":"10.3109\/15622975.2014.1001786","article-title":"World Federation of Societies of biological psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 2: maintenance treatment of major depressive disorder update 2015","volume":"16","author":"Bauer","year":"2015","journal-title":"World J Biol Psychiatry"},{"key":"2020072001463241900_ref26","doi-asserted-by":"crossref","first-page":"77","DOI":"10.3109\/13651501.2012.667114","article-title":"Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care","volume":"16","author":"Bandelow","year":"2012","journal-title":"Int J Psychiatry Clin Pract"},{"key":"2020072001463241900_ref27","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1097\/NMD.0000000000000953","article-title":"How the DSM is used in clinical practice","volume":"207","author":"First","year":"2019","journal-title":"J Nerv Ment Dis"},{"key":"2020072001463241900_ref28","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1177\/070674371305801106","article-title":"Overdiagnosis problems in the DSM-IV and the new DSM-5: can they be resolved by the distress-impairment criterion?","volume":"58","author":"Bolton","year":"2013","journal-title":"Can J Psychiatry"},{"key":"2020072001463241900_ref29","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1097\/NMD.0b013e318257c4a2","article-title":"Diagnostic inflation: causes and a suggested cure","volume":"200","author":"Bastra","year":"2012","journal-title":"J Nerv Ment Dis"},{"key":"2020072001463241900_ref30","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/2156869318811435","article-title":"Beyond symptoms: race and gender predict anxiety disorder diagnosis","volume":"9","author":"Vandermindedn","year":"2019","journal-title":"Society and Ment Health"},{"key":"2020072001463241900_ref31","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1176\/appi.ps.201500453","article-title":"Trends in racial-ethnic disparities in access to mental health care, 2004\u20132012","volume":"68","author":"Cook","year":"2017","journal-title":"Psychiatr Serv"},{"key":"2020072001463241900_ref32","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1186\/s12888-017-1422-z","article-title":"Missed diagnoses in African Americans with obsessive-compulsive disorder: the structured clinical interview for DSM-IV Axis I disorders (SCID-I)","volume":"17","author":"Chasson","year":"2017","journal-title":"BMC Psychiatry"}],"container-title":["International Journal for Quality in Health Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/intqhc\/advance-article-pdf\/doi\/10.1093\/intqhc\/mzaa066\/33499669\/mzaa066.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/intqhc\/article-pdf\/32\/6\/405\/33512318\/mzaa066.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/intqhc\/article-pdf\/32\/6\/405\/33512318\/mzaa066.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,24]],"date-time":"2021-03-24T21:54:23Z","timestamp":1616622863000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/intqhc\/article\/32\/6\/405\/5871955"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7]]},"references-count":32,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,7,16]]},"published-print":{"date-parts":[[2020,7,20]]}},"URL":"https:\/\/doi.org\/10.1093\/intqhc\/mzaa066","relation":{},"ISSN":["1353-4505","1464-3677"],"issn-type":[{"type":"print","value":"1353-4505"},{"type":"electronic","value":"1464-3677"}],"subject":[],"published-other":{"date-parts":[[2020,7]]},"published":{"date-parts":[[2020,7]]}}}