Reducing Diagnostic Error Through Medical Home-Based Primary Care Reform

If implemented correctly, the patient-centered medical home (PCMH) can potentially address many current safety concerns in primary care. One highly relevant but underemphasized safety concern is diagnostic error (i.e., missed, delayed, or wrong diagnosis), 1 possibly the leading type of error in primary care. Diagnostic errors are the single largest contributor to ambulatory malpractice claims (40% in some studies) and cost approximately $300,000 per claim on average. Also integral to the PCMH concept are electronic health records (EHRs), which, despite their current limitations, can enhance access to data and advanced decision support to reduce diagnostic error. 3 However, PCMH models, as currently envisioned, do not address other fundamental and deeply rooted systems and cognitive problems that cause diagnostic error. For instance, the Department of Veterans Affairs (VA) uses an advanced EHR and has a relatively unique integrated model of care that resembles PCMH, yet diagnostic errors persist in this system. e effectiveness of medical homes depends in large part on their ability to deliver timely and reliable diagnosis, one of the core functions of primary care. In this commentary, we use Vincent's framework for analyzing risk and safety in clinical medicine, 7 as well as insights from our own work, to recommend five "rights" for reducing diagnostic errors in future PCMHs within and outside the VA system.