Rush Research Team
Sarah Ailey, Principal Investigator, Rush University College of Nursing
Tricia Johnson, Co-Investigator, Rush University College of Health Sciences
Karl Smith, Co-Investigator, Rush University Medical Center
Funding Source
NIH/NICHD
Award Period
August, 2024 – July, 2029
Abstract
Addressing manifestations of ableism in the healthcare context program we aim to identify and create understanding of mechanisms underlying diagnostic overshadowing and mitigate and reduce its effects. Diagnostic overshadowing—attributing symptoms to disability rather than a potentially new or comorbid condition—is a result of ableism. It contributes to diagnostic errors (i.e., missed, delayed, wrong diagnoses) that result in major causes of death in the US, and are estimated to cost >$100B/year. Some diagnoses are prone to diagnostic error including vascular events, infections, oral problems, and cancer. Among people with disabilities (PWD), specific populations are known to be at-risk, including those with major mobility impairments, mental health concerns, severe visual impairments/ blindness, severe hearing loss/deafness, intellectual and developmental disabilities (IDD). People from marginalized racial and ethnic groups as a whole are at higher risk of diagnostic overshadowing, as are people who have experienced trauma. And, PWD and people from marginalized racial and ethnic groups are at higher risk for trauma. The intersections make PWD from marginalized racial and ethnic groups at particularly high risk. We will use established methods of analysis of Current Procedural Technology (CPT) evaluation and management (E/M) code differences and Joint Commission-style individual mock tracers and environment of care tracers to identify underlying mechanisms of diagnostic overshadowing We will analyze CPT E/M code differences by presence of the above specific disabilities and influenced by race, ethnicity, gender and other intersectional identities followed by targeted retrospective chart reviews and staff interviews. Using this information, we will update/develop and conduct in both inpatient and outpatient settings individual mock tracers following the care of patients with the specific disabilities listed above and an environment of care tracer focused on the environment surrounding diagnostic overshadowing. Mock tracer teams will provide formative evaluation of care to involved staff. Using inductive thematic analysis of notes from chart reviews, interviews, and mock tracers, we will identify themes of mechanisms underlying diagnostic overshadowing. We will partner with affected groups to confirm and prioritize themes through a Participatory and Planning Model process and then develop targeted education programs and Electronic Health Record decision supports to mitigate and reduce diagnostic overshadowing. We will evaluate CPT codes (quantitative), chart reviews (mixed methods) and interviews and tracer results (qualitative) at Year 5 compared to Year 1 expecting changes. We will evaluate mitigation efforts through 1) pre and post knowledge checks of usage of education programs and 2) descriptive pre and post data on use of specific EHR decision supports. If successful, we will have developed a system for identifying and creating understanding of mechanisms underlying diagnostic overshadowing and will have created specific means to mitigate and reduce its effects.