Prepared by:
University of California at San Francisco (UCSF)-Stanford University
Evidence-based Practice Center
A. Eugene Washington, M.D., M.Sc.
EPC Director
Kathryn M. McDonald, M.M.
EPC Coordinator
Kaveh G. Shojania, M.D.
Elizabeth C. Burton, M.D.
Kathryn M. McDonald, M.M.
Lee Goldman, M.D., M.P.H.
Investigators
File Name Description Software Version File Size _______________________________________________________________________________________________________ 01front.doc Microsoft Word® Document MS Word® 2002 56KB 9 pages Contents: Title Page, Preface, Structured Abstract, Table of Contents _______________________________________________________________________________________________________ 02summ.doc Microsoft Word® Document MS Word® 2002 58KB 8 pages Contents: Summary: Overview, Reporting the Evidence, Findings, Conclusions, Future Research _______________________________________________________________________________________________________ 03chap1.doc Microsoft Word® Document MS Word® 2002 55KB 5 pages Contents: Chapter 1. Introduction: Background, Objectives _______________________________________________________________________________________________________ 04chap2.doc Microsoft Word® Document MS Word® 2002 40KB 4 pages Contents: Chapter 2. Methods: Search Strategy, Study Selection, Data Collection and Analysis _______________________________________________________________________________________________________ 05chap3.doc Microsoft Word® Document MS Word® 2002 246KB 34 pages Contents: Chapter 3. Results: The Autopsy as a Diagnostic Test, Reproducibility of Judgments of Autopsy-detected Errors in Clinical Diagnosis, Autopsy Detection of Clinically Unsuspected Diagnoses, The Autopsy as a Performance Measure for Clinical Diagnosis, Impact of the Autopsy on Clinical Performance Improvement, Autopsy Detected Diagnostic Errors at the Health System Level _______________________________________________________________________________________________________ 06chap4.doc Microsoft Word® Document MS Word® 2002 26KB 2 pages Contents: Chapter 4. Conclusions _______________________________________________________________________________________________________ 07chap5.doc Microsoft Word® Document MS Word® 2002 25KB 2 pages Contents: Chapter 5. Future Research _______________________________________________________________________________________________________ 08refs.doc Microsoft Word® Document MS Word® 2002 162KB 16 pages Contents: References _______________________________________________________________________________________________________ 09appa.doc Microsoft Word® Document MS Word® 2002 593KB 32 pages Contents: Appendix A. Additional Tables and Figures: Table 1. Studies Reporting Rates of Persistent Diagnostic Uncertainty After Autopsy Table 2. Studies Reporting "Class I" or "Class I Equivalent" Error Rates Table 3. Autopsy Studies Reporting Major Error Rates Table 4. Studies Reporting Autopsy-detected Diagnostic Errors in Terms of Discrepant Major ICD Disease Categories Table 5. Studies Addressing the Issue of Clinical Selection Bias in Referral for Autopsy Table 6. Unsuspected Complications of Care Detected at Autopsy Table 7. Sensitivity of Clinical Diagnosis for Patients with Five Target Conditions Figure 1. Autopsy Rates Over Time Based on Autopsy Studies of Diagnostic Errors Figure 2. Trends in U.S. Autopsy Rates Figure 3. Class I Error Rates with 95% Confidence Intervals Figure 5. Class I Error Rates Over Time Figure 6. Major Error Rates Over Time Figure 7. Class I Error as a Function of Autopsy Rate for 4 Different Time Periods Figure 8. Major Error Rates as a Function of Autopsy Rate for 4 Different Time Periods Figure 9a. Assessment of Publication Bias: Funnel Plot of All Studies Reporting Class I Errors Figure 9b. Assessment of Publication Bias: Funnel Plot Restricted to Studies Reporting Class I Errors Among General Inpatients Figure 10a. Assessment of Publication Bias: Funnel Plot for all Autopsy Studies Reporting "Major Errors" Figure 10b. Assessment of Publication Bias: Funnel Plot Restricted to Studies of Major Errors Among General Inpatients _______________________________________________________________________________________________________ 10apfig4.doc Microsoft Word® Document MS Word® 2002 120KB 5 pages Contents: Appendix A. Additional Tables and Figures: Figure 4. Major Error Rates with 95% Confidence Intervals _______________________________________________________________________________________________________ 11appb.doc Microsoft Word® Document MS Word® 2002 177KB 11 pages Contents: Appendix B. Statistical Analysis _______________________________________________________________________________________________________ 12appc.doc Microsoft Word® Document MS Word® 2002 58KB 5 pages Contents: Appendix C. Index of Study Topics _______________________________________________________________________________________________________ 13appd.doc Microsoft Word® Document MS Word® 2002 103KB 14 pages Contents: Appendix D. Article Abstraction Form for Autopsy Studies _______________________________________________________________________________________________________ 14appe.doc Microsoft Word® Document MS Word® 2002 72KB 9 pages Contents: Appendix E. Material Provided by Advisory Panel _______________________________________________________________________________________________________ 15appf.doc Microsoft Word® Document MS Word® 2002 331KB 56 pages Contents: Appendix F. Bibliography _______________________________________________________________________________________________________ 16appg.doc Microsoft Word® Document MS Word® 2002 50KB 2 pages Contents: Appendix G. Acknowledgments _______________________________________________________________________________________________________
AHRQ Publication No. 03-E002
Current as of October 2002
Internet Citation:
The Autopsy as an Outcome and Performance Measure. File Inventory, Evidence Report/Technology Assessment Number 58. AHRQ Publication No. 03-E002, October 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/autopinv.htm
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