A growing body of evidence shows that diagnostic errors are the most common, catastrophic and costly of all medical errors. They are difficult to identify and often go unrecognized until it is too late. The science of diagnostic safety and quality remains underdeveloped and underfunded.
The center, which is the first of its kind in the world, provides a unique, collaborative, transdisciplinary environment for clinicians, researchers, engineers and data experts to work together to tackle the challenges of medical misdiagnosis. The Armstrong Institute Center for Diagnostic Excellence was borne out of a need to address this dangerous and costly problem. Housed in the Armstrong Institute and led by Dr. David Newman-Toker, a world leader in diagnostic error research, the center plans to eliminate preventable patient harms from diagnostic errors.
- An estimated 12 million Americans are affected each year, and perhaps one-third are harmed as a result.
- These errors may account for 40,000 to 80,000 preventable deaths annually in U.S. hospitals.
Though appropriate use of diagnostic tests can help combat diagnostic errors and add value to patient-centered care, more testing alone will not deliver diagnostic value. The costs of advanced diagnostic tests are spiraling upward faster than any sector of the health care industry, and inappropriate overuse of diagnostic tests will only multiply the costs. Diagnostic error and diagnostic test overuse are global problems requiring bold, innovative solutions.
The center’s first signature initiative will be to tackle stroke misdiagnosis throughout Johns Hopkins Hospital emergency departments. Future initiatives will address sepsis and cancer diagnosis. Together, the initiatives will address the “big three” that account for at least one-third of all diagnostic errors and likely more than half of the harms from diagnostic errors.
Why Stroke Misdiagnosis?
- More than 1 million people in the United States suffer a stroke or transient ischemic attack (TIA, or pre-stroke) every year, with about three in four being first-time strokes.
- Stroke is the fifth leading cause of death in the United States, killing nearly 130,000 people a year, or one every 4 minutes. That’s one in every 20 deaths.
- Stroke is a leading cause of long-term disability and among the most preventable. Rapid access to treatment reduces brain injury, prevents complications, avoids major stroke after minor stroke and improves patient outcomes.
- Minor, early strokes are currently missed 30 to 50 percent of the time, often when patients have common symptoms — dizziness, vertigo, headaches — that are diagnosed as a less serious problem.
- Timely diagnosis leading to prompt, correct treatments can prevent death and disability.
Currently, a lack of prompt treatment leads to preventable harms because patients suffer major strokes after undiagnosed minor strokes. Our target is to cut harms from missed strokes in half within five years.
Our Multi-pronged Implementation Approach
We will train providers in the latest bedside diagnostic techniques using state-of-the art educational simulations. These will include screen-based case simulations for cognitive skills as well as novel partial task trainers for psychomotor skills. Our simulations will be driven by real-world data from our ongoing AVERT clinical trial (Clinical Trials.gov NCT02483429).
We will launch the Comprehensive Unit-based Safety Program to Improve Diagnosis (CUSPID). This adapted version of the highly successful culture change framework known as CUSP will specifically target achieving diagnostic excellence through local, grass-roots efforts that identify diagnostic error problems, determine causes and envision solutions.
We will apply cutting edge technologies to enhance early stroke recognition in the Johns Hopkins Health System’s emergency departments. Portable diagnostic devices will facilitate the use of telemedicine to deliver immediate expertise to the bedside. Automation of this process, currently underway in our AVERT clinical trial (Clinical Trials.gov NCT02483429), will further enhance accuracy and efficiency. These projects will increase quality and decrease costs.
We will develop operational measures of diagnostic accuracy, error and value for stroke. Our first-generation Diagnostic Performance Dashboard will monitor harms from missed stroke and process failures, enabling feedback to providers and ensuring accountability at all levels. We will conduct economic analyses of stroke interventions, identifying the highest value solutions.
Newly-released AHRQ Effective Healthcare Program report authored by the Johns Hopkins University Evidence-based Practice Center and experts at the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence synthesizes 20 years of medical research, providing critical new insights into the frequency, distribution, and causes of diagnostic error and associated harms in the emergency department.
Annual Diagnostic Excellence Summit
The Annual Diagnostic Excellence Summit features expert speakers and small group discussions focused on ways to envision keeping diagnosis human in the digital age.
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News and Publications
The Armstrong Institute Center for Diagnostic Excellence provides resources for patients, providers, scientists and administrators working together to tackle the challenges of misdiagnosis. Regularly featured in national media, the following is a collection of the outlets where faculty and staff members help advance public knowledge on ways to address the problem of diagnostic errors.
- Your diagnosis was wrong. Could doctor bias have been a factor? (Washington Post, November 18, 2019)
- Diagnosis errors account for one-third of severe harm malpractice claims (Modern Healthcare, July 11, 2019)
- Why Public Reporting of Diagnostic Errors Might Come Sooner than You Think (Voices for Safer Care, June 11, 2018)
- A Method to Measure Diagnostic Errors Could Be Key to Preventing Disability and Death from Misdiagnosis, (Science Daily, January 22, 2018)
- "Johns Hopkins Researchers Use Big Data Analytics to Target Diagnostic Errors, Improve Quality", (Fierce Healthcare, January 23, 2018)
- “Fighting Misdiagnosis”, (Dome, November 2016)
- “The Brain Tumor Is Benign, but Threats Remain” (The New York Times, April 27, 2016)
- “Diagnostic Errors Are Lead Cause of Medical Liability Payouts” (AMA Medical News, May 6, 2013)
- “Why Doctors Are Sued” (The New York Times, April 29, 2013)
- “Adding Up Diagnosis Errors” (Wall Street Journal, April 24, 2013)
- “Goggles-and-Laptop Device Might Help Detect Some Strokes” (Los Angeles Times, March 5, 2013)
- “5 Most Commonly Misdiagnosed Conditions in the ICU” (American Association of Retired Persons, Nov. 16, 2012)
- “Eye Movement Exam More Accurate Than MRI in Stroke Prediction” (HealthCare Business, Sept. 29, 2009)
- “Misdiagnosis and Wrong Diagnosis by Doctors Cause 40,000 Deaths Each Year” (The Legal Examiner, Aug. 16, 2009)
- Medical Misdiagnosis (America Tonight, Al Jazeera Network, minutes 44–55, September 2016)
- Maryland Commerce Supports Research Professorships at Eight Higher Education Institutions, October 19, 2021
- More than $14 million in research grants awarded for health technology solutions focused on heart and brain health, including special projects related to COVID-19 and CVD April 4, 2020
- Johns Hopkins Medicine Researchers Identify Health Conditions Likely to be MisDiagnosed, July 11, 2019
- A Method to Measure Diagnostic Errors from Big Data Could be Key to Preventing Disability and Death from Misdiagnosis, January 22, 2018
- David Newman-Toker Named President-Elect of the Society to Improve Diagnosis in Medicine, October 11, 2017
- Johns Hopkins Opens New Center to Reduce Diagnostic Errors, October 31, 2016
- Diagnostic Errors More Common, Costly and Harmful Than Treatment Mistakes, April 23, 2013
- Is It a Stroke or Benign Dizziness? A Simple Bedside Test Can Tell, March 5, 2013
- Johns Hopkins Patient Safety Team Finds Diagnostic ‘Fatal Flaws’ in the ICU May Account for as Many Annual Deaths as Breast Cancer, August 27, 2012
- Cheap, Quick Bedside ‘Eye Movement’ Exam Outperforms MRI for Diagnosing Stroke in Patients with Dizziness, September 18, 2009
- Diagnostic Errors: The New Focus of Patient Safety Experts, March 11, 2009
- Weigand, A., Dukhanin, V., McDonald, K.M., Peterson, S.K., Gonzalez, N., & Gleason, K.T. Patient and care partner assessments of diagnostic excellence in the emergency department: a cognitive interview study. (2023) International Journal of Nursing Studies Advances. Doi: 10.1016/j.ijnsa.2023.100129
- Bhandari R, Bhandari A, Hsieh YH, Edlow J, Omron R. Prevalence of Horizontal Canal Variant in 3,975 Patients With Benign Paroxysmal Positional Vertigo: A Cross-sectional Study. Neurol Clin Pract. 2023 Oct;13(5):e200191. doi: 10.1212/CPJ.0000000000200191. Epub 2023 Aug 23. PMID: 37664131; PMCID: PMC10473829.
- Zhu Y, Wang Z, Newman-Toker D. Misdiagnosis-related harm quantification through mixture models and harm measures. Biometrics. 2023 Sep;79(3):2633-2648. doi: 10.1111/biom.13759. Epub 2022 Oct 11. PMID: 36219626; PMCID: PMC10086076.
- Ellenbogen MI, Wiegand AA, Austin JM, Schoenborn NL, Kodavarti N, Segal JB. Reducing Overuse by Healthcare Systems: A Positive Deviance Analysis. J Gen Intern Med. 2023 Aug;38(11):2519-2526. doi: 10.1007/s11606-023-08060-3. Epub 2023 Feb 13. PMID: 36781578; PMCID: PMC10465435.
- Gleason KT, Powell DS, Wec A, Zou X, Gamper MJ, Peereboom D, Wolff JL. Patient portal interventions: a scoping review of functionality, automation used, and therapeutic elements of patient portal interventions. JAMIA Open. 2023 Aug 31;6(3):ooad077. doi: 10.1093/jamiaopen/ooad077. PMID: 37663406; PMCID: PMC10469545.
- Gleason KT, Wu MMJ, Wec A, Powell DS, Zhang T, Wolff JL. Patient Portal Use Among Older Adults With Dementia Diagnosis. JAMA Intern Med. 2023 Aug 1;183(8):881-883. doi: 10.1001/jamainternmed.2023.1568. PMID: 37358848; PMCID: PMC10294010.
- Newman-Toker DE, Nassery N, Schaffer AC, Yu-Moe CW, Clemens GD, Wang Z, Zhu Y, Saber Tehrani AS, Fanai M, Hassoon A, Siegal D. Burden of serious harms from diagnostic error in the USA. BMJ Qual Saf. 2023 Jul 17:bmjqs-2021-014130. doi: 10.1136/bmjqs-2021-014130. Epub ahead of print. PMID: 37460118.
- Edlow JA, Carpenter C, Akhter M, Khoujah D, Marcolini E, Meurer WJ, Morrill D, Naples JG, Ohle R, Omron R, Sharif S, Siket M, Upadhye S, E Silva LOJ, Sundberg E, Tartt K, Vanni S, Newman-Toker DE, Bellolio F. Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE-3): Acute dizziness and vertigo in the emergency department. Acad Emerg Med. 2023 May;30(5):442-486. doi: 10.1111/acem.14728. PMID: 37166022.
- Wiegand AA, Sheikh T, Zannath F, Trudeau NM, Dukhanin V, McDonald KM. "It's probably an STI because you're gay": a qualitative study of diagnostic error experiences in sexual and gender minority individuals. BMJ Qual Saf. 2023 May 10:bmjqs-2022-015629. doi: 10.1136/bmjqs-2022-015629. Epub ahead of print. PMID: 37164638.
- Liberman AL, Wang Z, Zhu Y, Hassoon A, Choi J, Austin JM, Johansen MC, Newman-Toker DE. Optimizing measurement of misdiagnosis-related harms using symptom-disease pair analysis of diagnostic error (SPADE): comparison groups to maximize SPADE validity. Diagnosis (Berl). 2023 Apr 5;10(3):225-234. doi: 10.1515/dx-2022-0130. PMID: 37018487.
- Channa R, Wolf RM, Abràmoff MD, Lehmann HP. Effectiveness of artificial intelligence screening in preventing vision loss from diabetes: a policy model. NPJ Digit Med. 2023 Mar 27;6(1):53. doi: 10.1038/s41746-023-00785-z. PMID: 36973403; PMCID: PMC10042864.
- Kim JG, Mazotti L, McDonald KM, Holmboe E, Kanter MH. Rowing Together: Publicly Reported Quality of Care Measures, US Graduate Medical Education Accountability, and Patient Outcomes. Jt Comm J Qual Patient Saf. 2023 Mar;49(3):174-178. doi: 10.1016/j.jcjq.2022.12.005. Epub 2022 Dec 21. PMID: 36653211.
- Miller SD, Murphy Z, Gray JH, Marsteller J, Oliva-Hemker M, Maslen A, Lehmann HP, Nagy P, Hutfless S, Gurses AP. Human-Centered Design of a Clinical Decision Support for Anemia Screening in Children with Inflammatory Bowel Disease. Appl Clin Inform. 2023 Mar;14(2):345-353. doi: 10.1055/a-2040-0578. Epub 2023 Feb 21. PMID: 36809791; PMCID: PMC10171996.
- Verma N, Lehmann H, Alam AA, Yazdi Y, Acharya S. Development of a Digital Assistant to Support Teleconsultations Between Remote Physicians and Frontline Health Workers in India: User-Centered Design Approach. JMIR Hum Factors. 2023 Feb 2;10:e25361. doi: 10.2196/25361. PMID: 36729578; PMCID: PMC9936362.
- Gleason KT, Peereboom D, Wec A, Wolff JL. Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations: A Scoping Review. JAMA Netw Open. 2022 Dec 1;5(12):e2248696. doi: 10.1001/jamanetworkopen.2022.48696. PMID: 36576738; PMCID: PMC9857556.
- Newman-Toker DE, Peterson SM, Badihian S, Hassoon A, Nassery N, Parizadeh D, Wilson LM, Jia Y, Omron R, Tharmarajah S, Guerin L, Bastani PB, Fracica EA, Kotwal S, Robinson KA. Diagnostic Errors in the Emergency Department: A Systematic Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 Dec. Report No.: 22(23)-EHC043. PMID: 36574484.
- Rastall DP, Green K. Deep learning in acute vertigo diagnosis. J Neurol Sci. 2022 Dec 15;443:120454. doi: 10.1016/j.jns.2022.120454. Epub 2022 Oct 19. PMID: 36379134.
- Ellenbogen MI, Prichett L, Brotman DJ. Characterizing the Relationship Between Payer Mix and Diagnostic Intensity at the Hospital Level. J Gen Intern Med. 2022 Nov;37(15):3783-3788. doi: 10.1007/s11606-022-07453-0. Epub 2022 Mar 9. PMID: 35266125; PMCID: PMC9640504.
- Liberman AL, Zhang C, Lipton RB, Kamel H, Parikh NS, Navi BB, Segal AZ, Razzak J, Newman-Toker DE, Merkler AE. Short-term stroke risk after emergency department treat-and-release headache visit. Headache. 2022 Oct;62(9):1198-1206. doi: 10.1111/head.14387. Epub 2022 Sep 8. PMID: 36073865; PMCID: PMC10041409.
- Wang MC, Zhu Y. Bias correction via outcome reassignment for cross-sectional data with binary disease outcome. Lifetime Data Anal. 2022 Oct;28(4):659-674. doi: 10.1007/s10985-022-09559-3. Epub 2022 Jun 24. PMID: 35748999.
- Edlow JA, Agrawal Y, Newman-Toker DE. Correct Diagnosis for the Proper Treatment of Acute Vertigo-Putting the Diagnostic Horse Before the Therapeutic Cart. JAMA Neurol. 2022 Sep 1;79(9):841-843. doi: 10.1001/jamaneurol.2022.1493. PMID: 35849406.
- Yuan CT, Dy SM, Yuanhong Lai A, Oberlander T, Hannum SM, Lasser EC, Heughan JA, Dukhanin V, Kharrazi H, Kim JM, Gurses AP, Bittle M, Scholle SH, Marsteller JA. Challenges and Strategies for Patient Safety in Primary Care: A Qualitative Study. Am J Med Qual. 2022 Sep-Oct 01;37(5):379-387. doi: 10.1097/JMQ.0000000000000054. Epub 2022 Apr 8. PMID: 35404306; PMCID: PMC9700196.
- Wagle N, Morkos J, Liu J, Reith H, Greenstein J, Gong K, Gangan I, Pakhomov D, Hira S, Komogortsev OV, Newman-Toker DE, Winslow R, Zee DS, Otero-Millan J, Green KE. aEYE: A deep learning system for video nystagmus detection. Front Neurol. 2022 Aug 11;13:963968. doi: 10.3389/fneur.2022.963968. PMID: 36034311; PMCID: PMC9403604.
- Wiegand AA, Dukhanin V, Sheikh T, Zannath F, Jajodia A, Schrandt S, Haskell H, McDonald KM. Human centered design workshops as a meta-solution to diagnostic disparities. Diagnosis (Berl). 2022 Aug 29;9(4):458-467. doi: 10.1515/dx-2022-0025. PMID: 36027891.
- Kim JG, Rodriguez HP, Holmboe ES, McDonald KM, Mazotti L, Rittenhouse DR, Shortell SM, Kanter MH. The Reliability of Graduate Medical Education Quality of Care Clinical Performance Measures. J Grad Med Educ. 2022 Jun;14(3):281-288. doi: 10.4300/JGME-D-21-00706.1. Epub 2022 Jun 13. PMID: 35754636; PMCID: PMC9200256.
- Zrelak PA, Utter GH, McDonald KM, Houchens RL, Davies SM, Skinner HG, Owens PL, Romano PS. Incorporating harms into the weighting of the revised Agency for Healthcare Research and Quality Patient Safety for Selected Indicators Composite (Patient Safety Indicator 90). Health Serv Res. 2022 Jun;57(3):654-667. doi: 10.1111/1475-6773.13918. Epub 2022 Jan 9. PMID: 34859429; PMCID: PMC9108039.
- Kattah JC, Newman-Toker DE. Video-Oculography to Guide Neuroimaging for Dizziness and Vertigo. JAMA Otolaryngol Head Neck Surg. 2022 May 1;148(5):474-475. doi: 10.1001/jamaoto.2022.0330. PMID: 35389451.
- Kim JS, Newman-Toker DE, Kerber KA, Jahn K, Bertholon P, Waterston J, Lee H, Bisdorff A, Strupp M. Vascular vertigo and dizziness: Diagnostic criteria. J Vestib Res. 2022;32(3):205-222. doi: 10.3233/VES-210169. PMID: 35367974; PMCID: PMC9249306.
- McDonald KM. Achieving Equity in Diagnostic Excellence. JAMA. 2022 May 24;327(20):1955-1956. doi: 10.1001/jama.2022.7252. PMID: 35522307.
- Segal JB, Davis S, Dukhanin V. Working Framework for Appropriate Use of Virtual Care in Primary Care. J Am Board Fam Med. 2022 May-Jun;35(3):629-633. doi: 10.3122/jabfm.2022.03.210469. PMID: 35641060.
- Segal JB, Dukhanin V, Davis S. Telemedicine in Primary Care: Qualitative Work Towards a Framework for Appropriate Use. J Am Board Fam Med. 2022 May-Jun;35(3):507-516. doi: 10.3122/jabfm.2022.03.210229. PMID: 35641038.
- Wolff JL, Dukhanin V, Burgdorf JG, DesRoches CM. Shared Access to Patient Portals for Older Adults: Implications for Privacy and Digital Health Equity. JMIR Aging. 2022 May 4;5(2):e34628. doi: 10.2196/34628. PMID: 35507405; PMCID: PMC9118085.
- Ellenbogen MI, Ellenbogen PM, Rim N, Brotman DJ. Characterizing the Relationship Between Hospital Google Star Ratings, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Scores, and Quality. J Patient Exp. 2022 Apr 7;9:23743735221092604. doi: 10.1177/23743735221092604. PMID: 35425850; PMCID: PMC9003640.
- Pettigrew C, Soldan A, Brichko R, Zhu Y, Wang MC, Kutten K, Bilgel M, Mori S, Miller MI, Albert M; BIOCARD Research Team. Computerized paired associate learning performance and imaging biomarkers in older adults without dementia. Brain Imaging Behav. 2022 Apr;16(2):921-929. doi: 10.1007/s11682-021-00583-9. Epub 2021 Oct 23. PMID: 34686968; PMCID: PMC9012682.
- Parker TM, Badihian S, Hassoon A, Saber Tehrani AS, Farrell N, Newman-Toker DE, Otero-Millan J. Eye and Head Movement Recordings Using Smartphones for Telemedicine Applications: Measurements of Accuracy and Precision. Front Neurol. 2022 Mar 18;13:789581. doi: 10.3389/fneur.2022.789581. PMID: 35370913; PMCID: PMC8975177.
- Strauss AT, Morgan C, El Khuri C, Slogeris B, Smith AG, Klein E, Toerper M, DeAngelo A, Debraine A, Peterson S, Gurses AP, Levin S, Hinson J. A Patient Outcomes-Driven Feedback Platform for Emergency Medicine Clinicians: Human-Centered Design and Usability Evaluation of Linking Outcomes Of Patients (LOOP). JMIR Hum Factors. 2022 Mar 23;9(1):e30130. doi: 10.2196/30130. PMID: 35319469; PMCID: PMC8987968.
- Zhu Y, Wang MC. Obtaining optimal cutoff values for tree classifiers using multiple biomarkers. Biometrics. 2022 Mar;78(1):128-140. doi: 10.1111/biom.13409. Epub 2020 Dec 22. PMID: 33249556; PMCID: PMC8557826.
- Sharp AL, Pallegadda R, Baecker A, Park S, Nassery N, Hassoon A, Peterson S, Pitts SI, Wang Z, Zhu Y, Newman-Toker DE. Are Mental Health and Substance Use Disorders Risk Factors for Missed Acute Myocardial Infarction Diagnoses Among Chest Pain or Dyspnea Encounters in the Emergency Department? Ann Emerg Med. 2022 Feb;79(2):93-101. doi: 10.1016/j.annemergmed.2021.08.016. Epub 2021 Oct 2. PMID: 34607739.
- Yousef EA, Sutcliffe KM, McDonald KM, Newman-Toker DE. Crossing Academic Boundaries for Diagnostic Safety: 10 Complex Challenges and Potential Solutions From Clinical Perspectives and High-Reliability Organizing Principles. Hum Factors. 2022 Feb;64(1):6-20. doi: 10.1177/0018720821996187. Epub 2021 Mar 3. PMID: 33657891.
- Liberman AL, Hassoon A, Fanai M, Badihian S, Rupani H, Peterson SM, Sebestyen K, Wang Z, Zhu Y, Lipton RB, Newman-Toker DE. Cerebrovascular disease hospitalizations following emergency department headache visits: A nested case-control study. Acad Emerg Med. 2022 Jan;29(1):41-50. doi: 10.1111/acem.14353. Epub 2021 Aug 18. PMID: 34309135; PMCID: PMC8766867.
- Lundberg B, McDonald K. Mandatory Public Health Measures for Coronavirus-19 Are Associated With Improved Mortality, Equity and Economic Outcomes. Int J Health Serv. 2022 Jan;52(1):23-29. doi: 10.1177/00207314211049306. Epub 2021 Oct 21. PMID: 34672836.
- Nair SS, Li C, Doijad R, Nagy P, Lehmann H, Kharrazi H. A scoping review of knowledge authoring tools used for developing computerized clinical decision support systems. JAMIA Open. 2021 Dec 16;4(4):ooab106. doi: 10.1093/jamiaopen/ooab106. PMID: 34927003; PMCID: PMC8677433.
- Tsai TH, Gerst MD, Engineer C, Lehmann HP. Applying Decision Science to the Prioritization of Healthcare-Associated Infection Initiatives. J Patient Saf. 2021 Oct 1;17(7):506-512. doi: 10.1097/PTS.0000000000000416. PMID: 28858967.
- Zhu Y, Wang Z, Liberman AL, Chang TP, Newman-Toker D. Statistical insights for crude-rate-based operational measures of misdiagnosis-related harms. Stat Med. 2021 Sep 10;40(20):4430-4441. doi: 10.1002/sim.9039. Epub 2021 Jun 11. PMID: 34115418; PMCID: PMC8365112.
- Gleason K, Dahm MR. How patients describe their diagnosis compared to clinical documentation. Diagnosis (Berl). 2021 Aug 16;9(2):250-254. doi: 10.1515/dx-2021-0070. PMID: 34391215.
- Ellenbogen MI, Prichett L, Newman-Toker DE, Brotman DJ. Characterizing the relationship between diagnostic intensity and quality of care. Diagnosis (Berl). 2021 Jul 14;9(1):123-126. doi: 10.1515/dx-2021-0062. PMID: 34261203.
- Chang TP, Bery AK, Wang Z, Sebestyen K, Ko YH, Liberman AL, Newman-Toker DE. Stroke hospitalization after misdiagnosis of "benign dizziness" is lower in specialty care than general practice: a population-based cohort analysis of missed stroke using SPADE methods. Diagnosis (Berl). 2021 Jun 21;9(1):96-106. doi: 10.1515/dx-2020-0124. PMID: 34147048.
- Horberg MA, Nassery N, Rubenstein KB, Certa JM, Shamim EA, Rothman R, Wang Z, Hassoon A, Townsend JL, Galiatsatos P, Pitts SI, Newman-Toker DE. Rate of sepsis hospitalizations after misdiagnosis in adult emergency department patients: a look-forward analysis with administrative claims data using Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) methodology in an integrated health system. Diagnosis (Berl). 2021 Apr 26;8(4):479-488. doi: 10.1515/dx-2020-0145. PMID: 33894108.
- Kotwal S, Fanai M, Fu W, Wang Z, Bery AK, Omron R, Tevzadze N, Gold D, Garibaldi BT, Wright SM, Newman-Toker DE. Real-world virtual patient simulation to improve diagnostic performance through deliberate practice: a prospective quasi-experimental study. Diagnosis (Berl). 2021 Mar 8;8(4):489-496. doi: 10.1515/dx-2020-0127. PMID: 33675203; PMCID: PMC9023126.
- Stunkel L, Newman-Toker DE, Newman NJ, Biousse V. Diagnostic Error of Neuro-ophthalmologic Conditions: State of the Science. J Neuroophthalmol. 2021 Mar 1;41(1):98-113. doi: 10.1097/WNO.0000000000001031. PMID: 32826712.
- Ellenbogen MI, Prichett L, Johnson PT, Brotman DJ. Development of a Simple Index to Measure Overuse of Diagnostic Testing at the Hospital Level Using Administrative Data. J Hosp Med. 2021 Feb;16(2):77-83. doi: 10.12788/jhm.3547. PMID: 33496661; PMCID: PMC7850599.
- Kattah JC, Badihian S, Pula JH, Tarnutzer AA, Newman-Toker DE, Zee DS. Ocular lateral deviation with brief removal of visual fixation differentiates central from peripheral vestibular syndrome. J Neurol. 2020 Dec;267(12):3763-3772. doi: 10.1007/s00415-020-10100-5. Epub 2020 Jul 28. PMID: 32719976; PMCID: PMC9106094.
- Parker TM, Farrell N, Otero-Millan J, Kheradmand A, McClenney A, Newman-Toker DE. Proof of Concept for an "eyePhone" App to Measure Video Head Impulses. Digit Biomark. 2020 Dec 30;5(1):1-8. doi: 10.1159/000511287. PMID: 33615116; PMCID: PMC7879263.
- Gleason KT, Peterson S, Dennison Himmelfarb CR, Villanueva M, Wynn T, Bondal P, Berg D, Jerde W, Newman-Toker D. Feasibility of patient-reported diagnostic errors following emergency department discharge: a pilot study. Diagnosis (Berl). 2020 Oct 5;8(2):187-192. doi: 10.1515/dx-2020-0014. PMID: 33006949; PMCID: PMC8019684.
- Wolf RM, Channa R, Abramoff MD, Lehmann HP. Cost-effectiveness of Autonomous Point-of-Care Diabetic Retinopathy Screening for Pediatric Patients With Diabetes. JAMA Ophthalmol. 2020 Oct 1;138(10):1063-1069. doi: 10.1001/jamaophthalmol.2020.3190. PMID: 32880616; PMCID: PMC7489415.
- Zamaro E, Saber Tehrani AS, Kattah JC, Eibenberger K, Guede CI, Armando L, Caversaccio MD, Newman-Toker DE, Mantokoudis G. VOR gain calculation methods in video head impulse recordings. J Vestib Res. 2020;30(4):225-234. doi: 10.3233/VES-200708. PMID: 32804110; PMCID: PMC9037838.
- Sharp AL, Baecker A, Nassery N, Park S, Hassoon A, Lee MS, Peterson S, Pitts S, Wang Z, Zhu Y, Newman-Toker DE. Missed acute myocardial infarction in the emergency department-standardizing measurement of misdiagnosis-related harms using the SPADE method. Diagnosis (Berl). 2020 Jul 24;8(2):177-186. doi: 10.1515/dx-2020-0049. PMID:
- Newman-Toker DE, Wang Z, Zhu Y, Nassery N, Saber Tehrani AS, Schaffer AC, Yu-Moe CW, Clemens GD, Fanai M, Siegal D. Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the "Big Three". Diagnosis (Berl). 2020 May 14;8(1):67-84. doi: 10.1515/dx-2019-0104. PMID: 32412440.