BMJ Quality & Safety最新文献

{"title":"Bridging diagnostic safety and mental health: a systematic review highlighting inequities in autism spectrum disorder diagnosis.","authors":"Abirami Srivarathan, Andrea Bradford, Sara Shearkhani, Layla Heimlich, Sheryl Jefferson, Kristen E Miller, Kelly Smith, Helen Haskell, Traber D Giardina","doi":"10.1136/bmjqs-2025-018723","DOIUrl":"10.1136/bmjqs-2025-018723","url":null,"abstract":"<p><strong>Introduction: </strong>There is increased recognition that diagnostic errors disproportionately affect marginalised and underserved patient populations in the USA. However, evidence on diagnostic inequities in mental disorders is sparse and not well integrated into the overall diagnostic safety literature.</p><p><strong>Objective: </strong>We systematically reviewed and narratively synthesised evidence on inequities in diagnosis of mental disorders, guided by the Diagnostic Process Framework developed by The National Academies of Sciences, Engineering, and Medicine.</p><p><strong>Methods: </strong>We conducted a systematic review and a narrative synthesis. Medline, Embase, PsycInfo and CINAHL were searched for studies published between 2015 and 2024. Studies were eligible if they reported on inequities in the diagnosis of mental disorders and applied a quantitative, qualitative or mixed-methods design. Studies had to be peer reviewed, US based and published in English. The Mixed-Methods Appraisal Tool was used for quality appraisal. Data were analysed with a descriptive intent, and inequities were mapped into the diagnostic process.</p><p><strong>Results: </strong>20 studies of varying methodological quality were included. Though not the initial focus, autism spectrum disorder (ASD) emerged as the most studied mental disorder (n=17). Of the diagnostic errors identified, most fell into the category of delayed diagnosis. 11 factors emerged as contributors to diagnostic inequities. Limited health literacy among patients and caregivers was the leading cause of diagnostic error in symptom recognition. Insurance coverage issues delayed patient engagement with the healthcare system. Provider bias during clinical history-taking and interviewing was seen as a key cause of delays and misdiagnoses. Within diagnostic testing and interpretation, culturally inequivalent assessment measures might cause misdiagnosis and delayed diagnosis for Black/African American and Hispanic/Latino patients. The use of medical jargon and lack of qualified language interpreters during communicating the diagnosis were associated with diagnostic errors impacting patients with limited health literacy and low English language proficiency.</p><p><strong>Conclusions: </strong>Diagnostic inequities in ASD and other mental disorders persist across US patient populations. Multiple factors such as parental health literacy, provider bias and limited access interact and impact the diagnostic process. Addressing these interconnected barriers is essential to ensure timely, accurate and equitable care.</p><p><strong>Prospero registration number: </strong>CRD42024581271.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"487-497"},"PeriodicalIF":6.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12707049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thinking and organising in systems: reframing the long problem of learning from incidents.","authors":"Carl Macrae","doi":"10.1136/bmjqs-2025-019407","DOIUrl":"10.1136/bmjqs-2025-019407","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"435-439"},"PeriodicalIF":6.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thinking critically about AI documentation quality in primary care.","authors":"Gordon D Schiff, Maram Khazen","doi":"10.1136/bmjqs-2025-019475","DOIUrl":"10.1136/bmjqs-2025-019475","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"498-502"},"PeriodicalIF":6.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We need a new paradigm to think about generative AI.","authors":"Adam Rodman, Laura Zwaan","doi":"10.1136/bmjqs-2025-019828","DOIUrl":"10.1136/bmjqs-2025-019828","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"440-442"},"PeriodicalIF":6.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grand rounds in methodology: four key things to know about the reliability of measurement.","authors":"Timothy P Hofer","doi":"10.1136/bmjqs-2025-018924","DOIUrl":"10.1136/bmjqs-2025-018924","url":null,"abstract":"<p><p>Reliability is the most reported measurement characteristic used as evidence of the quality of a measurement. However, researchers often miss opportunities to design studies in a way that allows reliability to be calculated and report a calculation that is not germane to the purpose of the measurement.Reliability is a number that quantifies the ability of a measurement to distinguish between the members of a population with respect to a measured quantity. It is a simple function of the signal and noise in a measurement. In this paper, I review four key attributes. First, reliability has a single technical definition, but there are many statistics that purport to quantify reliability that do not fit this definition or obscure their relationship to it. This undermines the fundamental simplicity of the concept and its useful implications. Second, researchers sometimes do not appreciate that the relevant calculation of reliability changes with the purpose and conditions of measurement and then report the wrong number. Third, reliability is a summary measure with several components that may be as or more relevant to report than reliability. Fourth, reliability is specific to a population, for example, a patient satisfaction score that is highly reliable in one population could have abysmal reliability in a different population when using the same survey instrument.Reliability is an important part of evaluating and improving the measurements that form the foundations of scientific research in healthcare quality and safety. Understanding these four key attributes of reliability will improve the description and use of healthcare quality and safety measurements.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"474-486"},"PeriodicalIF":6.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shifting boundaries of risk-work in virtual wards in North-West England: a multisite qualitative evaluation.","authors":"Kelly Howells, Fay Bradley, Norina Gasteiger, William Whittaker, Emma Vardy, Dawn Dowding, Thomas Blakeman, Caroline Sanders","doi":"10.1136/bmjqs-2025-020002","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-020002","url":null,"abstract":"<p><strong>Background: </strong>Virtual wards (VWs) (also referred to as hospital at home (HaH)) are a key component of National Health Service (NHS) policy in England to shift acute care from hospital to community settings. While evidence suggests these models can improve patient experience and safety, delivering acute care at home redistributes responsibility for safety across clinicians, patients and carers. The concept of <i>risk-work</i> captures the relational and contextual practices through which clinicians, patients and their carers interpret and mitigate risks associated with clinical care. However, there is limited evidence as to how risk-work is enacted in remote care, particularly when patients and carers undertake elements of that work.</p><p><strong>Methods: </strong>We conducted a multisite ethnographic evaluation across four NHS VW services in North-West England (July 2024-February 2025). Data included 17 patient and five carer interviews, four patient observations, 43 staff interviews and 10 organisational level observations. Reflexive thematic analysis was guided by risk-work and Systems Thinking For Everyday Work as sensitising frameworks.</p><p><strong>Results: </strong><i>Three inter-related dimensions of risk-work were identified. Translating risk</i> describes how clinicians balanced protocolised guidance with tacit and relational knowledge when assessing eligibility, with decisions further shaped by workforce models. <i>Holding risk</i> illustrates the shared elements of risk-work, with temporal gaps in oversight, particularly out of hours and variation in workforce structures, shaping how risk-work was distributed between clinicians, patients and carers. <i>Living with and managing uncertainty</i> highlighted how clinicians, patients/carers navigated the unpredictability of acute illness at home. Governance structures, multidisciplinary teams and informal sense-checking provided collective safety-netting, although training and communication practices varied across sites.</p><p><strong>Conclusions: </strong>To our knowledge, this is the first exploration of risk-work within the context of VWs. These findings extend the previous theoretical framing of risk-work, which has focused predominantly on clinicians and in-person care. Our study demonstrates how in the context of remote acute care, risk-work is redistributed and shared with patients and carers.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regulating voluntary assisted dying at the clinical coalface: a qualitative interview study in Victoria, Australia.","authors":"Casey M Haining, Lindy Willmott, Ben P White","doi":"10.1136/bmjqs-2024-018314","DOIUrl":"10.1136/bmjqs-2024-018314","url":null,"abstract":"<p><strong>Background: </strong>Voluntary assisted dying (VAD) in Victoria, Australia, is governed by a stringent legislative framework, designed and enforced by the state, as well as other forms of regulation. However, there remains limited understanding about how these various forms of regulation operate at the frontline or how clinicians themselves can influence regulation.</p><p><strong>Objectives: </strong>This article explores how clinicians working at the frontline (clinical coalface) may influence the regulation of VAD in Victoria, and how this contributes to the safe and effective delivery of VAD.</p><p><strong>Methods: </strong>Reflexive thematic analysis of 30 semistructured interviews with 37 'regulators' (defined as those capable of steering and guiding behaviour with respect to VAD).</p><p><strong>Results: </strong>Data analysis resulted in the generation of three main themes: (1) coalface regulation extends regulations at the clinical level, ensuring adherence to laws while developing new standards and systems for safe and effective practice; (2) coalface regulation guides day-to-day VAD practice; and (3) coalface regulation plays a critical role in quality monitoring and improvement.</p><p><strong>Conclusions: </strong>Clinicians play a significant role in VAD regulation in Victoria and fulfil what we define as a 'coalface regulator' role. These coalface regulators are influential in ensuring the safe and effective delivery of VAD. Understanding how coalface regulation intersects with other forms of VAD regulation and how this regulatory influence can be harnessed is critical for optimising VAD regulation, safety and improving service delivery at a local and system level.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"393-404"},"PeriodicalIF":6.5,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are we careless about continuity of care?","authors":"Persijn Honkoop, Marco Krukerink","doi":"10.1136/bmjqs-2025-019416","DOIUrl":"10.1136/bmjqs-2025-019416","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"363-365"},"PeriodicalIF":6.5,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145586047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Less continuity with more complaints: a repeated cross-sectional study of the association between relational continuity of care and patient complaints in English general practice.","authors":"Jinyang Chen, Panos Kasteridis, Zecharias Anteneh, Sheila Greenfield, Fiona Scheibl, Kamil Sterniczuk, Brian H Willis, Iestyn Williams, Tom Marshall","doi":"10.1136/bmjqs-2025-018989","DOIUrl":"10.1136/bmjqs-2025-018989","url":null,"abstract":"<p><strong>Objective: </strong>Relational continuity of care is associated with better patient experience and health outcomes. In England, relational continuity of primary care has been declining over a decade, coinciding with an increase in patient complaints. This study investigates the relationship between relational continuity of care and patient complaints.</p><p><strong>Methods: </strong>Cross-sectional analysis of linked practice-level data in the English National Health Service (NHS) (2016/2017-2022/2023) obtained from NHS Digital and General Practice Patient Survey (GPPS). A negative binomial model was used to investigate the association between the proportion of patients never or almost never seeing their preferred general practitioner (GP) and new written complaints per 10 000 patients, with adjustment for patient demographics, socioeconomic status, care experiences, practice care capacity and care quality. Mediation analysis was further conducted to examine patients' lost trust and unmet clinical needs as potential mechanisms.</p><p><strong>Results: </strong>A 10 percentage point increase in the proportion of patients reporting low continuity was associated with 1.34 more new complaints per 10 000 patients (95% CI 1.23 to 1.46). The association may be stronger after than before the pandemic, among general practices with historically better continuity, and in more deprived areas. The findings were robust in using different measures of relational continuity, adjusting for primary case demand-supply mismatches, implementing a Poisson model with practice fixed effects and excluding ethnicity from the model specification. Mediation analysis showed that neither lost trust nor unmet care needs were important mediators of the effects of low continuity.</p><p><strong>Conclusion: </strong>Self-reported low continuity of primary care is associated with more patient complaints in England. Future research should explore potential underlying mechanisms and establish whether the same relationship exists between objectively measured relational continuity and patient complaints.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"370-379"},"PeriodicalIF":6.8,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lucian Leape's legacy for patient safety.","authors":"Atul A Gawande","doi":"10.1136/bmjqs-2025-019852","DOIUrl":"10.1136/bmjqs-2025-019852","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"431-434"},"PeriodicalIF":6.8,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145932064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}