Diagnostic Discrepancies: Comparing Psychiatric Diagnoses Between Primary Teams and CL Psychiatrists

Abstract:

Background: There is significant heterogeneity in psychiatric diagnosis. Many factors contribute to variations in characterizing mental health disorders. Data from primary care settings suggest there is wide variability in the recognition and diagnosis of mental illness among nonpsychiatric providers (Rogers, 2021). There is also a robust body of research to suggest there are significant racial and ethnic differences in psychiatric diagnosis and treatment (Coleman, 2016). Little is known about discrepancies in diagnosis between primary teams and consult-liaison (CL) psychiatrists in the hospital setting, particularly in the United States. One prior study in Canada suggested that primary teams and psychiatry consultants tend to align on certain diagnoses (e.g. neurocognitive disorders) while diverging on others (e.g. mood disorders) (AlSalem, 2020). Our primary aim will be to compare psychiatric diagnoses of referring providers to the final diagnoses given by the CL psychiatry team to determine if diagnostic discrepancies exist. As an exploratory aim, we will examine whether differences in demographics (e.g. race and ethnicity) influence discordance of diagnoses.

Methods: We are conducting a retrospective chart review using electronic health record (EHR) data of all adults for whom psychiatric consultation was requested during the study period. Our cohort consists of adults who were admitted to Massachusetts General Hospital and received psychiatric consultation from March through August, 2021. Data gathered will include demographics (e.g. race, ethnicity, gender and age), consultation question, prior medical and psychiatric diagnoses, management recommendations from the consulting team, disposition and final psychiatric diagnoses given by CL trainees and attendings, based on notes in the Electronic Health Record (EHR) and billing data.

Results: Data collection and analysis is currently in process and will be complete by Summer, 2024. We will discuss the results of the study, with a focus on diagnostic discrepancies between primary teams and the CL psychiatry service.

Discussion: Based on the results from our data analysis, we hope to gain a better understanding of the differences in diagnostic practice between referring providers and CL psychiatrists. We hypothesize that provider specialty and training may impact the accuracy of psychiatric diagnosis among patients admitted to general medical hospitals. We anticipate that primary teams may be less adept at correctly diagnosing certain psychiatric illness, including bipolar disorder. We also anticipate that minority patients may be at greater risk for misdiagnosis.


Conclusion: We hope the results of this study will provide insight into diagnostic inaccuracies and discrepancies among patients with psychiatric illness in the general hospital setting. These findings may in turn facilitate targeted interventions to improve psychiatric screening, diagnosis and treatment.

References:
Coleman KJ, et al., E. Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network. Psychiatr Serv. 2016 Jul 1;67(7):749-57.

Rogers R, et al., Identifying Mental Disorders in Primary Care: Diagnostic Accuracy of the Connected Mind Fast Check Electronic Screen. J Clin Psychol Med Settings. 2021 Dec;28(4):882-896.

AlSalem M, et al., L. Accuracy of initial psychiatric diagnoses given by nonpsychiatric physicians: A retrospective chart review. Medicine (Baltimore). 2020 Dec 18;99(51).







Presentation Eligibility: Not previously published or presented.

Diversity, Equity, and Inclusion: There are significant racial and ethnic disparities in psychiatric diagnosis and treatment. For example, research has shown that Black and Hispanic patients are disproportionately diagnosed with psychotics disorders as compared to their White counterparts. We suspect that minority patients may be at greater risk for psychiatric misdiagnosis in the hospital setting, which in turn may negatively impact their treatment. We hope to identify these discrepancies in an effort to target potential disparities moving forward.