Table 3. Brief Vignettes to Illustrate Three Types of Reviewer Agreement.
| No. | Vignette | Provider Diagnosis | Reviewer 1 | Reviewer 2 | Reviewer 3 |
|---|---|---|---|---|---|
| 1. | 88 y/o male with h/o lymphoma presented with headache, cough, green sputum, and fever. Provider did not order labs or x-ray to evaluate for pneumonia. | Acute Bronchitis | Missed pneumonia | Missed pneumonia | N/A |
| 2. | 61 y/o male with h/o hypertension and neck pain presented with intermittent numbness, weakness, and tingling of both hands | Peripheral neuropathy | Missed cervical myelopathy with cord compression | Missed cervical cord compression | N/A |
| 3. | 45 y/o female with cough and fever; diagnosed with pharyngolaryngo-tracheitis. PCP read chest x-ray as normal; patient returned with continued symptoms and found to have lobar pneumonia on initial x-ray that had been read by the radiologist. | Tracheitis | Pneumonia | No error | Pneumonia |
| 4. | 87 y/o male with right hand swelling, pain and new onset bilateral decreased grip; diagnosed few weeks later with carpel tunnel syndrome. | Osteoarthritis | No error | Missed carpal tunnel syndrome | Missed carpal tunnel syndrome |
| 5. | 65 y/o male with left hand swelling and erythema after a small cut; treated for cellulitis at index visit. Returned 4 days later with “failure to respond” and admitted for IV antibiotics with some improvement. Uric acid found elevated and thus additionally treated for gout; given prednisone. | Cellulitis | No error | Missed gout | No error |
| 6. | 42 y/o female with post hospitalization follow-up for CHF exacerbation c/o 1 week shortness of breath and congestion. Treated for URI but Lasix increased to address CHF. Symptoms progressed so patient admitted for CHF exacerbation/URI. | CHF and bronchitis | Missed CHF exacerbation | No error | No error |
Note. 1-2 are case scenarios where both initial reviewers agreed on error; 3-4 are case scenarios when the independent third reviewer judged it to be an error after initial disagreement, and 5-6 are case scenarios when the independent third reviewer judged it not to be an error (after initial disagreement).
Abbreviations: c/o, complaint of; CHF, chronic heart failure; h/o, history of; NA, not available; PCP, primary care provider; URI, upper respiratory infection; y/o, 3 year old.