Journal of General Internal Medicine

, Volume 33, Issue 9, pp 1447–1453 | Cite as

Diagnostic Discordance, Health Information Exchange, and Inter-Hospital Transfer Outcomes: a Population Study

  • Michael UsherEmail author
  • Nishant Sahni
  • Dana Herrigel
  • Gyorgy Simon
  • Genevieve B. Melton
  • Anne Joseph
  • Andrew Olson
Original Research



Studying diagnostic error at the population level requires an understanding of how diagnoses change over time.


To use inter-hospital transfers to examine the frequency and impact of changes in diagnosis on patient risk, and whether health information exchange can improve patient safety by enhancing diagnostic accuracy.


Diagnosis coding before and after hospital transfer was merged with responses from the American Hospital Association Annual Survey for a cohort of patients transferred between hospitals to identify predictors of mortality.


Patients (180,337) 18 years or older transferred between 473 acute care hospitals from NY, FL, IA, UT, and VT from 2011 to 2013.

Main Measures

We identified discordant Elixhauser comorbidities before and after transfer to determine the frequency and developed a weighted score of diagnostic discordance to predict mortality. This was included in a multivariate model with inpatient mortality as the dependent variable. We investigated whether health information exchange (HIE) functionality adoption as reported by hospitals improved diagnostic discordance and inpatient mortality.

Key Results

Discordance in diagnoses occurred in 85.5% of all patients. Seventy-three percent of patients gained a new diagnosis following transfer while 47% of patients lost a diagnosis. Diagnostic discordance was associated with increased adjusted inpatient mortality (OR 1.11 95% CI 1.10–1.11, p < 0.001) and allowed for improved mortality prediction. Bilateral hospital HIE participation was associated with reduced diagnostic discordance index (3.69 vs. 1.87%, p < 0.001) and decreased inpatient mortality (OR 0.88, 95% CI 0.89–0.99, p < 0.001).


Diagnostic discordance commonly occurred during inter-hospital transfers and was associated with increased inpatient mortality. Health information exchange adoption was associated with decreased discordance and improved patient outcomes.



We would like to thank Anne Marie Webber-Main PhD for her critical review of a draft of this paper writing clarification. This paper was presented at the Society of General Internal Medicine National Meeting in May 2016.

Funding Information

Funding support for this study was provided by the NIH Clinical and Translational Science Award at the University of Minnesota: 8UL1TR000114-02.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Supplementary material

11606_2018_4491_MOESM1_ESM.docx (976 kb)
ESM 1 (DOCX 976 kb)


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Michael Usher
    • 1
    Email author
  • Nishant Sahni
    • 1
  • Dana Herrigel
    • 2
  • Gyorgy Simon
    • 1
    • 3
  • Genevieve B. Melton
    • 3
    • 4
  • Anne Joseph
    • 1
  • Andrew Olson
    • 5
  1. 1.Division of General Internal Medicine, Department of Medicine University of Minnesota Medical SchoolMinneapolisUSA
  2. 2.Department of Hospital Internal MedicineMayo Clinic FloridaJacksonvilleUSA
  3. 3.Institute for Health InformaticsUniversity of Minnesota Medical SchoolMinneapolisUSA
  4. 4.Division of Colon and Rectal Surgery, Department of SurgeryUniversity of Minnesota Medical SchoolMinneapolisUSA
  5. 5.Division of General Internal Medicine, Department of Medicine, and Division of Pediatric Hospital Medicine, Department of PediatricsUniversity of Minnesota Medical SchoolMinneapolisUSA

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