{"id":"https://openalex.org/W1985672878","doi":"https://doi.org/10.1515/dx-2013-0027","title":"A unified conceptual model for diagnostic errors: underdiagnosis, overdiagnosis, and misdiagnosis","display_name":"A unified conceptual model for diagnostic errors: underdiagnosis, overdiagnosis, and misdiagnosis","publication_year":2014,"publication_date":"2014-01-01","ids":{"openalex":"https://openalex.org/W1985672878","doi":"https://doi.org/10.1515/dx-2013-0027","mag":"1985672878","pmid":"https://pubmed.ncbi.nlm.nih.gov/28367397","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/5373075"},"language":"en","primary_location":{"id":"doi:10.1515/dx-2013-0027","doi":"https://doi.org/10.1515/dx-2013-0027","is_oa":true,"landing_page_url":"https://doi.org/10.1515/dx-2013-0027","pdf_url":"https://www.degruyter.com/document/doi/10.1515/dx-2013-0027/pdf","source":{"id":"https://openalex.org/S4210173877","display_name":"Diagnosis","issn_l":"2194-8011","issn":["2194-8011","2194-802X"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-d","medline","norway-1","poland-20","russia-white-list-1"],"host_organization":"https://openalex.org/P4310313990","host_organization_name":"De Gruyter","host_organization_lineage":["https://openalex.org/P4310313990"],"host_organization_lineage_names":["De Gruyter"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Diagnosis","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"hybrid","oa_url":"https://www.degruyter.com/document/doi/10.1515/dx-2013-0027/pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5021217241","display_name":"David E. Newman\u2010Toker","orcid":"https://orcid.org/0000-0003-2789-4115","observed_orcids":["https://orcid.org/0000-0003-2789-4115"]},"institutions":[{"id":"https://openalex.org/I145311948","display_name":"Johns Hopkins University","ror":"https://ror.org/00za53h95","country_code":"US","type":"education","lineage":["https://openalex.org/I145311948"]},{"id":"https://openalex.org/I2799853436","display_name":"Johns Hopkins Medicine","ror":"https://ror.org/037zgn354","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2799853436"]},{"id":"https://openalex.org/I4210150714","display_name":"Johns Hopkins Hospital","ror":"https://ror.org/05cb1k848","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2799853436","https://openalex.org/I4210150714"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"David E. Newman-Toker","raw_affiliation_strings":["1Associate Professor, Department of Neurology, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital Meyer Building 8-154 600 North Wolfe Street, Baltimore, MD 21287, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"1Associate Professor, Department of Neurology, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital Meyer Building 8-154 600 North Wolfe Street, Baltimore, MD 21287, USA","institution_ids":["https://openalex.org/I145311948","https://openalex.org/I2799853436","https://openalex.org/I4210150714"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5021217241"],"corresponding_institution_ids":["https://openalex.org/I145311948","https://openalex.org/I2799853436","https://openalex.org/I4210150714"],"apc_list":{"value":2400,"currency":"EUR","value_usd":2712},"apc_paid":{"value":2400,"currency":"EUR","value_usd":2712},"fwci":3.6455,"has_fulltext":true,"cited_by_count":102,"citation_normalized_percentile":{"value":0.91230338,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":88,"max":99},"biblio":{"volume":"1","issue":"1","first_page":"43","last_page":"48"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12574","display_name":"Clinical Reasoning and Diagnostic Skills","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12574","display_name":"Clinical Reasoning and Diagnostic Skills","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2714","display_name":"Family Practice"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10508","display_name":"Patient Safety and Medication Errors","score":0.0005000000237487257,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13555","display_name":"Healthcare cost, quality, practices","score":0.0,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/diagnostic-errors","display_name":"diagnostic errors","score":0.8100000023841858},{"id":"https://openalex.org/keywords/underdiagnosis","display_name":"underdiagnosis","score":0.9829999804496765},{"id":"https://openalex.org/keywords/overdiagnosis","display_name":"overdiagnosis","score":1.0},{"id":"https://openalex.org/keywords/misdiagnosis","display_name":"misdiagnosis","score":1.0},{"id":"https://openalex.org/keywords/unnecessary-testing","display_name":"unnecessary testing","score":0.6600000262260437},{"id":"https://openalex.org/keywords/terminology-and-definitions","display_name":"terminology and definitions","score":0.7080000042915344},{"id":"https://openalex.org/keywords/harm-mitigation","display_name":"harm mitigation","score":0.47999998927116394},{"id":"https://openalex.org/keywords/medical-safety","display_name":"medical safety","score":0.38499999046325684}],"concepts":[{"id":"https://openalex.org/C2779377019","wikidata":"https://www.wikidata.org/wiki/Q956131","display_name":"Overdiagnosis","level":2,"score":0.9543561935424805},{"id":"https://openalex.org/C547195049","wikidata":"https://www.wikidata.org/wiki/Q1725664","display_name":"Terminology","level":2,"score":0.7058024406433105},{"id":"https://openalex.org/C9354725","wikidata":"https://www.wikidata.org/wiki/Q286017","display_name":"Operationalization","level":2,"score":0.6116268634796143},{"id":"https://openalex.org/C534262118","wikidata":"https://www.wikidata.org/wiki/Q177719","display_name":"Medical diagnosis","level":2,"score":0.6003251671791077},{"id":"https://openalex.org/C98045186","wikidata":"https://www.wikidata.org/wiki/Q205663","display_name":"Process (computing)","level":2,"score":0.5084947347640991},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.44922322034835815},{"id":"https://openalex.org/C13606891","wikidata":"https://www.wikidata.org/wiki/Q2623243","display_name":"Conceptual model","level":2,"score":0.4337366819381714},{"id":"https://openalex.org/C112930515","wikidata":"https://www.wikidata.org/wiki/Q4389547","display_name":"Risk analysis (engineering)","level":1,"score":0.4297259449958801},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.4179554879665375},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.383637011051178},{"id":"https://openalex.org/C539667460","wikidata":"https://www.wikidata.org/wiki/Q2414942","display_name":"Management science","level":1,"score":0.352692186832428},{"id":"https://openalex.org/C111472728","wikidata":"https://www.wikidata.org/wiki/Q9471","display_name":"Epistemology","level":1,"score":0.21517401933670044},{"id":"https://openalex.org/C142724271","wikidata":"https://www.wikidata.org/wiki/Q7208","display_name":"Pathology","level":1,"score":0.11507546901702881},{"id":"https://openalex.org/C77088390","wikidata":"https://www.wikidata.org/wiki/Q8513","display_name":"Database","level":1,"score":0.0},{"id":"https://openalex.org/C41895202","wikidata":"https://www.wikidata.org/wiki/Q8162","display_name":"Linguistics","level":1,"score":0.0},{"id":"https://openalex.org/C111919701","wikidata":"https://www.wikidata.org/wiki/Q9135","display_name":"Operating system","level":1,"score":0.0},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.0},{"id":"https://openalex.org/C138885662","wikidata":"https://www.wikidata.org/wiki/Q5891","display_name":"Philosophy","level":0,"score":0.0}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.1515/dx-2013-0027","doi":"https://doi.org/10.1515/dx-2013-0027","is_oa":true,"landing_page_url":"https://doi.org/10.1515/dx-2013-0027","pdf_url":"https://www.degruyter.com/document/doi/10.1515/dx-2013-0027/pdf","source":{"id":"https://openalex.org/S4210173877","display_name":"Diagnosis","issn_l":"2194-8011","issn":["2194-8011","2194-802X"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-d","medline","norway-1","poland-20","russia-white-list-1"],"host_organization":"https://openalex.org/P4310313990","host_organization_name":"De Gruyter","host_organization_lineage":["https://openalex.org/P4310313990"],"host_organization_lineage_names":["De Gruyter"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Diagnosis","raw_type":"journal-article"},{"id":"pmid:28367397","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/28367397","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Diagnosis (Berlin, Germany)","raw_type":"Journal Article"},{"id":"pmh:oai:pubmedcentral.nih.gov:5373075","doi":null,"is_oa":true,"landing_page_url":"https://www.ncbi.nlm.nih.gov/pmc/articles/5373075","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"Diagnosis (Berl)","raw_type":"Text"}],"best_oa_location":{"id":"doi:10.1515/dx-2013-0027","doi":"https://doi.org/10.1515/dx-2013-0027","is_oa":true,"landing_page_url":"https://doi.org/10.1515/dx-2013-0027","pdf_url":"https://www.degruyter.com/document/doi/10.1515/dx-2013-0027/pdf","source":{"id":"https://openalex.org/S4210173877","display_name":"Diagnosis","issn_l":"2194-8011","issn":["2194-8011","2194-802X"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-d","medline","norway-1","poland-20","russia-white-list-1"],"host_organization":"https://openalex.org/P4310313990","host_organization_name":"De Gruyter","host_organization_lineage":["https://openalex.org/P4310313990"],"host_organization_lineage_names":["De Gruyter"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Diagnosis","raw_type":"journal-article"},"sustainable_development_goals":[{"score":0.8952000141143799,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"study_designs":[],"awards":[{"id":"https://openalex.org/G1766978607","display_name":"A MULTIYEAR GRANT TO SUPPORT THE DIAGNOSTIC ERROR IN MEDICINE (DEM) ANNUAL CONFER","funder_award_id":"R13HS019252","funder_id":"https://openalex.org/F4320332177","funder_display_name":"Agency for Healthcare Research and Quality"}],"funders":[{"id":"https://openalex.org/F4320332177","display_name":"Agency for Healthcare Research and Quality","ror":"https://ror.org/03jmfdf59"}],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W1985672878.pdf","grobid_xml":"https://content.openalex.org/works/W1985672878.grobid-xml"},"referenced_works_count":35,"referenced_works":["https://openalex.org/W1967291734","https://openalex.org/W1975677132","https://openalex.org/W1983342498","https://openalex.org/W1986439966","https://openalex.org/W1996475379","https://openalex.org/W1997066044","https://openalex.org/W2006150993","https://openalex.org/W2016008614","https://openalex.org/W2029841765","https://openalex.org/W2029907219","https://openalex.org/W2030900865","https://openalex.org/W2067039765","https://openalex.org/W2081267827","https://openalex.org/W2099752229","https://openalex.org/W2101756318","https://openalex.org/W2105625970","https://openalex.org/W2115398734","https://openalex.org/W2123434733","https://openalex.org/W2129114356","https://openalex.org/W2132131059","https://openalex.org/W2140657380","https://openalex.org/W2141222241","https://openalex.org/W2153799815","https://openalex.org/W2157863916","https://openalex.org/W2158073931","https://openalex.org/W2166750785","https://openalex.org/W2168133848","https://openalex.org/W2169041559","https://openalex.org/W2320324569","https://openalex.org/W2320350515","https://openalex.org/W2323169456","https://openalex.org/W2401857601","https://openalex.org/W2408123483","https://openalex.org/W2413543499","https://openalex.org/W2416719894"],"related_works":["https://openalex.org/W7141237749","https://openalex.org/W4393950828","https://openalex.org/W2062974444","https://openalex.org/W2980492563","https://openalex.org/W3200996755","https://openalex.org/W2757257608","https://openalex.org/W2173952979","https://openalex.org/W7134260754","https://openalex.org/W2752338996","https://openalex.org/W2156669711"],"abstract_inverted_index":{"Progress":[0],"in":[1],"diagnostic":[2,24,74],"error":[3],"research":[4],"has":[5],"been":[6],"hampered":[7],"by":[8],"a":[9,19,27,127,136],"lack":[10],"of":[11,82,87],"unified":[12,28],"terminology":[13,141],"and":[14,34,48,72,106,142],"definitions.":[15],"This":[16,131],"article":[17],"proposes":[18],"novel":[20],"framework":[21],"for":[22,31,138,145],"considering":[23],"errors,":[25],"offering":[26],"conceptual":[29],"model":[30,37,78,132],"underdiagnosis,":[32],"overdiagnosis,":[33],"misdiagnosis.":[35],"The":[36,76],"clarifies":[38],"the":[39,80,89],"critical":[40],"separation":[41],"between":[42,69],"'diagnostic":[43],"process":[44],"failures'":[45,51],"(incorrect":[46,52],"workups)":[47],"'diagnosis":[49],"label":[50],"diagnoses).":[53],"By":[54],"dividing":[55],"processes":[56],"into":[57],"those":[58],"that":[59],"are":[60,67],"substandard,":[61],"suboptimal,":[62],"or":[63,108],"optimal,":[64],"important":[65],"distinctions":[66],"drawn":[68],"'preventable',":[70],"'reducible,'":[71],"'unavoidable'":[73],"errors.":[75],"new":[77,109],"emphasizes":[79],"importance":[81],"mitigating":[83],"diagnosis-related":[84,124],"harms,":[85],"regardless":[86],"whether":[88],"solutions":[90],"require":[91],"traditional":[92],"safety":[93],"strategies":[94],"(preventable":[95],"errors),":[96],"more":[97],"effective":[98],"evidence":[99],"dissemination":[100],"(reducible":[101],"errors;":[102],"harms":[103],"from":[104,126],"overtesting":[105],"overdiagnosis),":[107],"scientific":[110],"discovery":[111],"(currently":[112],"unavoidable":[113],"errors).":[114],"Doing":[115],"so":[116],"maximizes":[117],"our":[118],"ability":[119],"to":[120],"prioritize":[121],"solving":[122],"various":[123],"problems":[125],"societal":[128],"value":[129],"perspective.":[130],"should":[133],"serve":[134],"as":[135],"foundation":[137],"developing":[139],"consensus":[140],"operationalized":[143],"definitions":[144],"relevant":[146],"diagnostic-error":[147],"categories.":[148]},"counts_by_year":[{"year":2026,"cited_by_count":5},{"year":2025,"cited_by_count":7},{"year":2024,"cited_by_count":9},{"year":2023,"cited_by_count":12},{"year":2022,"cited_by_count":8},{"year":2021,"cited_by_count":17},{"year":2020,"cited_by_count":8},{"year":2019,"cited_by_count":15},{"year":2018,"cited_by_count":10},{"year":2017,"cited_by_count":6},{"year":2016,"cited_by_count":1},{"year":2015,"cited_by_count":3},{"year":2014,"cited_by_count":1}],"updated_date":"2026-11-07T11:25:07.637180","created_date":"2016-06-24T00:00:00"}