The Autopsy as a Performance Measurement Tool—Diagnostic Discrepancies and UnresolvedClinical Questions

Abstract Objective.—To develop a multi-institutional reference database for quality improvement purposes using the autopsy to define clinical diagnostic discrepancies and resolve clinical questions. Design.—Using the College of American Pathologists Q{-}Probes format, institutions prospectively assessed a maximum of 15 consecutive autopsies each, excluding forensic cases and stillborn infants, conducted over a 6-month period. They documented answers to clinical questions provided at autopsy and classified unexpected disease diagnoses according to a standardized system. Setting and Participants.—Hospital-based autopsies performed at 248 institutions participating in the 1993 College of American Pathologists Q-Probes Quality Improvement Program. Main Outcome Measures.—Percentages of clinical questions resolved by the autopsy and percentage of autopsies with unexpected findings of graded clinical impact. Results.—In the aggregate database of 6427 questions from 2479 autopsies, overall 93.0% were answered by ...