Achieving Diagnostic Excellence through Prevention and Teamwork (ADEPT):
Principal Investigators:
Andrew Auerbach, MD, MPH (University of California, San Francisco)
Jeffrey Schnipper, MD, MPH (Brigham and Women’s Hospital)
Many factors contribute to diagnostic errors, but key among them are foundational issues in healthcare: complex and fragmented care systems, the limited time available to providers trying to ascertain a firm diagnosis, and the work systems and cultures that support or impede improvements in diagnostic performance. While approaches to identifying diagnostic errors exist, few studies have linked identification of underlying systemic and structural causes of errors to existing quality improvement programs. Even fewer have applied resilience theories or positive deviance approaches to characterize the features of cases where the diagnostic process is optimal and then use those findings to frame health system improvement.
The AHRQ-funded Achieving Diagnostic Excellence through Prevention and Teamwork (ADEPT) study builds directly on our AHRQ-funded Utility of Predictive Systems to identify Inpatient Diagnostic Errors (UPSIDE) study, which is defining risk factors, underlying causes, and prevalence of diagnostic errors among patients admitted to hospitals participating in our 55-hospital research collaborative, the Hospital Medicine Reengineering Network (HOMERuN). UPSIDE has developed reference standard approaches to adjudication of diagnostic errors, defined factors associated with errors, and created collaborations with our sites and national organizations, providing a uniquely powerful opportunity to transform how diagnostic process evaluation programs can be used to improve patient safety.
ADEPT will build on UPSIDE to create a learning health system which integrates diagnostic error and process assessments into existing quality and safety programs, shares data, infrastructure, and expertise to catalyze improvement in diagnostic performance, and lays the groundwork for efforts which will last beyond the duration of the grant.
Publications:
- Raffel KE, Webber CJ, Narayanan M, Tozier M, Cerasale M, Lee TM, Burden M, Auerbach A, Schnipper JL, Keniston A. A multi-institutional rapid qualitative assessment of factors supporting diagnostic excellence in hospital medicine. J Hosp Med. 2026 Jul 10.
- Barish P, Auerbach AD, Ranji SR. The 5R’s of large language model-assisted diagnosis: A practical framework for hospitalists. J Hosp Med. 2026 Jul 3.
- Miyagami T, Auerbach A, Schnipper JL, Ranji S, Barish P, Kantor MA, Dalal A, Lee T, Raffel KE; for the ADEPT Research Group. Informal peer diagnostic second opinion: Hospitalist practices and perspectives. J Hosp Med. 2026 Jul 6.
- Auerbach A, Raffel K, Rasooly IR, Schnipper J. Diagnostic excellence: turning to diagnostic performance improvement. Diagnosis (Berl). 2025 Sep 16.
- Knees M, Raffel KE, Kissler M, Burden M, Porter S, Schnipper J, Auerbach A. Cognitive Load Theory and its Impact on Diagnostic Accuracy. Rockville, MD: Agency for Healthcare Research and Quality; 2024. Publication No. 24-0010-2-EF.
- Schnipper JL, Raffel KE, Keniston A, et al. Achieving Diagnostic Excellence through Prevention and Teamwork (ADEPT) Study Protocol: a multi-center, prospective quality and safety program to improve diagnostic processes in medical inpatients. J Hosp Med. 2023 Oct 27; 1-10.
Abstracts:
- Keniston A, Auerbach A, Barbouche E, John J, Knees M, Olson A, Peterson A, Saunders S, Tagaram S, Weiss R, Schnipper J, Raffel K. Understanding Everyday Safety: An Ethnographic Study of Hospitalist Diagnostic Work. Abstract published at AcademyHealth Annual Research Meeting, Seattle, WA. May 2026.
- Keniston A, Tagaram S, Barbouche E, Peterson A, John J, Auerbach A, Weiss RLJ, Schnipper J. Understanding Everyday Safety: An Ethnographic Study of Hospitalist Diagnostic Work. Abstract published at SHM Converge 2026. Abstract 831.
- Bhatia M, Auerbach A, Keniston A, Schnipper J, Kipps K, Raffel K, Burden M, Astik G, Westergaard S, Harrison JD. Patterns in the Noise: Understanding Adaptive Approaches to Accurate Diagnosis in Hospital Medicine Using a Rapid Qualitative Approach. Abstract published at SHM Converge 2026. Abstract 829.
- Barbouche E, Kenik J, Bond A, Ziman N. Local Implementation of a National Diagnostic Crosscheck Intervention to Increase Diagnostic Excellence. Abstract published at SHM Converge 2026. Abstract 939
- Miyagami T, Barish P, Dalal AK, Kantor M, Auerbach A, Schnipper J, Glasheen JJ, Rani S, Weiss R, Lee T, Raffel K. Informal peer diagnostic second opinion: Hospitalist practices and perspectives. Abstract published at SHM Converge 2026. Abstract 747
- Bond A, Raffel K, Ziman N, Schnipper J, Glasheen JJ, Kantor M, Lee T, Cornell E, Goyal A, Barish P, Esmaili A, Lai AR, Sui M, Zorian A, Ranji S, Auerbach A. Diagnostic Cross-check: A multi-institutional intervention to facilitate peer second opinion discussions in patients experiencing clinical decompensation. Abstract published at SHM Converge 2026. Abstract 6.
- Ziman N, Auerbach A, Schnipper J, Glasheen JJ, Raffel K, Esmaili A, Kantor M, Klein RM, Bond A. Training Hospitalists to Conduct Peer-to-Peer Diagnostic Cross-checks: Early Multicenter Experience from the ADEPT Collaborative Group. Abstract published at SHM Converge 2026. Abstract 655.
- Fiash AM, Linker AS, Kochar A. The Long-Latent Lesion: Unraveling the Mystery of Marjolin Ulcers. Abstract published at SHM Converge 2026. Abstract 183
- Barbouche E, Kochar A, Linker A, Mehta A, Barish P, Ranji S, Dalal AK, Schnipper JL, Auerbach A, Raffel K. Assessing Organizational Readiness to Pursue Diagnostic Excellence Collaboration. Abstract published at SHM Converge 2025. Abstract 0180.
- Keniston A, Tozier M, Klein R, Barish P, Kantor M, Ranji S, Auerbach A, Schnipper J, Raffel K. Environmental scan of hospital diagnostic excellence interventions: Perspectives of hospitalists from the ADEPT study. Diagnostic Excellence 2025 Meeting, Ann Arbor, MI. October 2025.
- Keniston A, Peterson A, Auerbach A, Tagaram S, Barbouche E, John J, Weiss R, Knees M, Schnipper J, Raffel K. Understanding every day safety: An ethnographic study of hospitalist diagnostic work. Diagnostic Excellence 2025 Meeting, Ann Arbor, MI. October 2025.
- Raffel K, Auerbach A, Schnipper JL, Kercsmar A, Maloney K, Cuff C, Pierce R, Glasheen JJ. Fostering Leaders in Diagnostic Safety: Building Capacity for Diagnostic Excellence. Diagnostic Excellence 2025 Meeting, Ann Arbor, MI. October 2025.
- Kantor MA, Barish P, Bhatia M, Esmaili A, Fenton C, Kipps K, Lee T, Subramanian CR, Sui M, Raffel K, Glasheen J, Schnipper JL, Auerbach A. Building a hospital medicine diagnostic excellence program. Abstract published at SHM Converge 2025. Abstract 0364.
- Barish P, Leeson M, Kantor MA, Auerbach A, Raffel K, Ranji S, Lee T, Schnipper JL, Dalal AK. Site-level analysis of diagnostic process failures: A novel quality improvement tool. Abstract published at SHM Converge 2025. Abstract published at SHM Converge 2025. Abstract 0380.
- Coetzee D, Olson A, Hilliard B, Davis E. When Sepsis Is Subtle: Lessons Learned from a Case of Diagnostic Error. Abstract published at SHM Converge 2025. Abstract 0567
- Kipps K, Esmaili A, Kantor MA, Auerbach A. Post-Operative Monitoring of Patients with Increased Cardiovascular Risk Factors. Abstract published at SHM Converge 2025. Abstract 0667.
- Kipps K, Kantor MA. The Unseen Danger: Diagnosing Intracranial Subdural Empyema. Abstract published at SHM Converge 2025. Abstract 0723.
- Ngov LK, Virapongse A, Patel H. Diagnostic Resilience: COVID, HSV, Anti-NDMA All in 1 Case. Abstract published at SHM Converge 2025. Abstract 0747.
- Devi R, Martin N. Hidden in Plain Sight. Abstract published at SHM Converge 2025. Abstract 0866.
- Tagaram S, Taku A, Bukli J, Raffel K. Catastrophe Loading and the Clock Is Ticking. Abstract published at SHM Converge 2025. Abstract 0935
Participating Sites:
UCSF
Brigham and Women’s Hospital
Northwestern Memorial Hospital
University of Minnesota
University of Colorado Anschutz Medical Campus
Washington University St Louis
University of Wisconsin-Madison
Vanderbilt University Medical Center
Mount Sinai Hospital
University of Washington Northwest Campus
Zuckerberg San Francisco General Hospital
Maine Health
HealthPartners Institute, Regions Hospital
University of Massachusetts Medical School