Best Estimate Final Diagnosis (BEFD)

Best Estimate Lifetime Diagnosis (BEFD) procedure for the Diagnostic Interview for Genetic Studies (DIGS):  The Diagnostic Interview for Genetic Studies (DIGS) is a clinical interview especially constructed for the assessment of major mood and psychotic disorders and their spectrum conditions.  The DIGS, first developed and piloted as a collaborative effort of investigators from sites in the National Institute of Mental Health (NIMH) Genetics Inititative, has the following additional features: (1) polydiagnostic capacity; (2) a detailed assessment of the course of the illness, chronology of psychotic and mood syndromes, and comorbidity; (3) additional phenomenologic assessments of symptoms.

As part of its phenotypic diagnostic assessment process, the BEFD was developed to allow senior clinicians (serving as Final Reviewers) the opportunity to review "all sources of information" collected on a particular research participant. Accordingly, the best estimate process uses a consensus-based approach to arrive at final diagnoses. Clinical information is gathered from the Diagnostic Interview for Genetic Studies (DIGS), Family Interview for Genetic Studies (FIGS) and received medical records.

During the BEFD procedure, two senior clinicians each separately and independently assesses all sources of information to arrive at his/her own diagnosis. Following this independent diagnosis, the two clinicians discuss their finding with each other. If they both agree or if minor disagreements exist and can be attributed to oversight or misinterpretation of information, and agreement can be achieved, then the Best Estimate Final Diagnosis (BEFD) is recorded as their consensus diagnosis, which is then entered into the computer database.  Non-resolved cases are referred to a "tie-breaker" (also a senior clinician) who reviews all sources of information available (including the diagnostic decisions of the two Final Reviewers) and reaches a set of final diagnoses.  These consensus diagnoses are then entered in the database.

The best-estimate diagnostic approach helps to ensure diagnostic precision and reduce misclassifications getting better phenotype characterization of the study subjects.

Rutgers University Rutgers University USC Information Sciences Institute Washington University in St.Louis National Institute of Mental Health