Developing Health Care Organizations That Pursue Learning and Exploration of Diagnostic Excellence: An Action Plan
Developing Health Care Organizations That Pursue Learning and Exploration of Diagnostic Excellence: An Action Plan
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DOI：
10.1097/acm.0000000000003062
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发表时间：
2020-08-01
影响因子：
7.4
通讯作者：
Torretti, Dennis
中科院分区：
文献类型：
--
作者：
Singh, Hardeep;Upadhyay, Divvy K.;Torretti, Dennis
减少诊断错误是患者安全的下一个重大挑战。诊断安全改进工作应该成为医疗保健组织，付款人和认证机构的优先事项;然而，外部激励措施，政策和实践指导，以发展这些努力在很大程度上是不存在的。在这一观点中，作者强调了卫生保健组织可以追求学习和探索卓越诊断（LEDE）的方法。基于目前的证据和他们最近在盖辛格发展这样一个学习型组织的经验，作者提出了一个5点行动计划和相应的政策杠杆，以支持LEDE组织的发展。这些建议适用于许多医疗保健组织，包括（1）实施虚拟中心，以协调组织活动，以改善诊断，例如识别风险并优先考虑跨机构内孤岛的干预措施，同时促进学习和安全文化;（2）参与新的科学倡议，以产生和翻译证据，考虑到快速发展的诊断卓越的“基础科学”;（3）避免“度量暴政”，将重点放在改进的测量上，而不是使用奖励或惩罚的措施;（4）让临床医生参与改进诊断的活动，并将错过的机会积极地视为学习机会，而不是消极地视为错误;以及（5）发展一种负责任的文化，让患者参与并向患者学习，患者往往是未充分开发的信息来源。作者还概述了支持各组织实施这些建议的具体政策行动。他们认为，该行动计划可以促进实现卓越诊断和减少可预防的患者伤害所需的科学，实践和政策进展。
Reducing errors in diagnosis is the next big challenge for patient safety. Diagnostic safety improvement efforts should become a priority for health care organizations, payers, and accrediting bodies; however, external incentives, policies, and practical guidance to develop these efforts are largely absent. In this Perspective, the authors highlight ways in which health care organizations can pursue learning and exploration of diagnostic excellence (LEDE). Building on current evidence and their recent experiences in developing such a learning organization at Geisinger, the authors propose a 5-point action plan and corresponding policy levers to support development of LEDE organizations. These recommendations, which are applicable to many health care organizations, include (1) implementing a virtual hub to coordinate organizational activities for improving diagnosis, such as identifying risks and prioritizing interventions that cross intra-institutional silos while promoting a culture of learning and safety; (2) participating in novel scientific initiatives to generate and translate evidence, given the rapidly evolving "basic science" of diagnostic excellence; (3) avoiding the "tyranny of metrics" by focusing on measurement for improvement rather than using measures to reward or punish; (4) engaging clinicians in activities for improving diagnosis and framing missed opportunities positively as learning opportunities rather than negatively as errors; and (5) developing an accountable culture of engaging and learning from patients, who are often underexplored sources of information. The authors also outline specific policy actions to support organizations in implementing these recommendations. They suggest this action plan can stimulate scientific, practice, and policy progress needed for achieving diagnostic excellence and reducing preventable patient harm.