Defining Diagnostic Error: A Scoping Review to Assess the Impact of the National Academies' Report Improving Diagnosis in Health Care.
Defining Diagnostic Error: A Scoping Review to Assess the Impact of the National Academies' Report Improving Diagnosis in Health Care.
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DOI：
10.1097/pts.0000000000000999
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发表时间：
2022-12-01
影响因子：
2.2
通讯作者：
Smith, Kelly M.
中科院分区：
文献类型：
--
作者：
Giardina, Traber D.;Hunte, Haslyn;Hill, Mary A.;Heimlich, S. Layla;Singh, Hardeep;Smith, Kelly M.
准确和及时诊断的标准是不明确的。2015年，美国国家科学、工程和医学院（NASEM）委员会发表了一份具有里程碑意义的报告《改善医疗诊断》，并提出了诊断错误的新定义，即“未能（a）对患者的健康问题做出准确和及时的解释，或（B）将该解释传达给患者”。本研究旨在探讨研究人员如何操作NASEM的诊断错误的定义与准确性，及时性，和/或同行评议的已发表文献中的沟通。使用Arskey和O 'Malley的框架框架，我们使用Medline和Google Scholar识别了2015年10月至2021年2月期间发表的文献。我们还对研究人员进行了主题专家采访。在确定的34项研究中，对16项进行了分析和抽象，以确定如何操作和测量诊断错误。研究按主题分组：流行病学，患者焦点，测量/监测和临床医生焦点。9项研究使用NASEM定义。其中，5项研究也采用了在全国扫描电镜报告之前提出的现有定义。四项研究操作的NASEM定义的组成部分，并没有引用现有的定义。三项研究仅使用现有定义说明了操作错误。主题专家指出，NASEM定义是研究人员将诊断错误概念化的基础。NASEM报告对诊断错误产生了共识，包括准确性，及时性和沟通。在最近的同行评审文献中，大多数研究人员继续使用NASEM报告前的定义来实现准确性和及时性。该报告促进了以患者为中心的概念在定义中的使用，导致新兴的研究集中在检查与患者沟通诊断相关的错误。
Standards for accurate and timely diagnosis are ill-defined. In 2015, the National Academies of Science, Engineering, and Medicine (NASEM) committee published a landmark report, Improving Diagnosis in Health Care, and proposed a new definition of diagnostic error, “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient.” This study aimed to explore how researchers operationalize the NASEM’s definition of diagnostic error with relevance to accuracy, timeliness, and/or communication in peer-reviewed published literature. Using the Arskey and O’Malley’s framework framework, we identified published literature from October 2015 to February 2021 using Medline and Google Scholar. We also conducted subject matter expert interviews with researchers. Of 34 studies identified, 16 were analyzed and abstracted to determine how diagnostic error was operationalized and measured. Studies were grouped by theme: epidemiology, patient focus, measurement/surveillance, and clinician focus. Nine studies indicated using the NASEM definition. Of those, 5 studies also operationalized with existing definitions proposed before the NASEM report. Four studies operationalized the components of the NASEM definition and did not cite existing definitions. Three studies operationalized error using existing definitions only. Subject matter experts indicated that the NASEM definition functions as foundation for researchers to conceptualize diagnostic error. The NASEM report produced a common understanding of diagnostic error that includes accuracy, timeliness, and communication. In recent peer-reviewed literature, most researchers continue to use pre-NASEM report definitions to operationalize accuracy and timeliness. The report catalyzed the use of patient-centered concepts in the definition, resulting in emerging studies focused on examining errors related to communicating diagnosis to patients.