Advancing the research agenda for diagnostic error reduction.
Advancing the research agenda for diagnostic error reduction.
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推进减少诊断错误的研究议程。
DOI：
10.1136/bmjqs-2012-001624
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发表时间：
2013
影响因子：
5.4
通讯作者：
Singh,Hardeep
中科院分区：
文献类型：
--
作者：
Zwaan,Laura;Schiff,GordonD;Singh,Hardeep
诊断错误仍然是患者安全研究中一个不受重视和研究不足的领域。我们简要总结了用于流行病学研究的方法、影响因素和与诊断错误相关的干预措施，并概述了未来研究的方向。研究诊断错误的流行病学的研究方法提供了对诊断错误率的一些估计。然而，由于所使用的定义和研究方法的不同，报告的比率似乎有很大的差异。因此，未来的方法应该侧重于在不同的护理环境下获得更准确的估计。这将为随着时间的推移测量错误率以评估改进情况奠定基础。研究方法研究了自然环境和实验环境中诊断错误的影响因素。这两种方法都揭示了重要和互补的信息。需要来自医疗保健以外的更新的概念模型来推进系统分析的深度和严谨性，以及对错误原因的认知洞察。虽然文献提出了许多可能有效的减少诊断错误的干预措施，但大多数都没有得到系统的评估和/或在实践中广泛实施。需要研究有前景的干预领域，如加强患者对诊断的参与，通过使用电子工具改善诊断，识别和减少特定诊断过程的“陷阱”(例如，在“正常”乳房X光检查后未能对乳房肿块进行适当的诊断评估)。过去十年对诊断误差的研究取得了令人振奋的进展，并为推进该领域的更严格方法奠定了基础。
Diagnostic errors remain an underemphasised and understudied area of patient safety research. We briefly summarise the methods that have been used to conduct research on epidemiology, contributing factors and interventions related to diagnostic error and outline directions for future research. Research methods that have studied epidemiology of diagnostic error provide some estimate on diagnostic error rates. However, there appears to be a large variability in the reported rates due to the heterogeneity of definitions and study methods used. Thus, future methods should focus on obtaining more precise estimates in different settings of care. This would lay the foundation for measuring error rates over time to evaluate improvements. Research methods have studied contributing factors for diagnostic error in both naturalistic and experimental settings. Both approaches have revealed important and complementary information. Newer conceptual models from outside healthcare are needed to advance the depth and rigour of analysis of systems and cognitive insights of causes of error. While the literature has suggested many potentially fruitful interventions for reducing diagnostic errors, most have not been systematically evaluated and/or widely implemented in practice. Research is needed to study promising intervention areas such as enhanced patient involvement in diagnosis, improving diagnosis through the use of electronic tools and identification and reduction of specific diagnostic process ‘pitfalls’ (eg, failure to conduct appropriate diagnostic evaluation of a breast lump after a ‘normal’ mammogram). The last decade of research on diagnostic error has made promising steps and laid a foundation for more rigorous methods to advance the field.