Diagnostic Failures in Dentistry

项目总结/摘要 尽管越来越多的人认识到诊断失败是患者安全研究的“新前沿”， 没有研究系统地检查牙科诊断失败（延迟，错误或漏诊）。 我们建议的主要目标是通过系统地评估牙科诊断来弥补这一知识差距。 失败（DDFs）与牙周病相关的目标是将专业转向诊断 卓越牙周（牙龈）疾病影响46%的美国成年人，并可能经常导致疼痛，牙齿脱落，和/或 生活质量不高，管理不当。 这项工作意义重大，因为它是第一次尝试系统地评价诊断性能 在牙科。它是创新的，因为它利用了一种新的方法来挖掘EHR数据，以确定诊断 错误，并检查诊断错误和临床/卫生服务结果之间的关联。的 这种方法是基于我们广泛的前期工作。调查人员是经验丰富的研究人员， 开创了牙科患者安全研究的先河，并为以诊断为中心的职业奠定了基础 通过开发和传播牙科诊断术语SNODDS，使牙医能够 以标准化的方式在EHR中准确记录患者的诊断。我们的研究将是 在两个学术机构进行，这将提供一个强大的学习环境。 在目标1中，我们确定与牙周炎相关的牙科诊断失败（DDFs）的发生率。 疾病和条件。该目的旨在评估临床医生给出的诊断与 美国牙周病学会（AAP）制定的诊断标准，以确定 与牙周病相关的DDFs基线发病率。具体来说，我们将部署自动查询 从EHR中提取关键数据元素的脚本，这些数据元素将用于生成基于EHR的诊断， 与临床医生的诊断进行比较。所有不一致病例将由经过培训的 研究中心临床医生和专家小组共同确认是否存在DDF。 在目标2中，我们评估DDFs后的临床和治疗模式以及临床结局。在这一目标中， 我们将研究患者在牙周诊断后接受的治疗模式， 牙周健康的结果。我们假设，诊断不准确的患者（DDFs）将更多 与推荐治疗相比，可能接受不适当的治疗（治疗过度或治疗不足） 治疗指南。他们也会有较差的临床结果（如牙周病的进展， 牙齿脱落）与准确诊断（非DDFs）的患者相比。 我们希望我们的研究将为牙科专业提供一个基本的理解， 与牙周疾病和状况相关的DDFs。它还将提供一个坚实的路线图， 并实施DDF缓解策略，以防止对牙科患者造成不必要的伤害。

Project Summary/Abstract Despite growing recognition that diagnostic failures are the “new frontier” for patient safety research, there has been no study to systematically examine diagnostic failures (delayed, wrong or missed diagnoses) in dentistry. The primary goal of our proposal is to close this knowledge gap by systematically evaluating dental diagnostic failures (DDFs) associated with periodontal diseases with a goal of moving the profession towards diagnostic excellence. Periodontal (gum) diseases affect 46% of US adults and may often lead to pain, tooth loss, and/or poor quality of life when not properly managed. This work is significant because it is the first attempt to systematically evaluate diagnostic performance in dentistry. It is innovative because it utilizes a new methodology for mining EHR data to identify diagnostic errors, and examines the association between diagnostic errors and clinical/health service outcomes. The approach is grounded in our extensive preliminary work. The investigators are experienced researchers who have pioneered patient safety research in dentistry and laid the foundation for a diagnostic-centered profession through developing and disseminating the dental diagnostic terminology SNODDS that enables dentists to accurately document patients' diagnoses within the EHR in a standardized manner. Our study will be conducted at two academic institutions, which will provide a robust learning environment. In Aim 1, we determine the incidence of dental diagnostic failures (DDFs) associated with periodontal diseases and conditions. This Aim seeks to assess the concordance between clinician-given diagnoses and established diagnostic criteria from the American Academy of Periodontology (AAP) in order to determine the baseline incidence of DDFs associated with periodontal diseases. Specifically, we will deploy automated query scripts to extract critical data elements from the EHR that will be used to generate an EHR-based diagnosis for comparison with the clinician-given diagnosis. All discordant cases will be reviewed independently by trained site clinicians and collectively by the expert panel to confirm the presence or absence of a DDF. In Aim 2 we evaluate clinical and treatment patterns and clinical outcomes following DDFs. In this Aim, we will examine the patterns of treatment received by patients following their periodontal diagnoses and their periodontal health outcomes. We hypothesize that patients with inaccurate diagnoses (DDFs) will be more likely to receive inappropriate treatment (over- or under-treatment) when compared against recommended treatment guidelines. They will also have poorer clinical outcomes (e.g. progression of periodontal disease, tooth loss) compared to those with accurate diagnoses (non-DDFs). We expect that our research will provide the dental profession with a fundamental understanding of DDFs related to periodontal diseases and conditions. It will also provide a solid roadmap from which to develop and implement DDF mitigation strategies that will prevent unnecessary harm to dental patients.