Understanding Referral Communication, the Diagnostic Process, and Diagnostic Error in Pediatric Critical Care

项目摘要/摘要 克里斯蒂娜·奇夫拉博士的目标是成为诊断安全性研究的独立研究员和领导者 重点预防危重儿童的诊断错误相关伤害。Cifra博士的职业发展计划 结合在高级流行病学和生物统计学方面的有指导的研究和培训，定性/混合 方法研究和沟通，以提高诊断性能。她将由一支由 在患者安全问题的流行病学和定性调查方面具有专业知识的经验丰富的调查人员- 具备安全诊断和沟通方面的专业技能。L.Herwaldt博士(主要导师)是一位 成就卓著的流行病学家，有指导成功的年轻调查人员的既定记录。H博士。 辛格是国际知名的儿科诊断安全研究的先驱，在COM-2方面具有特殊的专长。 沟通以提高诊断率。赖辛格博士是一位医学人类学家，擅长混合方法。 研究。J.Dawson博士是一位熟练的生物统计学家，他曾在各种联邦- 资助生物医学研究。Cifra博士的工作环境非常支持她的成功，她 获得实现她的目标所需的所有资源。诊断错误(DES)是 与医疗保健相关的危重儿童伤害。然而，我们对诊断的理解存在很大差距 儿科重症监护病房(PICU)的入院程序阻止了靶向策略的发展。 GES以防止DE相关的伤害。为了解决这一差距，Cifra博士提出了一项混合方法研究，研究对象为 目标是开发一个特定于PICU的转介沟通概念模型，作为 PICU诊断流程。她将通过以下方式实现这一点：1)在最初的12小时内确定DE的患病率 非选择性入院PICU后与患者、提供者和工作系统特征相关联 使用DE，以及2)检查转诊临床医生之间转诊沟通的方式和内容 接受PICU医生会影响PICU入院时的诊断过程。对于量化目标1，Dr。 Cifra将使用结构化图表审查和经过验证的工具进行回溯性队列研究，以确定 住进2个三级转诊学术PICU的患者。对于定性目标2，Cifra博士将进行以下操作： 由爱荷华州立大学PICU的人种学(观察、访谈和文件审查)来检验 转诊沟通如何影响入院时的PICU诊断过程。量与质 结果将被整合，产生一个新的特定于PICU的转介沟通概念模型和 在PICU入院的诊断过程中的作用。所提出的研究具有创新性，它将多学科、多学科、多领域的 学科混合方法的方法。结果将是重要的，为未来的诊断产生假设 安全研究和提供信息，以防止DE对儿童造成的伤害，儿童是AHRQ的优先人群。 这项工作将为Cifra博士计划的R01应用程序提供基础，以开发和测试这些干预- 加快了她走向独立的进程。

PROJECT SUMMARY / ABSTRACT Dr. Christina Cifra’s goal is to become an independent investigator and leader in diagnostic safety research focused on preventing diagnostic error-related harm in critically ill children. Dr. Cifra’s career development plan incorporates mentored research and training in advanced epidemiology and biostatistics, qualitative/mixed methods research, and communication to improve diagnostic performance. She will be mentored by a team of experienced investigators with expertise in epidemiological and qualitative investigation of patient safety prob- lems and specific proficiency in diagnostic safety and communication. Dr. L. Herwaldt (primary mentor) is an accomplished epidemiologist with an established record of mentoring successful young investigators. Dr. H. Singh is an internationally known pioneer in pediatric diagnostic safety research with specific expertise in com- munication to improve diagnosis. Dr. H. Reisinger is a medical anthropologist with expertise in mixed methods research. Dr. J. Dawson is a proficient biostatistician who has collaborated on a wide variety of federally- funded biomedical research. Dr. Cifra works in an environment extremely supportive of her success and has access to all of the resources required to achieve her goals. Diagnostic errors (DEs) are a major source of healthcare-associated harm in critically ill children. However, a large gap in our understanding of the diagnostic process on admission to the Pediatric Intensive Care Unit (PICU) prevents the development of targeted strate- gies to prevent DE-related harm. To address this gap, Dr. Cifra proposes a mixed methods study with the ob- jective of developing a PICU-specific conceptual model of referral communication as an integral part of the PICU diagnostic process. She will achieve this by: 1) determining the prevalence of DE in the first 12 hours after non-elective admission to the PICU and patient, provider, and work system characteristics associated with DE, and 2) examining how the manner and content of referral communication between referring clinicians and accepting PICU physicians affect the PICU diagnostic process on admission. For quantitative Aim 1, Dr. Cifra will conduct a retrospective cohort study using structured chart reviews and a validated tool to identify DEs in patients admitted to 2 tertiary referral academic PICUs. For qualitative Aim 2, Dr. Cifra will conduct fo- cused ethnography (observation, interviews, and document review) at the University of Iowa PICU to examine how referral communication affects the PICU diagnostic process on admission. Quantitative and qualitative results will be integrated, producing a novel PICU-specific conceptual model of referral communication and its role in the diagnostic process on PICU admission. The proposed research is innovative in its integrated multi- disciplinary mixed methods approach. Results will be significant, generating hypotheses for future diagnostic safety research and providing information to prevent DE-related harm in children, an AHRQ priority population. This work will provide the foundation for Dr. Cifra’s planned R01 application to develop and test these interven- tions, accelerating her progress towards independence.