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

项目总结/摘要 Christina Cifra博士的目标是成为诊断安全研究的独立调查员和领导者 重点是预防重症儿童中与诊断错误相关的伤害。Cifra博士的职业发展计划 纳入了高级流行病学和生物统计学、定性/混合 方法研究和沟通，以提高诊断性能。她将接受一个由 在流行病学和患者安全性问题定性研究方面具有专业知识的经验丰富的研究者， LEMS和诊断安全和通信的具体熟练程度。Dr. L. Herwaldt（主要导师）是一位 他是一位有成就的流行病学家，有指导成功的年轻研究者的记录。H博士 Singh是国际知名的儿科诊断安全研究先驱，在COM方面具有特定的专业知识， 沟通，以提高诊断。H博士赖辛格是一位医学人类学家， research.道森博士是一位精通生物统计学的人，他曾在各种各样的联邦- 资助的生物医学研究。Cifra博士在一个非常支持她成功的环境中工作， 获得实现目标所需的所有资源。诊断错误（DE）是一个主要来源， 重症儿童的医疗保健相关伤害。然而，我们对诊断的理解存在很大的差距， 进入儿科重症监护室（PICU）的过程阻止了靶向基质的发展， 预防与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， 目标是开发一个PICU特定的转诊沟通概念模型，作为 PICU诊断过程。她将通过以下方式实现这一目标：1）确定前12小时内DE的患病率 非选择性进入PICU后，患者、提供者和工作系统特征相关 与DE，以及2）检查转诊临床医生之间转诊沟通的方式和内容 PICU医生的接诊影响PICU入院诊断过程。对于定量目标1，博士。 Cifra将使用结构化图表审查和经验证的工具进行回顾性队列研究，以确定 入住2个三级转诊学术PICU的患者的DE。对于定性目标2，Cifra博士将进行- 我在爱荷华州PICU进行了人种志（观察、访谈和文件审查）研究 转诊沟通如何影响PICU入院时的诊断过程。定量和定性 结果将被整合，产生一个新的PICU特定的转诊沟通的概念模型， 在PICU入院诊断过程中的作用。该研究是创新的，在其综合多， 学科混合方法。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相关的伤害儿童，一个AHRQ的优先人群。 这项工作将为Cifra博士计划的R 01应用程序提供基础，以开发和测试这些干预措施。 加快了她走向独立的步伐。

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.