Optimizing Implementation of Multiplex Molecular Panel Testing to Reduce Diagnostic Error

呼吸道和胃肠道疾病是成年人最常见的原因之一， 都是在急诊室开的抗生素近年来，多重分子面板， 同时检测15-25种病原体，包括细菌和病毒， 普遍使用，并大大改变了临床医生对这些条件的基本方法。的 多重检测板的潜在优点是，如果使用得当， 靶向抗生素或抗病毒治疗。但是多重检测是“猎枪”检测， 产生假阳性。如果不考虑意外后果， 它们的使用要么没有影响，要么导致不适当的抗生素。这项研究将解决一个 文献中的空白，通过确定多重检测组何时可以改变临床管理 或使患者受益，并设计干预措施，在这些情况下推动测试。 拟议的研究将促进患者安全，并通过诊断减少误诊 管理，一种新兴的传染病护理模式，使用“轻推”干预措施， 鼓励循证检验。目标1将定义多重检测板的高价值和低价值使用 通过检查200岁时在急诊护理中就诊的患者的临床结果进行测试 为Premier Healthcare Database提供数据的医院。目标2将发展电子健康 基于记录的干预措施，以推动更好的测试实践，在急性护理的基础上， 前线临床医生的意见。目标3将是一个诊断管理的准实验性试验 在马里兰州系统的两家医院进行干预。其他系统医院将 同时进行控制。这项研究将导致第一次大规模的试验， 多重分子面板测试在急性护理的管理。 我是一名传染病医生和医院流行病学家，拥有卫生服务博士学位 research.我的长期职业目标是成为一名独立的调查员， 服务研究，以重新设计护理系统，重点是患者的分子诊断 疑似感染者为了实现这个目标，我将接受正式的分子训练， 微生物学、医疗保健信息学和实施科学。我将由一位 包括丹尼尔摩根博士在内的跨学科小组，他是AHRQ资助的诊断专家， J. Kristie约翰逊博士，临床微生物学专家， 混合方法和以用户为中心的设计，以及安东尼哈里斯博士，准专家， 实验性试验我研究的长期科学目标是改善抗生素的使用 通过高质量和高价值的传染病诊断检测。

Respiratory and gastrointestinal complaints are among the most common reasons why adults are prescribed antibiotics in acute care. In recent years, multiplex molecular panels that rapidly test for 15-25 for pathogens simultaneously, including bacteria and viruses, have entered common use and dramatically changed clinicians’ basic approach to these conditions. The potential advantage of multiplex panels is that, if uses properly, rapid diagnosis may facilitate targeted antibiotic or antiviral therapy. But multiplex panels are “shotgun” tests that frequently produce false positives. When implemented without consideration of unintended consequences, their use can either have no impact or lead to inappropriate antibiotics. This study will address a gap in the literature by identifying when multiplex panel tests can change clinical management or benefit the patient and designing interventions to nudge testing in those situations. The proposed studies will promote patient safety and reduce misdiagnosis through diagnostic stewardship, an emerging model for infectious diseases care that uses “nudge” interventions to encourage evidence-based testing. Aim 1 will define high- and low-value use of multiplex panel testing by examining clinical outcomes after testing among patients seen in acute care at 200 hospitals contributing to the Premier Healthcare Database. Aim 2 will develop electronic health record-based interventions to nudge better testing practices in acute care based on qualitative input from frontline clinicians. Aim 3 will be a quasi-experimental trial of diagnostic stewardship interventions at two hospitals in the University of Maryland System. Other system hospitals will be concurrent controls. This research will lead to the first large-scale trial evaluating diagnostic stewardship of multiplex molecular panel tests in acute care. I am an infectious disease physician and hospital epidemiologist with a PhD in health services research. My long-term career goal is to become an independent investigator performing health services research to redesign systems of care with a focus on molecular diagnostics for patients with suspected infections. To achieve this goal, I will undergo formal training in molecular microbiology, healthcare informatics, and implementation science. I will be mentored by an interdisciplinary team including Dr. Daniel Morgan, an AHRQ-funded expert in diagnostic stewardship, Dr. J. Kristie Johnson, expert in clinical microbiology, Dr. Sarah Krein, an expert in mixed methods and user-centered design, and Dr. Anthony Harris, an expert in quasi- experimental trials. The long-term scientific goal of my research is to improve antibiotic use through high-quality and high-value diagnostic testing for infectious diseases.