Engaging Patients in Diagnostic Error Reporting

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Project Summary/Abstract Diagnostic errors pose a significant threat to patient safety. According to the recent Institute of Medicine report, Improving Diagnosis in Health Care, most people will likely experience at least one diagnostic error in their lifetime, some with devastating consequences. Despite increased interest in diagnostic errors and policy initiatives to increase patient engagement, patient experiences of diagnostic error are underutilized as tools for improvement. The goal of this proposal is to develop and test an electronic patient-centered diagnostic error- reporting system. The specific aims are to: 1) Determine patients' and family members' experiences of diagnostic errors and views on patient-centered best practices for error reporting; 2) Identify current work system barriers and facilitators to patient reporting of diagnostic error; and 3) Develop and test an electronic, patient-centered, diagnostic error-reporting system to capture and classify patient- and family-reported diagnostic errors. In Aim 1, in-depth interviews will be conducted with patients and family members affected by diagnostic errors. In Aim 2, key informant interviews will be conducted with patient safety officers, safety and legal staff and clinicians to identify facilitators and barriers to learning from patient reports, including how to integrate it into existing error reporting strategies. In Aim 3, a taxonomy will be developed based on the language and personal experiences of patients and family members from Aim 1, findings from Aim 2 and input from key stakeholders (e.g., patients and experts in patient safety and clinical informatics). An electronic error- reporting system will be developed using the taxonomy to inform the data structure. To refine the electronic system, iterative usability testing will be conducted with patients and family members who have experienced diagnostic error. Finally, the patient-centered electronic error-reporting system will be pilot tested to determine its feasibility and acceptability with patients who have experienced a diagnostic error. This K01 award will facilitate Dr. Traber Giardina's long-term career goal to become an independent health services researcher. The protected time will allow her training and experience in four key areas: patient safety, participatory research methods, informatics and human factors principles. Training will be accomplished through a combination of didactic coursework, seminars, conferences and mentored research projects. My mentors, Hardeep Singh, MD, MPH, an experienced mentor and internationally recognized expert in diagnostic error research, and Dean Sittig, PhD, a nationally recognized expert in the field of applied clinical informatics, will supervise training. The proposed work represents a substantive departure from previous research in the area of improving patient safety by incorporating patient experiences into the diagnostic error literature and developing a patient-centered electronic diagnostic error-reporting system to capture and utilize patient reported diagnostic errors.