Closing the Feedback Loop to Improve Diagnostic Quality

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DESCRIPTION (Provided by the Applicant): This project is aimed at developing ways to close the loop of outpatient diagnosis in an effort to improve the quality of diagnostic and therapeutic decision making in ambulatory settings. We will have four sites-three ambulatory clinic settings and one Emergency Room setting. These sites all have different electronic medical records and different patient populations, including patients of all ages with a variety of acute and chronic conditions, including special needs patients (HIV and CP). The targeted professionals include residents and fellows, attending physicians, nurses, and allied health professionals in both primary care and specialty practice. The intervention involves developing automated processes of proactive follow-up and ongoing rapid feedback to physicians and will focus on measuring the quality of diagnoses. In the clinic settings we will also assess the quality of medication prescribing. The focus in all three of the clinic sites will be on automating systematic follow-up of, and feedback to physicians on, patients who are treated on an outpatient basis. The focus in the emergency medicine site will be on folIow-up and feedback to the Emergency Room physicians on the diagnoses of patients admitted to the hospital. Methods include modification of the electronic medical records and information systems in all sites to capture MD-designated diagnosis and prognosis predictions and follow-up intervals, permit data collection and provide direct feedback to physicians. Patients seen in the three clinics will receive phone calls to assess their health status and response to medication. The phone call process as well as the data collection and feedback processes will be automated. In the Emergency Room, automated methods of obtaining the admission and discharge diagnoses of admitted patients and providing this information to the emergency room physician who initially cared for these patients will be developed. Providers' response to the feedback will be assessed as well as provider satisfaction with the feedback process. For all settings, outcomes to be assessed include impact on diagnostic and therapeutic quality, extent of adoption of the system, use of the feedback by physicians for quality improvement. For the clinic sites, additional outcomes to be assessed include patient satisfaction and impact on healthcare costs.