Improving Cancer Care Patient Safety through Pathology Training Simulation

通过病理学培训模拟提高癌症护理患者的安全

• 批准号: 8301297
• 负责人: STEPHEN S RAAB
• 金额: $ 35万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-05-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8301297
• 关键词: Improving; Cancer; Care; Patient; Safety

DESCRIPTION (provided by applicant): Uncontrolled practice variability in diagnostic testing has contributed to high rates of error and skyrocketing costs. In the field of oncologic pathology diagnostic testing, more than 70% of patient diagnostic testing samples are defective and an error affects the management of more than 230,000 of the 1.6 million patients diagnosed with cancer annually in the United States. This error frequency has remained unchanged over the last several decades. We believe that simulation based medical education (SBME) combined with Lean methods of quality improvement has the potential to improve cancer diagnostic care by fundamentally changing the underlying culture and processes that contribute to unsafe practices. Within the past year, we initiated the development of an anatomic pathology education-based simulation laboratory (PSL) at the University of Colorado Denver (UCD). The incorporation of simulation training in pathology residency education offers several potential benefits: reduction of patient risk, elimination of practice variability, deliberate practice, development of complex skill sets in an off-line environment, close monitoring of practice with graduated responsibility, practice in environments with simulated failure, and practice with high case volume that include rare and challenging patient specimens specifically prone to error. We hypothesize that anatomic pathology Lean-SBME will replace ineffective and outdated models of training and produce pathologists who are highly skilled, make fewer errors, team-focused and trained in quality improvement. We will perform a single institution, double cohort case-control study by separating residents on the University Hospital anatomic pathology rotation into two groups: 1) an integrated Lean-SBME tract and 2) a traditional apprenticeship tract. We will compare: 1) resident performance outcomes and 2) oncologic pathology patient safety outcomes for the two tracts over a three year interval. We hypothesize that compared to anatomic pathology traditional apprenticeship residents, Lean-SBME residents will perform at higher levels of competence, measured through standardized and validated assessment tools, and the entire post-implementation laboratory will makes fewer errors, measured by standardized quality assurance tools. As a result, patients who have cancer or signs and symptoms suspicious for cancer will receive safer healthcare and will have improved outcomes as a result of improved diagnostic testing services. PUBLIC HEALTH RELEVANCE: The public health relevance of this study primarily lies in the fact that the University of Colorado Hospitals (UCH) serves as one of the major "safe harbor" hospitals in the area; the service population is comprised of 14% of families below poverty level, 30% who do not speak English at home, and 30-40% who are not white. Our goal is to improve the quality of care and patient safety in this population.

描述（由申请人提供）：诊断测试中不受控制的实践变异性导致了高错误率和飞涨的成本。在肿瘤病理学诊断测试领域，超过70%的患者诊断测试样本是有缺陷的，并且在美国每年有160万名被诊断患有癌症的患者，其中超过230，000名患者的管理受到错误的影响。这种错误频率在过去几十年中保持不变。我们相信，基于模拟的医学教育（SBME）结合精益质量改进方法，有可能通过从根本上改变导致不安全实践的潜在文化和流程来改善癌症诊断护理。在过去的一年里，我们开始在科罗拉多丹佛大学（UCD）开发一个基于解剖病理学教育的模拟实验室（PSL）。在病理学住院医师教育中纳入模拟培训提供了几个潜在的好处：降低患者风险，消除实践可变性，刻意练习，在离线环境中开发复杂的技能集，密切监控具有分级责任的实践，在模拟失败的环境中练习，和实践高病例量，包括罕见的和具有挑战性的病人标本，特别容易出错。我们假设解剖病理学Lean-SBME将取代无效和过时的培训模式，并培养出技术熟练、错误较少、以团队为中心并接受过质量改进培训的病理学家。我们将进行一项单机构、双队列病例对照研究，将大学医院解剖病理学轮换的住院医师分为两组：1）综合Lean-SBME道和2）传统学徒道。我们将比较：1）住院医师性能结局和2）两个管道在三年内的肿瘤病理学患者安全性结局。我们假设，与解剖病理学传统学徒制居民相比，Lean-SBME居民将通过标准化和验证的评估工具来衡量更高水平的能力，整个实施后实验室将通过标准化的质量保证工具来衡量，错误更少。因此，患有癌症或疑似癌症体征和症状的患者将获得更安全的医疗保健，并将因诊断检测服务的改善而改善结果。 公共卫生关系：本研究的公共卫生相关性主要在于，科罗拉多大学医院（UCH）是该地区主要的“安全港”医院之一;服务人群包括14%的贫困线以下家庭，30%的人在家不说英语，30-40%的人不是白色。我们的目标是提高这一人群的护理质量和患者安全。