Using Public Deliberation to Define Patient Roles in Reducing Diagnostic Error

描述（由申请人提供）：健康领域需要以患者为中心的策略，以减少诊断错误，改善健康，挽救生命。诊断错误，或诊断错误，遗漏或延迟，是住院和门诊设置中的一个严重问题。大多数提高诊断质量的建议都集中在医生和医疗保健系统上;很少有患者-医疗保健服务的消费者-参与预防，识别和报告诊断错误。这个创新项目，使用公共协商来定义患者在减少诊断错误中的角色，将使用审议方法来吸引医疗保健消费者和专业人员制定明智和实用的以患者为中心的战略，以减少可能对患者安全，医疗保健产生重大影响的诊断错误。 交付和健康成果。具体而言，该项目采用随机和对照实验方法，涉及来自两个人群（医疗保健专业人员和医疗保健消费者）的参与者。将对两个人群中的潜在参与者进行治疗前调查。数据将用于构建四个匹配的配对小组（两个用于医疗保健专业人员，两个用于医疗保健消费者），第五个不匹配的医疗保健消费者小组，以及医疗保健专业人员和消费者的对照组。所有消费者小组将从AHRQ优先人群中进行过采样。四个配对小组中的参与者将被随机分配暴露于两种治疗条件之一：（1）关于诊断错误的教育，或（2）关于诊断错误的教育和审议。审议小组将探讨患者愿意和能够在预防、识别和报告诊断错误方面发挥的作用;应用于使患者发挥这些作用的策略;以及患者承担这些作用所需的系统和结构。第一个审议消费者小组将创建有关以患者为中心的减少诊断错误的策略的明智建议，这将与第五个（无与伦比的）审议消费者小组进行测试，该小组还将对建议进行排名和优先级排序。项目评估将使用对所有小组和对照组进行的测试前和测试后调查。评估设计是重要的和创新的，因为它允许比较的相对效果没有治疗，只教育，教育与医疗保健消费者和专业人士的审议。该评估将检查有关诊断错误，患者激活，健康素养和公众审议等措施的看法，态度和知识的变化。改善医学诊断协会（SIDM）将利用这些建议制定战略计划，政策声明，关于患者参与减少诊断错误的研究议程，以及为医疗保健系统，提供者和消费者创建患者参与“工具包”。项目结束后，将与小岛屿发展中国家的主要人员进行面谈，评估他们对建议的质量和有用性的看法，以及他们传播和执行建议的计划。

DESCRIPTION (provided by applicant): The health field requires patient-focused strategies to reduce diagnostic error, improve health, and save lives. Diagnostic error, or diagnoses that are wrong, missed, or delayed, is a serious issue in inpatient and outpatient settings. Most proposals to improve diagnostic quality focus on physicians and healthcare systems; few engage patients - the consumers of healthcare services - in preventing, identifying, and reporting diagnostic error. This innovative project, Using Public Deliberation to Define Patient Roles in Reducing Diagnostic Error, will use deliberative approaches to engage healthcare consumers and professionals in developing informed and practical patient-focused strategies for reducing diagnostic error that are likely to have significant impacts on patient safety, healthcare delivery, and health outcomes. Specifically, the project utilizes a randomized and controlled experimental approach that involves participants from two populations (healthcare professionals and healthcare consumers). A pre-treatment survey will be administered to potential participants in both populations. Data will be used to construct four matched pair panels (two for healthcare professionals and two for healthcare consumers), a fifth unmatched panel of healthcare consumers, and a control group of healthcare professionals and consumers. All consumer panels will oversample from AHRQ priority populations. Participants in the four matched pair panels will be randomly assigned for exposure to one of two treatment conditions: (1) education about diagnostic error, or (2) education and deliberation about diagnostic error. The deliberative panels will explore the role(s) patients are willing and able to play in preventing, identifying, ad reporting diagnostic error; the strategies that should be used to enable patients to play those roles; and the systems and structures needed for patients to assume those roles. The first deliberative consumer panel will create informed recommendations about patient-focused strategies for reducing diagnostic error, which will be tested with the fifth (unmatched) deliberative consumer panel, which will also rank and prioritize the recommendations. Project evaluation will use pre-and post-test surveys administered to all panels and the control group. The evaluation design is significant and innovative because it allows for a comparison of the relative effects of no treatment, education only, and education with deliberation on both healthcare consumers and professionals. The evaluation will examine changes in perceptions, attitudes, and knowledge about diagnostic error, patient activation, health literacy, and public deliberation, among other measures. The Society to Improve Diagnosis in Medicine (SIDM) will use the recommendations to develop strategic plans, policy statements, research agendas about patient engagement in reducing diagnostic error, as well as to create a patient engagement "tool kit" for healthcare systems, providers, and consumers. After the project concludes, interviews will be conducted with key SIDM personnel to assess their perceptions of the quality and usefulness of the recommendations, as well as their plans for disseminating and implementing the recommendations.