Armstrong Institute Center for Diagnostic Excellence-Pursuing Scalable System-Level Diagnostic Quality, Value and Equity by Applying Safety Science to Emergency Department Diagnosis

项目摘要（摘要） 这项为期四年的中心赠款提案的长期目标是积极发展和传播 利用安全科学在急诊科（艾德）实现卓越诊断的方法 原则和战略。该提案旨在使艾德诊断的安全性、质量、公平性和 在约翰霍普金斯医学（JHM）现有的中心的价值导向的活动。阿姆斯特朗研究所 卓越诊断中心（DXC）将成为AHRQ赞助的新诊断网络的一部分。 通过RFA-HS-22-008的卓越中心（DCE），本申请对此作出响应。 诊断错误是美国医疗保健中可预防伤害的最大原因，可能影响超过12 每年有100万美国人死亡，导致至少50万人永久残疾或死亡。艾德是一个 已知诊断错误的高风险部位，患者面临误诊相关伤害的风险。实现 为了实现卓越诊断的目标，不仅需要制定改善诊断的战略， 这不仅是为了提高数据的准确性和可靠性，而且是为了查明和克服有效使用和传播数据的障碍。 安全科学应用工程和社会科学专业知识来解决医疗保健领域的危害。 目前，安全I（例如，“查找并修复”）和安全II（例如，“弹性工程”;“高可靠性组织”） 是积极的和不断发展的质量改进方法。安全I战略强调告知危害 通过识别失败的过程和不良事件来预防，而安全II战略需要复杂性和 人为因素对于理解社会技术护理系统对患者安全的影响至关重要， 质量.改进团队通常采用一种或另一种策略，但是，在本建议书中，我们将混合这两种策略 通过双循环学习过程，利用每种方法的优势。“双环” 学习起源于组织科学，强调通过刻意的“Meta”学习， 研究结构和心理规范如何与正常的操作“单环”相互作用 反馈和学习机制。因此，双环学习代表了一种独特的机制， 整合安全I和II战略，从而推进安全科学，追求卓越诊断。 该提案支持的项目将通过研究和质量的结合来追求艾德诊断的卓越性 在JHM内外开展改进活动。我们的跨学科研究团队将 通过三个具体目标追求卓越诊断：（1）针对艾德严重误诊的首要原因- 相关危害;（2）与DCE网络和其他人合作并分享知识;（3）制定JHM DXC的使命的可持续性框架。每个目标将伴随着双循环“Meta” 学习，告知我们对诊断卓越的障碍和促进因素的理解。完成 这些目标将直接减少艾德中的诊断错误/危害，并产生可推广的科学见解， 简化未来创新方法的开发和传播，以实现卓越诊断。

Project Summary (Abstract) This four-year Center grant proposal has as its long-range goal the active development and dissemination of approaches to achieve Diagnostic Excellence in the emergency department (ED) by leveraging safety science principles and strategies. The proposal seeks to mature and focus ED diagnostic safety, quality, equity, and value-oriented activities at an existing Center at Johns Hopkins Medicine (JHM). The Armstrong Institute Center for Diagnostic Excellence (DXC) will become part of a new AHRQ-sponsored network of Diagnostic Centers of Excellence (DCE) via RFA-HS-22-008, to which this application responds. Diagnostic errors are the largest cause of preventable harms in US medical care, likely affecting more than 12 million Americans each year and leading to permanent disability or death for at least 0.5 million. The ED is a known high-risk site for diagnostic errors where patients are at risk for misdiagnosis-related harms. To achieve the goal of Diagnostic Excellence, it will be necessary not only to develop strategies that improve diagnostic accuracy and reliability, but also to identify and overcome barriers to their effective use and dissemination. Safety science applies engineering and social science expertise to address hazards in the health care field. Currently, Safety I (e.g., “find and fix”) and Safety II (e.g., “resilience engineering”; “high reliability organizing”) are active and ever-evolving approaches to quality improvement. Safety I strategies emphasize informing harm prevention by identifying failed processes and adverse events, while Safety II strategies take complexity and human factors as critical to understanding the effects of socio-technical systems of care on patient safety and quality. Often improvement teams adopt one or the other strategy, but, in this proposal, we will blend the two approaches, capitalizing on the strengths of each through the process of double-loop learning. “Double-loop” learning originates from organizational science and emphasizes “meta” learning through deliberate examination of how structural and psychological norms interact with the normal operational “single-loop” mechanisms of feedback and learning. As a result, double-loop learning represents a unique mechanism to integrate Safety I and II strategies and thereby advance safety science in pursuit of Diagnostic Excellence. Projects supported by this proposal will pursue ED Diagnostic Excellence through a mix of research and quality improvement activities both within and beyond the walls of JHM. Our transdisciplinary research team will pursue Diagnostic Excellence via three Specific Aims: (1) target the top causes of ED serious misdiagnosis- related harms; (2) partner and share knowledge with the DCE network and others; and (3) develop a JHM framework for sustainability of the DXC’s mission. Each Aim will be accompanied by double-loop “meta” learning that informs our understanding of barriers and facilitators to Diagnostic Excellence. Accomplishing these Aims will directly reduce diagnostic errors/harms in the ED and yield generalizable scientific insights that streamline future development and dissemination of innovative approaches to achieve Diagnostic Excellence.