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拨款方案的长期目标是积极发展和传播 利用安全科学实现急诊科(ED)卓越诊断的方法 原则和战略。该提案寻求成熟和关注ED诊断的安全性、质量、公平性和 约翰霍普金斯医学院(JHM)现有中心的价值导向活动。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 卓越中心(DCE)通过RFA-HS-22-008，本申请对此做出响应。 诊断错误是美国医疗保健中可预防的损害的最大原因，可能影响到12个以上 每年有100万美国人，并导致至少50万人永久残疾或死亡。教育署是一间 已知的诊断错误高危场所，患者面临与误诊相关的危害风险。要实现 要实现卓越诊断的目标，不仅需要制定改进诊断的策略 这不仅是为了确保其准确性和可靠性，而且也是为了查明和克服有效使用和传播这些信息的障碍。 安全科学应用工程学和社会科学的专业知识来解决卫生保健领域的危险。 目前，安全一期(如“查找和修复”)和安全二期(如“复原力工程”；“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 通过识别失败的流程和不良事件进行预防，而安全II战略则采取复杂性和 人的因素对于理解社会技术护理系统对患者安全和 质量。改进团队通常采用一种或另一种策略，但是，在这个提案中，我们将把这两种策略结合起来 方法，通过双环学习过程，利用各自的长处。“双环” 学习起源于组织科学，强调通过刻意的元学习 考察结构和心理规范如何与正常运行的“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和安全II战略，从而推动安全科学追求卓越诊断。 这项提案支持的项目将通过研究和质量的组合来追求ED诊断卓越 在JHM内部和外部的改进活动。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)针对导致ED严重误诊的首要原因- 相关危害；(2)与DCE网络和其他机构合作并分享知识；以及(3)制定JHM DXC使命的可持续性框架。每一个目标都将伴随着双循环的“元” 通过学习，我们了解了通往卓越诊断的障碍和促进者。完成 这些目标将直接减少急诊室的诊断错误/危害，并产生可推广的科学见解 简化未来开发和传播创新方法，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.