Diagnostic Safety Center for Advancing E-triggers and Rapid Feedback Implementation (DISCOVERI)

在减少诊断错误方面进展缓慢，部分原因是识别和学习的方法定义不明确 他们。向临床医生和领导提供诊断安全数据的方法可以使他们根据这些数据采取行动 防止诊断损害的数据。医疗保健组织(HCO)现在有机会探索他们的 增加用于学习、研究和质量改进的电子健康记录(EHR)数据的存储 与诊断有关。电子触发(e-rigger)工具，可挖掘大量临床和管理信息 识别可能不良事件的信号的数据提供了一种很有希望的方法。我们的工作显示了电子触发器 算法可以有效地识别提示初级保健中遗漏或延迟诊断的护理模式， 急诊护理和住院设置。可靠的审查和分析方法可以发现安全问题 并提供与诊断过程有关的分类信息，包括促成因素。这 信息可以产生学习和反馈，供个人和团队改进。 然而，尽管它们可能用于测量和提高诊断安全性，但电子触发器仍然 主要局限于研究，尚未转化为实践。因此，我们建议发展“诊断学” 高级电子触发器和快速反馈实施安全中心(DISCOVERI)的目标是 为HCO的诊断安全实施监测和反馈系统。我们的长期目标是 在美国各地重视诊断安全性的组织中，加快采用电子触发器来衡量诊断安全性 卓越诊断的学习和探索(Lede组织)。DISCOVERI将帮助创建 用于基于电子触发器的学习和反馈系统的概括性知识、工具、策略和方法 用于提高Lede组织内的诊断安全性。具体目标是： 目标1：创建工具、策略和方法，以实现诊断错误监视的e-Trigger算法 以及利德组织中的预防。 目标2：开发和评估提供临床医生和保健服务的安全-I和安全-II相关方法 具有快速诊断性能反馈的组织。 目标三：综合实施经验，发展安全监察系统“Safer Dx e-Watch”，以 促进美国卫生系统的大规模实施工作。 我们将与3个卫生系统合作，并使用多种定性和定量方法，涉及混合在- 个人和虚拟参与式方法。我们将定义如何收集电子触发器数据的流程 并作为学习和改进的反馈提供给组织领导人和临床医生。 我们将利用我们在翻译研究方面的经验来改进实践和传播 实施干预措施。DISCOVERI产生的知识和方法将加快实施 建立一个基于电子触发器的学习和反馈系统，在全国范围内防止诊断错误造成的伤害。

Progress in reducing diagnostic errors is slow partly due to poorly defined methods to identify and learn from them. Methods to provide diagnostic safety data to clinicians and leaders can enable them to act upon these data to prevent diagnostic harm. Health care organizations (HCOs) now have an opportunity to explore their increasing stores of electronic health record (EHR) data for learning, research, and quality improvement related to diagnosis. Electronic trigger (e-trigger) tools, which mine vast amounts of clinical and administrative data to identify signals for likely adverse events, offer a promising method to do so. Our work shows e-trigger algorithms can efficiently identify patterns of care suggestive of missed or delayed diagnoses in primary care, emergency care and inpatient settings. Robust review and analysis methods can then uncover safety concerns and provide information on breakdowns related to the diagnostic process, including contributory factors. This information can generate learning and feedback that could be used for improvement by individuals and teams. However, despite their potential use for measurement and improvement of diagnostic safety, e-triggers are still largely confined to research and not yet translated into practice. We thus propose developing the “Diagnostic Safety Center for Advancing E-triggers and Rapid Feedback Implementation (DISCOVERI)” with a goal of implementing surveillance and feedback systems for diagnostic safety in HCOs. Our long-term goal is to accelerate uptake of e-triggers for measurement of diagnostic safety across the US in organizations that value Learning and Exploration of Diagnostic Excellence (LEDE organizations). DISCOVERI will help create generalizable knowledge, tools, strategies and methods for an e-trigger based learning and feedback system for improving diagnostic safety within LEDE organizations. Specific aims are: Aim 1: Create tools, strategies, and methods to implement e-trigger algorithms for diagnostic error surveillance and prevention in LEDE organizations. Aim 2: Develop and evaluate Safety-I and Safety-II related methods for providing clinicians and health care organizations with rapid diagnostic performance feedback. Aim 3: Synthesize implementation experiences to develop a safety surveillance system “Safer Dx e-Watch” to facilitate large-scale implementation efforts in US health systems. We will work with 3 health systems and use multiple qualitative and quantitative methods involving hybrid in- person and virtual participatory approaches. We will define processes for how e-trigger data can be gathered from EHRs and delivered as feedback for learning and improvement to organizational leaders and clinicians. We will leverage our experience in translating research to improve practice and disseminating and implementing interventions. Knowledge and methods generated by DISCOVERI will accelerate implementation of an e-trigger based learning and feedback system to prevent harm from diagnostic error at a national scale.