Averting Diagnostic Error Through Improved Recognition of Child Abuse

通过提高对虐待儿童的认识来避免诊断错误

• 批准号: 10696104
• 负责人: Irit R Rasooly
• 金额: $ 14.19万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10696104
• 关键词: Averting; Diagnostic; Error; Through; Improved

Project Summary/Abstract Dr. Irit R. Rasooly’s goal is to become an independent clinician scientist dedicated to promoting accurate, timely, and equitable pediatric diagnosis. To further develop the novel skillset necessary to apply data-driven, systems-informed approaches to improve diagnosis, Dr. Rasooly’s career development plan incorporates mentored research and training in clinical informatics, longitudinal analysis, human factors engineering, implementation science, and trauma informed care. She will be mentored by experienced investigators with whom she has established, productive collaborative relationships: Dr. Christopher P. Bonafide (Primary Mentor) is an expert in developing, evaluating, and implementing interventions at the intersection of patient safety and technological innovation. Dr. Joanne N. Wood (Co-Mentor) is an expert in child physical abuse research whose scholarship has focused on racial disparities and variation in abuse evaluations. Dr. Kathy Shaw (Co-Mentor) is a national and intuitional leader in patient safety science and diagnostic error. The Children’s Hospital of Philadelphia and University of Pennsylvania are deeply supportive of Dr. Rasooly’s work and provide an unparalleled research training environment. Missed diagnosis of child abuse, in which abusive injury goes unrecognized or is misattributed to accidental trauma, is among the gravest examples of pediatric diagnostic error and a serious threat to pediatric health. While electronic health record (EHR) clinical decision support (CDS) has shown promise in improving timeliness and reducing disparities in abuse diagnosis in emergency department settings, there is a critical need for strategies to support diagnosis in primary care, where most pediatric care is delivered and where there may be opportunity to intervene before children sustain serious injuries. To lay the groundwork for creation of CDS to improve abuse diagnosis in primary care, the objective of this work is to apply EHR data- and systems-analysis to inform identification of strategies to support diagnosis of child physical abuse in primary care. Specific aims are to: (1) Detect and validate markers of physical abuse in longitudinal, clustered, EHR-derived data to distinguish young children experiencing abuse from matched controls, (2) Determine causes of abuse-related diagnostic error in primary care by conducting scenario-based high-fidelity human factors engineering EHR simulations, and (3) Identify and prioritize feasible, acceptable, and appropriate CDS strategies through a consensus approach. Findings will inform development of CDS to be tested in a future multi-center, R01 funded clinical trial. Completion of the proposed research and training will position Dr. Rasooly to launch an independent research career advancing pediatric diagnostic excellence and reducing health disparities in primary care, thereby addressing multiple AHRQ research priority areas.

项目概要/摘要 Irit R. Rasooly 博士的目标是成为一名独立的临床科学家，致力于促进准确、 及时、公平的儿科诊断。为了进一步发展应用数据驱动所需的新颖技能， Rasooly 博士的职业发展计划包括采用基于系统的方法来改进诊断 指导临床信息学、纵向分析、人因工程的研究和培训， 实施科学和创伤知情护理。她将接受经验丰富的调查员的指导 她与之建立了富有成效的合作关系：Christopher P. Bonafide 博士（小学 Mentor）是开发、评估和实施针对患者交叉点的干预措施的专家 安全和技术创新。 Joanne N. Wood 博士（共同导师）是儿童身体虐待方面的专家 这项研究的学术重点是种族差异和虐待评估的差异。凯西博士 Shaw（共同导师）是患者安全科学和诊断错误领域的全国性直觉领导者。这 费城儿童医院和宾夕法尼亚大学大力支持 Rasooly 博士的工作 并提供无与伦比的研究培训环境。虐待儿童的漏诊，其中虐待 伤害未被识别或被错误地归因于意外创伤，是儿科最严重的例子之一 诊断错误严重威胁儿科健康。电子健康记录 (EHR) 临床决策 支持（CDS）在提高滥用诊断的及时性和减少差异方面表现出了希望 急诊科环境中，迫切需要制定支持初级保健诊断的策略， 提供大多数儿科护理的地方，以及在儿童维持生命之前可能有机会进行干预的地方 严重受伤。为了为 CDS 的创建奠定基础，以改善初级保健中的滥用诊断， 这项工作的目标是应用电子病历数据和系统分析来确定战略 支持初级保健中儿童身体虐待的诊断。具体目标是： (1) 检测和验证标记 纵向、集群、电子病历衍生数据中的身体虐待情况，以区分遭受虐待的幼儿 根据匹配的对照，(2) 通过进行以下操作来确定初级保健中与滥用相关的诊断错误的原因： 基于场景的高保真人因工程 EHR 模拟，以及 (3) 识别并确定优先级 通过共识方法制定可行、可接受且适当的 CDS 策略。调查结果将告知 CDS 的开发将在未来的多中心 R01 资助的临床试验中进行测试。完成拟议的 研究和培训将使 Rasooly 博士开启独立的研究生涯，推动儿科发展 卓越诊断并减少初级保健中的健康差异，从而解决多个 AHRQ 研究优先领域。

项目成果

Opportunities for Diagnostic Improvement Among Pediatric Hospital Readmissions.

儿科再入院诊断改进的机会。

• DOI: 10.1542/hpeds.2023-007157
• 发表时间: 2023
• 期刊: Hospital pediatrics
• 作者: Congdon,Morgan;Rauch,Bridget;Carroll,Bryn;Costello,Anna;Chua,WinonaD;Fairchild,Victoria;Fatemi,Yasaman;Greenfield,MorganE;Herchline,Daniel;Howard,Alexandra;Khan,Amina;Lamberton,CourtneyE;McAndrew,Lisa;Hart,Jessica;Shaw,Kath
• 通讯作者: Shaw,Kath