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Developing e-Triggers to Detect Telemedicine Related Diagnostic Safety Events

开发电子触发器来检测远程医疗相关的诊断安全事件

基本信息

批准号：
10686925
负责人：
Daniel R Murphy
金额：
$ 40万
依托单位：
BAYLOR COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10686925
关键词：
Developing Triggers Detect Telemedicine Related

项目摘要

Despite the benefits of a rapid, large-scale deployment of telemedicine in the US, making an accurate diagnosis via telemedicine involves several potential challenges that warrant further study. Currently, it is not well known how telemedicine implementation impacts ‘telediagnosis,’ defined as the co-production of an accurate and timely explanation of a patient’s health problems through remote interactions and transmitted data, including the clear communication of that explanation to the patient. But early evidence of telemedicine- related misdiagnosis is already emerging even though the precise frequency of diagnostic errors related to telemedicine visits and the factors that contribute to these diagnostic errors are unknown. Even before the global pandemic, diagnostic errors were common and underreported in health care. The goal of this project is to identify contributory factors for telediagnosis errors, develop methods to efficiently detect them, and enable risk-assessment strategies to prevent them. We will first use qualitative methods to understand factors increasing the risk of telediagnosis errors and identify what clues can be used to detect a telediagnosis error. We will then use these findings to develop electronic triggers (e-triggers, i.e., tools to mine vast amounts of clinical and administrative data to identify signals for likely adverse events) to identify telemedicine-related diagnostic errors. We will thus build on our prior work on using e-trigger algorithms to detect patterns of care suggestive of missed or delayed diagnoses. Review and analysis of e-trigger identified cases can uncover safety concerns and provide information on breakdowns related to the diagnostic process and contributory factors. This will generate learning and feedback for improvement efforts by individuals, teams, and healthcare organizations. Finally, we will perform co-design workshops and use these findings to develop a self- assessment tool for systems, providers, and patients to identify and mitigate the risk of telediagnosis errors. The project will capitalize on our existing strong collaborative partnerships at Baylor College of Medicine and the U.S. Department of Veterans Affairs (VA) and leverage databases containing electronic health records (EHRs) from over 10 million individuals to accomplish the following specific aims. Aim 1: Evaluate factors that increase the risk of telediagnosis errors using interviews with clinicians, staff, patient safety personnel, telemedicine experts and patients. Aim 2: Develop e-triggers to identify telemedicine-related diagnostic errors and identify potential contributory factors. Aim 3: Develop a self-assessment tool to evaluate the risk of telemedicine-related diagnostic errors. A portfolio of e-triggers to identify errors can be used for quality improvement activities and implementation of solutions to reduce error. The risk assessment tool will enable health systems, providers, and patients to self- assess their risk for telediagnosis errors, and act prospectively to reduce such risks.

尽管在美国快速、大规模部署远程医疗的好处，通过远程医疗进行诊断涉及若干潜在挑战，需要进一步研究。目前，众所周知，远程医疗的实施如何影响“远程诊断”，“远程诊断”被定义为共同生产一个通过远程交互准确及时地解释患者的健康问题，数据，包括向患者明确传达该解释。但是远程医疗的早期证据相关的误诊已经出现，即使诊断错误的确切频率与远程医疗就诊和导致这些诊断错误的因素尚不清楚。还没全球大流行，诊断错误是常见的，在卫生保健中报告不足。这个项目的目标是识别远程诊断错误的促成因素，开发有效检测它们的方法，并使风险评估战略，以防止它们。我们将首先使用定性方法来了解因素增加了远程诊断错误的风险，并确定可以使用什么线索来检测远程诊断错误。然后，我们将使用这些发现来开发电子触发器（e触发器，即，工具来开采大量识别可能的不良事件信号的临床和管理数据），以识别与远程医疗相关的诊断错误。因此，我们将建立在我们以前的工作上，使用电子触发算法来检测护理模式提示漏诊或延误诊断审查和分析电子触发器确定的案例可以发现安全问题，并提供与诊断过程和促成因素有关的故障信息因素这将为个人、团队和医疗保健的改进工作提供学习和反馈组织的最后，我们将进行共同设计研讨会，并利用这些发现来开发一个自我，系统、提供者和患者的评估工具，以识别和减轻远程诊断错误的风险。该项目将利用我们在贝勒医学院现有的强大合作伙伴关系，美国退伍军人事务部（VA），并利用包含电子健康记录的数据库（EHR）超过1000万人，以实现以下具体目标。目的1：通过与临床医生的访谈，评估增加远程诊断错误风险的因素，工作人员、患者安全人员、远程医疗专家和患者。目标2：开发电子触发器，以查明与远程医疗有关的诊断错误并查明潜在的贡献因素。目标3：开发自我评估工具，以评价与远程医疗有关的诊断错误的风险。用于识别错误的电子触发器组合可用于质量改进活动和解决方案，以减少错误。风险评估工具将使卫生系统、提供者和患者能够自我评估，评估他们的远程诊断错误的风险，并采取前瞻性行动，以减少这种风险。