Patient-Reported Diagnostic Safety Events in Ambulatory Care Settings: A National Survey of Systemic Influences, Disparities and Persisting Consequences

项目摘要 诊断错误、延迟和相关问题已被证明在门诊环境中普遍存在。 这些经历的患者和家庭报告提供了关于范围、原因和 这些不幸事件的后果。然而，到目前为止，有关患者经历的信息相当有限。 在美国，主要涉及住院治疗或来自几个卫生系统或 自选的患者权益倡导团体。 该项目将提供第一次具有全国代表性的对美国人在和 对门诊护理中的诊断安全性的担忧。部署包含多项创新产品的调查 调查方法，这项研究将(A)比过去的调查更可靠地确定患者报告的安全事件， (B)更充分地引出病人和家属对这些事件的叙述；和(C)更一致 跟踪诊断问题的扩展后果。数据将从3300个美国家庭中收集 在2020年至2025年期间经历了诊断问题。如此大小的样品使得 跨多个环境(包括紧急护理诊所等新出现的站点)和 不同的患者亚群，包括那些历史上最边缘化的患者。 因为建立准确、及时的诊断通常对临床医生具有挑战性，并使人困惑 对于患者及其家人来说，诊断问题在每个医疗系统中都是常见的。但美国人 医疗融资和提供体系尤其分散。我们假设这种碎片化 增加了诊断故障的风险和危害，特别是在门诊环境中。这项研究将测试 这些假设涉及三种形式的不安全：(A)覆盖不安全，与 对医疗保险覆盖范围的焦虑，(B)从患者的困难中出现的指导不安全感 确定可以帮助他们导航诊断流程的临床医生，以及(C)流程不安全，出现 当多个临床医生和护理设置与诊断相关联时，患者的情况不一致 对诊断过程将如何展开的期望。因为这三种形式的不安全感在 在美国的医疗保健方面，我们都可以经验地评估分散对诊断结果的影响 并估计减少这三种形式的碎片化的潜在好处。

Project Summary Diagnostic errors, delays, and related problems have been shown to be widespread in outpatient settings. Patient and family reports of these experiences offer a vital perspective on the scope, causes, and consequences of these mishaps. Yet, to date, information regarding patient experiences has been quite limited in the U.S., largely involving inpatient treatment or limited samples of patients from a few health systems or self-selected patient advocacy groups. This project would provide the first nationally representative estimates of Americans’ experiences with and concerns about diagnostic safety in ambulatory care. Deploying a survey incorporating several innovative survey methods, the study would (a) more reliably identify patient-reported safety events than in past surveys, (b) more fully elicit patient- and family-reported narrative accounts of those events, and (c) more consistently track the extended consequences of diagnostic problems. Data would be collected from 3,300 U.S. households that experienced diagnostic problems between 2020 and 2025. A sample this size makes possible comparisons across multiple settings (including newly emergent sites like urgent care clinics) and among different subgroups of patients, including those most marginalized historically. Because establishing an accurate, timely diagnosis is often challenging for clinicians and confounding to patients and their families, diagnostic problems are common in every healthcare system. But American healthcare financing and delivery systems are especially fragmented. We hypothesize that this fragmentation elevates the risks and harms of diagnostic breakdowns, particularly in outpatient settings. The study will test these hypothesis for three forms of insecurity induced by fragmentation (a) coverage insecurity, linked to anxieties about what healthcare insurance will cover, (b) guidance insecurity, emerging from patients’ difficulty identifying a clinician who can help them navigate the diagnostic process, and (c) process insecurity, emerging when multiple clinicians and care settings are associated with the diagnosis, leaving patients with inconsistent expectations for how the diagnostic process will unfold. Because all three forms of insecurity vary greatly within the American healthcare, we can both empirically assess the impact of fragmentation on diagnostic outcomes and estimate the potential benefits of reducing these three forms of fragmentation.