Targeted EHR-based Communication of Diagnostic Uncertainty (TECU) in the ED: An Effectiveness Implementation Trial

急诊室中基于 EHR 的有针对性的诊断不确定性沟通 (TECU)：有效性实施试验

• 批准号: 10830108
• 负责人: Danielle M McCarthy
• 金额: $ 50万
• 依托单位: THOMAS JEFFERSON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10830108
• 关键词: Targeted; EHR; based; Communication; Diagnostic

PROJECT SUMMARY At least 37% of patients treated in the emergency department (ED) are discharged without a definitive diagnosis, thus leaving the encounter with diagnostic uncertainty. Transitions of care are high-risk periods for patient safety, especially when patients are discharged with diagnostic uncertainty, and thus are still within the diagnostic process. Effective communication between clinicians and patients is essential to improve the quality of these care transitions. In prior AHRQ-funded research, we developed several tools to support high quality discharge in the setting of diagnostic uncertainty, including a communication checklist, a training program for physicians in uncertainty communication, and a patient-facing 1-page information sheet about being discharged with uncertainty. We now propose to leverage the electronic health record (EHR) to implement a multifaceted strategy to facilitate higher quality discharge transitions for patients discharged from the ED with diagnostic uncertainty. Our Targeted EHR-based Communication about Uncertainty (TECU) strategy will be activated every time an ED clinician enters an uncertain diagnosis for a patient being discharged, and will notify the clinician to counsel the patient about uncertainty while additionally triggering automated 1) insertion and printing of the patient handout, 2) printing of the clinician-facing checklist to guide the discharge conversation, and 3) sending of an inbox message to the primary care provider (PCP). We will conduct a pre- post pilot trial with a hybrid type 1 effectiveness implementation design with the goals of: 1) Testing the preliminary effectiveness of TECU compared to standard of care in reducing patient uncertainty and return ED visits and 2) Evaluating the adoption of TECU and exploring patient and clinician barriers and facilitators to TECU implementation. This work will be led by experienced researchers with expertise in health services research, clinical trials in emergency medicine, patient communication, health literacy, diagnostic uncertainty, informatics, and implementation science. The TECU strategy will be easily disseminated as it will be built in Epic, the world’s leading EHR vendor, and will be available for health systems to implement through the Epic Community Library. This project has potential to significantly impact the quality and safety of care transitions for the one-third of patients leaving the emergency department with diagnostic uncertainty.

项目摘要 在急诊科（艾德）接受治疗的患者中，至少有37%在没有明确诊断的情况下出院。 诊断，从而使遇到诊断不确定性。护理的过渡是高风险时期， 患者安全，特别是当患者出院时诊断不确定，因此仍在 诊断过程。临床医生和患者之间的有效沟通是提高质量的关键 这些护理过渡。在之前AHRQ资助的研究中，我们开发了几种工具来支持高质量的 在诊断不确定性的情况下出院，包括沟通检查表， 医生在不确定性的沟通，和一个面向病人的1页信息表， 带着不确定性出院。我们现建议利用电子健康记录，推行 多方面的策略，以促进从艾德出院的患者更高质量的出院过渡， 诊断不确定性我们的目标EHR为基础的沟通不确定性（TECU）战略将是 每当艾德临床医生为出院患者输入不确定的诊断时激活， 通知临床医生就不确定性向患者提出建议，同时另外触发自动1）插入 和打印患者讲义，2）打印面向临床医生的检查表，以指导出院 对话，以及3）将收件箱消息发送给初级保健提供者（PCP）。我们将进行预- 采用混合型1有效性实施设计的试点试验后，目标是：1）测试 与标准治疗相比，TECU在减少患者不确定性和恢复艾德方面的初步有效性 访视和2）评估TECU的采用，并探索患者和临床医生的障碍和促进者， 执行TECU。这项工作将由具有卫生服务专业知识的经验丰富的研究人员领导 研究，急诊医学临床试验，患者沟通，健康素养，诊断不确定性， 信息学和实施科学。TECU战略将很容易传播，因为它将内置于 Epic是全球领先的EHR供应商，将通过Epic提供给卫生系统实施 社区图书馆。该项目有可能对护理过渡的质量和安全产生重大影响 三分之一的病人在离开急诊室时诊断不确定。