The Epidemiology of Diagnostic Error in Emergency Care in the United States and the Association with Patient Outcomes and Healthcare Costs

诊断错误被认为是常见的，昂贵的，并与实质性的患者伤害有关 in the United States（美国）.卫生保健研究和质量机构最近的一份报告显示， （AHRQ）强调了解决紧急护理中诊断错误的重要性，并呼吁 进一步研究美国紧急情况下当代诊断错误率 部门（ED）。艾德就诊很常见，五分之一的美国人去艾德就诊， 每年有1.3亿艾德就诊。紧急情况下的诊断准确性至关重要， 最佳的患者结果。然而，艾德的本质，包括不可预测的病人 数量，有限的时间和可用信息，以及频繁的中断，可以使 艾德挑战性的诊断准确性。虽然已经有大量的关注， 急诊护理质量的变化，相对较少的研究 艾德的诊断安全性，正如最近的AHRQ报告所强调的那样。This project will use 代表性的国家索赔数据，以提供详细的证据， 美国ED的错误我们将量化高风险紧急情况的诊断错误率 以及与这些疾病相关的常见症状。此外，我们将研究 急诊护理中诊断错误与患者伤害相关的程度。我们将 确定与诊断错误风险较大相关的患者、临床医生和医院因素。 最后，我们将检查在艾德诊断错误后进行门诊随访是否可以 减轻与误诊相关的危害。这项全国性研究将使前线 临床医生和政策制定者了解美国ED诊断错误的程度 这些因素可能是质量改进工作的目标，以解决这一重要的公众问题。 健康问题。

Diagnostic error is thought to be common, costly, and associated with substantial patient harm in the United States (U.S.). A recent report by the Agency for Healthcare Research and Quality (AHRQ) highlighted the importance of addressing diagnostic error in emergency care and called for additional research examining contemporary diagnostic errors rates in U.S. emergency departments (EDs). ED visits are common, with 1 in 5 Americans visiting the ED, leading to over 130 million ED visits annually. Diagnostic accuracy for emergency conditions is essential for optimal patient outcomes. Yet, the very nature of the ED, including unpredictable patient volume, limited time and available information, as well as frequent interruptions, can make diagnostic accuracy in the ED challenging. While there has been substantial attention paid to the variation in the quality of emergency care, there has been relatively less research on diagnostic safety in the ED, as highlighted by the recent AHRQ report. This project will use representative national claims data to provide detailed evidence on the landscape of diagnostic error in U.S. EDs. We will quantify the rate of diagnostic error for high-risk emergency conditions as well as the common symptoms associated with these diseases. Additionally, we will examine the degree to which diagnostic error in emergency care is associated with patient harm. We will identify the patient, clinician, and hospital factors associated with greater risk of diagnostic error. Finally, we will examine if having an ambulatory follow-up visit after an ED diagnostic error can mitigate the harms associated with misdiagnosis. This national study will enable frontline clinicians and policymakers to understand the extent of diagnostic error in U.S. EDs and the factors that may be targeted for quality improvement efforts to address this important public health problem.