Safety II Together: Coupling teaming science with patient engagement and health information transparency to coproduce diagnostic excellence

Safety II Together：将科学与患者参与和健康信息透明度结合起来，共同创造卓越的诊断

• 批准号: 10849649
• 负责人: SIGALL BELL
• 金额: $ 96.68万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 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 2026-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10849649
• 关键词: Safety; II; Together; Coupling; teaming

Ambulatory diagnostic error is a vexing problem because events unfold across time with shifting team members. Accurate and timely diagnosis relies on keeping patients and health care professionals (HCPs) on the same page, both in and between clinic visits. Experts urge shared mental models (SMMs) of the diagnostic process (DxP), because research shows their central role for effective team communication and coordination. Yet little is known about how patients and HCPs develop and sustain SMMs, especially in the dynamic setting of the DxP. While we have many examples of diagnostic errors in Safety-I research, there are few models of “what good looks like” using a Safety-II lens. Since diagnostic excellence relies on factors and interactions beyond any single HCP, progress will require identifying specific teaming behaviors that help patients and HCPs to coproduce safety at known DxP risk points. We will close this foundational knowledge gap. We will then develop and disseminate tools to support patients, care partners, interpreters and clinicians as active contributors to the DxP through 3 partnering national organizations. In our current AHRQ grant, we learned that patients have unique insights about the DxP, including identification of “diagnostic blindspots” – events or conditions pertaining to DxP safety that HCPs or systems may not observe. These include events occurring between visits, omissions, and misalignments stemming from lack of a SMM between patients and HCPs. Interestingly, online access to visit notes (“open notes”) – now nearly universal through 2021 federal legislation – may help development of SMMs because patients can gain context on HCP perspectives and potential gaps in their understanding by reading notes. One sobering finding was that the most common contributing factor to patient-reported diagnostic error was not feeling heard. Based on these data, we designed an online tool – OurDX – to elicit patient priorities, histories, and potential concerns. We found that patients with limited English proficiency (LEP) were 5x as likely to report not feeling heard, and older patients with poorer health were more likely to identify a diagnostic blindspot. Teams that work need new approaches to share information, to listen, and to respond, especially since harnessing the unique knowledge of each member (including early identification of otherwise undetected blindspots) can increase system resilience. Our diagnostic center of excellence – Safety2gether – is based on innovative and disciplined coupling of teaming science with patient engagement to coproduce diagnostic safety, with a focus on safety-II principles and priority populations: LEP and elderly patients with chronic illness and their care partners. Safety2gether will partner with patients, train learners, define future research questions, foster collaborations, and share multistakeholder tools through 3 national organizations to both learn from, and serve as a resource for, other DCEs. Our team is specifically curated with over a decade of expertise in teaming, diagnostic safety and patient engagement, and is uniquely poised to help build safety equity through an evidence-based emphasis on listening and resilience.

门诊诊断错误是一个令人烦恼的问题，因为随着时间的推移， 成员准确和及时的诊断依赖于患者和医疗保健专业人员（HCP）保持 同一页，无论是在诊所访问和之间。专家敦促诊断的共享心理模型（SMM） 这是因为研究表明，他们在有效的团队沟通和协调中发挥着核心作用。 然而，关于患者和HCP如何发展和维持SMM，特别是在动态环境中， 关于DxP虽然我们在安全I研究中有许多诊断错误的例子，但很少有模型 “什么是好的样子”使用安全-II透镜。由于诊断的卓越性依赖于因素和相互作用 除了任何一个单一的HCP，进步将需要确定特定的团队行为，帮助患者， HCP在已知DxP风险点共同产生安全性。我们将缩小这一基础知识差距。我们将 然后开发和传播工具，以支持患者、护理伙伴、口译员和临床医生积极参与 通过3个合作的国家组织为DxP做出贡献。在我们目前的AHRQ赠款中，我们了解到， 患者对DxP有独特的见解，包括识别“诊断盲点”-事件或 HCP或系统可能未遵守的与DxP安全性相关的条件。其中包括发生在 由于患者和HCP之间缺乏SMM而导致的访视、遗漏和不一致。 有趣的是，在线访问访问笔记（“开放笔记”）-现在几乎普遍通过2021年联邦立法 - 可能有助于SMM的开发，因为患者可以获得HCP观点和潜在差距的背景 通过阅读笔记来提高他们的理解力。一个发人深省的发现是， 患者报告的诊断错误感觉不到。基于这些数据，我们设计了一个在线工具- OurDX -引出患者的优先事项、历史和潜在问题。我们发现英语水平有限的病人 熟练程度（LEP）的患者报告感觉不到被倾听的可能性是5倍，健康状况较差的老年患者更多 可能会发现诊断盲点工作的团队需要新的方法来分享信息，倾听， 并作出反应，特别是因为利用每个成员的独特知识（包括早期 否则未检测到的盲点的识别）可以增加系统弹性。我们的诊断中心 卓越-Safety 2gether-基于科学与患者合作的创新和纪律耦合 参与共同生产诊断安全，重点是安全II原则和优先人群：LEP 以及长期病患者和他们的护理伙伴。Safety 2gether将与患者合作，培训 学习者，定义未来的研究问题，促进合作，并通过3个共享多利益相关者工具 国家组织向其他地区选举委员会学习，并为其他地区选举委员会提供资源。我们的团队专门 在团队合作、诊断安全和患者参与方面拥有十多年的专业知识， 准备通过以证据为基础的重视倾听和复原力来帮助建立安全公平。