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Diagnostic Safety Center for Advancing E-triggers and Rapid Feedback Implementation (DISCOVERI)

推进电子触发和快速反馈实施的诊断安全中心 (DISCOVERI)

基本信息

批准号：
10708961
负责人：
HARDEEP SINGH
金额：
$ 99.41万
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：
2022-09-30 至 2026-09-29
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10708961
关键词：
Diagnostic Safety Center Advancing triggers

项目摘要

Progress in reducing diagnostic errors is slow partly due to poorly defined methods to identify and learn from them. Methods to provide diagnostic safety data to clinicians and leaders can enable them to act upon these data to prevent diagnostic harm. Health care organizations (HCOs) now have an opportunity to explore their increasing stores of electronic health record (EHR) data for learning, research, and quality improvement related to diagnosis. Electronic trigger (e-trigger) tools, which mine vast amounts of clinical and administrative data to identify signals for likely adverse events, offer a promising method to do so. Our work shows e-trigger algorithms can efficiently identify patterns of care suggestive of missed or delayed diagnoses in primary care, emergency care and inpatient settings. Robust review and analysis methods can then uncover safety concerns and provide information on breakdowns related to the diagnostic process, including contributory factors. This information can generate learning and feedback that could be used for improvement by individuals and teams. However, despite their potential use for measurement and improvement of diagnostic safety, e-triggers are still largely confined to research and not yet translated into practice. We thus propose developing the “Diagnostic Safety Center for Advancing E-triggers and Rapid Feedback Implementation (DISCOVERI)” with a goal of implementing surveillance and feedback systems for diagnostic safety in HCOs. Our long-term goal is to accelerate uptake of e-triggers for measurement of diagnostic safety across the US in organizations that value Learning and Exploration of Diagnostic Excellence (LEDE organizations). DISCOVERI will help create generalizable knowledge, tools, strategies and methods for an e-trigger based learning and feedback system for improving diagnostic safety within LEDE organizations. Specific aims are: Aim 1: Create tools, strategies, and methods to implement e-trigger algorithms for diagnostic error surveillance and prevention in LEDE organizations. Aim 2: Develop and evaluate Safety-I and Safety-II related methods for providing clinicians and health care organizations with rapid diagnostic performance feedback. Aim 3: Synthesize implementation experiences to develop a safety surveillance system “Safer Dx e-Watch” to facilitate large-scale implementation efforts in US health systems. We will work with 3 health systems and use multiple qualitative and quantitative methods involving hybrid in- person and virtual participatory approaches. We will define processes for how e-trigger data can be gathered from EHRs and delivered as feedback for learning and improvement to organizational leaders and clinicians. We will leverage our experience in translating research to improve practice and disseminating and implementing interventions. Knowledge and methods generated by DISCOVERI will accelerate implementation of an e-trigger based learning and feedback system to prevent harm from diagnostic error at a national scale.

减少诊断错误的进展缓慢，部分原因是识别和学习的方法定义不清他们向临床医生和领导者提供诊断安全数据的方法可以使他们能够根据这些数据采取行动数据，以防止诊断伤害。卫生保健组织（HCO）现在有机会探索其增加用于学习、研究和质量改进的电子健康记录（EHR）数据存储与诊断有关。电子触发器（e-trigger）工具，可挖掘大量的临床和行政数据来识别可能的不良事件的信号，提供了一种很有前途的方法。我们的工作表明，算法可以有效地识别提示初级护理中漏诊或延迟诊断的护理模式，急诊护理和住院治疗。强大的审查和分析方法可以发现安全问题并提供与诊断过程有关的故障信息，包括促成因素。这信息可以产生学习和反馈，可用于个人和团队的改进。然而，尽管它们在测量和改善诊断安全性方面具有潜在的用途，但电子触发器仍然是主要局限于研究，尚未转化为实践。因此，我们建议开发“诊断推进电子触发器和快速反馈实施安全中心（DISCOVERI）”的目标是在人道主义事务协调员办公室实施诊断安全监督和反馈系统。我们的长期目标是在美国各地重视诊断安全性的组织中加速采用电子触发器，学习和探索卓越诊断（LEDE组织）。DISCOVERI将帮助创建用于基于电子触发器的学习和反馈系统的可推广知识、工具、策略和方法提高LEDE组织内的诊断安全性。具体目标是：目标1：创建工具、策略和方法，以实现用于诊断错误监视的电子触发器算法和预防。目标2：开发和评价安全性-I和安全性-II相关方法，为临床医生和医疗保健提供服务快速诊断性能反馈的组织。目标3：综合实施经验，开发安全监督系统“Safer Dx e-Watch”，促进美国卫生系统的大规模实施工作。我们将与3个卫生系统合作，并使用多种定性和定量方法，包括混合- 个人和虚拟参与方法。我们将定义如何收集电子触发器数据的流程并作为反馈提供给组织领导者和临床医生，以供学习和改进。我们将利用我们在翻译研究方面的经验来改进实践和传播，实施干预措施。DISCOVERI产生的知识和方法将加速实施一个基于电子触发器的学习和反馈系统，以防止全国范围内的诊断错误造成的伤害。