Diagnostic Safety and Quality Optimization in Sepsis (DISQOS)

每年，数百万美国成年人因疑似败血症住院。目前的指南建议 及时给予抗生素，以降低最终诊断为 败血症然而，诊断方面的挑战阻碍了快速抗生素安全输送到适当的患者。由于 脓毒症相关诊断错误的高患病率和显著相关危害，脓毒症是 “三大”条件优先考虑减少诊断错误的努力。脓毒症治疗不足和治疗过度- 由于误诊相关的伤害，治疗会对人口健康产生重大影响。然而，健康 目前的系统缺乏有效的、根据上下文定制的策略来提高和保持诊断质量 在败血症中（即，正确识别最有可能从治疗中获益的患者，同时避免不良反应 过度治疗的后果）。该项目的目标是提高安全和质量， 使用安全性原则和工具（SaferDx）和实施科学进行早期脓毒症诊断 （实施研究综合框架）。我们的目标是了解哪种败血症诊断 在这些实践中，环境对于准确的早期识别是有效的、必要的或补充的， 治疗到艾德就诊的脓毒症患者，并开发一个工具包，以促进该证据的翻译 付诸实践我们将采用混合方法评估方法来完成这一目标， 完成以下目标：表征和描述i）脓毒症诊断实践（收集的 使用利益相关者调查），ii）作为最佳脓毒症的障碍和促进因素的背景条件 诊断（从利益相关者访谈中获得），和iii）风险调整的脓毒症诊断结果（即，两 治疗不足和过度治疗，使用住院期间的电子健康记录数据测量 2021-2023年）在不同的医院（目标1）;应用巧合分析，以确定脓毒症的组合 诊断实践及其发生的背景对于以下方面来说至少是足够和必要的 实现脓毒症诊断的安全性和质量（即，在治疗不足和过度治疗方面均表现出色 共同设计、传播和评估组织工具包的可用性， 最佳脓毒症诊断实践，并使用经验证的实施结果评估工具包的效用 尺度（目标3）。建议的项目是创新的，利用联合概念，尽量减少两个不足- 和过度治疗，重新构建脓毒症诊断卓越和接近脓毒症诊断作为一个团队， 组织和机构的过程，而不仅仅是个人的决策过程。我们 方法将产生一个可操作的工具包，该工具包在概念上有基础，并以严格的因果关系为依据， 推理方法，并在不同的医院和环境中实施可行。结果将提供 医院可持续和可扩展的方法，以提高脓毒症的诊断安全性和质量， 脓毒症诊断错误的巨大人口健康负担。

Each year, millions of American adults are hospitalized with suspected sepsis. Current guidelines recommend prompt administration of antibiotics to reduce mortality among patients who are ultimately diagnosed with sepsis. However, diagnostic challenges impede safe delivery of rapid antibiotics to appropriate patients. Due to the high prevalence and significant associated harm of sepsis-related diagnostic errors, sepsis is one of the `Big Three' conditions prioritized for diagnostic error reduction efforts. Both sepsis under-treatment and over- treatment have significant population health impact due to misdiagnosis-related harm. However, health systems currently lack effective, contextually tailored strategies to improving and maintaining diagnostic quality in sepsis (i.e., correctly identifying patients most likely to benefit from treatment while avoiding adverse consequences of excessive treatment). The goal of this project is to improve the safety and quality of early sepsis diagnosis using principles and tools of safety (SaferDx) and implementation sciences (Consolidated Framework for Implementation Research). We aim to understand which sepsis diagnosis practices in which contexts are effective, necessary, or complementary for accurate early identification and treatment of sepsis patients presenting to the ED and develop a toolkit to facilitate translation of this evidence into practice. We will apply a mixed-methods evaluation approach to accomplish this by successfully completing the following aims: Characterize and describe variability in i) sepsis diagnosis practices (collected using stakeholder surveys), ii) contextual conditions that serve as barriers and facilitators to optimal sepsis diagnosis (captured from stakeholder interviews), and iii) risk-adjusted sepsis diagnosis outcomes (i.e., both under-treatment and over-treatment, measured using electronic health record data from hospitalizations during 2021-2023) across diverse hospitals (Aim 1); Apply coincidence analysis to identify combinations of sepsis diagnostic practices and the context in which they occur that are minimally sufficient and necessary for achieving sepsis diagnostic safety and quality (i.e., high-performance on both under- and over-treatment outcomes) (Aim 2); and Co-design, disseminate, and evaluate usability of an organizational toolkit to facilitate optimal sepsis diagnostic practices and evaluate the toolkit's utility using validated implementation outcome scales (Aim 3). The proposed project is innovative by leveraging the joint concepts of minimizing both under- and over-treatment in reframing sepsis diagnostic excellence and approaching sepsis diagnosis as a team, organizational, and institutional process, rather than an individual decision-making process alone. Our approach will produce an actionable toolkit that is conceptually grounded, informed by rigorous causal inference methods, and feasible to implement in diverse hospitals and contexts. Results will provide a sustainable and scalable approach for hospitals to advance diagnostic safety and quality in sepsis and reduce the immense population health burden of sepsis diagnostic error.