Diagnostic Safety and Quality Optimization in Sepsis (DISQOS)
Diagnostic Safety and Quality Optimization in Sepsis (DISQOS)
批准号:
10773940
负责人:
Sarah Abigail Birken
金额:
$40.0万
依托单位国家:
美国
项目类别:
财政年份:
2023
资助国家:
美国
项目状态:
未结题
起止时间:
2023-09-30 至 2028-07-31
中文摘要
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
英文摘要
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.
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Where the Rubber Meets the Road: Middle Managers Role in Innovation Implementatio
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批准号:7982763
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项目类别:
-
资助金额:$3.97万
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财政年份:2010
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负责人:Sarah Abigail Birken
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依托单位:
海外基金