Diagnostic Safety and Quality Optimization in Sepsis (DISQOS)

脓毒症诊断安全性和质量优化 (DISQOS)

• 批准号: 10773940
• 负责人: Sarah Abigail Birken
• 金额: $ 40万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10773940
• 关键词: Diagnostic; Safety; Quality; Optimization; Sepsis

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.

每年，数百万美国成年人因疑似败血症而住院。目前的指南建议 及时使用抗生素以降低最终诊断出患有此病的患者的死亡率 败血症。然而，诊断挑战阻碍了向适当患者安全地提供快速抗生素。由于 脓毒症相关诊断错误的发生率很高且具有显着的相关危害，脓毒症是其中之一 “三大”条件优先考虑减少诊断错误的工作。败血症治疗不足和过度治疗 由于误诊相关危害，治疗会对人群健康产生重大影响。然而，健康 系统目前缺乏有效的、根据具体情况量身定制的策略来提高和维持诊断质量 在脓毒症中（即，正确识别最有可能从治疗中受益的患者，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 使用安全原理和工具 (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脓毒症诊断 背景对于准确的早期识别和补充来说是有效的、必要的或补充的实践 治疗到急诊科就诊的脓毒症患者并开发工具包以促进这些证据的转化 付诸实践。我们将采用混合方法评估方法来成功实现这一目标 完成以下目标： 描述并描述 i) 脓毒症诊断实践的变异性（收集 使用利益相关者调查），ii）作为最佳败血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取），以及 iii) 风险调整后的脓毒症诊断结果（即， 治疗不足和过度治疗，使用住院期间的电子健康记录数据进行测量 2021-2023）跨不同医院（目标 1）；应用巧合分析来识别脓毒症的组合 诊断实践及其发生的背景至少是充分和必要的 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 结果）（目标 2）；共同设计、传播和评估组织工具包的可用性，以促进 最佳败血症诊断实践并使用经过验证的实施结果评估工具包的实用性 规模（目标 3）。拟议的项目是创新的，利用了最大限度减少欠下的联合概念 以及过度治疗，重新构建脓毒症诊断卓越性并作为一个团队进行脓毒症诊断， 组织和制度过程，而不是单独的个人决策过程。我们的 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，并且可以在不同的医院和环境中实施。结果将提供 医院采用可持续且可扩展的方法来提高脓毒症的诊断安全性和质量，并减少 脓毒症诊断错误造成巨大的人口健康负担。