Diagnostic Safety and Quality Optimization in Sepsis (DISQOS)

每年，数百万美国成年人因疑似败血症而住院。目前的指导方针建议 及时给予抗生素，以降低最终被诊断为霍乱的患者的死亡率 败血症。然而，诊断方面的挑战阻碍了将快速抗生素安全地提供给适当的患者。由于 脓毒症相关诊断错误的高发生率和重大相关危害，脓毒症是 “三大”条件优先用于减少诊断错误的努力。脓毒症正在接受治疗和过度- 由于误诊相关的危害，治疗对人群健康有重大影响。然而，健康 系统目前缺乏有效的、根据具体情况量身定做的策略来提高和保持诊断质量 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 (执行研究综合框架)我们的目标是了解哪个败血症的诊断 上下文对于准确的早期识别是有效的、必要的或补充的实践 向急诊室提交的脓毒症患者的治疗，并开发一个工具包来促进这一证据的翻译 付诸实践。我们将应用一种混合方法的评估方法来实现这一点，方法是成功 完成以下目标：描述和描述1)败血症诊断实践中的可变性(收集 利用利益相关者调查)，二)作为最佳脓毒症的障碍和促进者的环境条件 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(即两者都有 治疗不足和治疗过度，使用住院期间的电子健康记录数据进行衡量 2021-2023)跨不同医院(目标1)；应用符合分析来确定脓毒症的组合 最低限度充分和必要的诊断实践及其发生的背景 实现脓毒症诊断的安全性和质量(即，对治疗不足和过度治疗都有高性能 成果)(目标2)；共同设计、传播和评估组织工具包的可用性，以促进 优化脓毒症诊断实践，并使用经过验证的实施结果评估工具包的实用性 比例(目标3)。拟议的项目是创新的，它利用了联合概念，最大限度地减少了 以及在重新构建脓毒症诊断优势和作为一个团队接近脓毒症诊断方面的过度治疗， 这是一个组织和体制的过程，而不是一个单独的决策过程。我们的 方法将产生一个可操作的工具包，它在概念上是基础的，由严格的因果关系提供信息 推理方法，在不同的医院和背景下实施是可行的。结果将提供一个 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，并减少 脓毒症诊断错误给人群健康带来的巨大负担。

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.