DECODE: Diagnostic Excellence Center on Diagnostic Error

摘要 我们计划建立一个卓越诊断中心，专注于减少与以下方面相关的诊断错误 诊断成像有两种方式。我们将：1)实施高度可靠和弹性的系统，以增强安全性 通过减少在及时执行临床上必要的诊断成像检查和 解释性错误(安全2)，以及2)通过使用可用的数据建立共识来提高诊断精度 关于诊断错误的四个常见原因的证据-可能导致肺部诊断的发现， 前列腺癌、胰腺癌和肾上腺癌。DCE将建立在强大的预先存在的研究和运营基础上 安全科学家、生物医学信息学家和卫生服务研究人员组成的团队在 马萨诸塞州总布里格姆(MGB)医疗系统。MGB由2名大专院校组成 医院，7家社区急性护理医院，3家专科医院，多种门诊护理和门诊 在门诊、住院和急诊环境中为患者服务的成像设施，其提供商网络超过 10,000名在职和附属初级保健和专科护理医生。MGB最近的整合已经 优先考虑临床整合，创建一个首席运营官办公室，一个首席运营官办公室 医务官和单一的企业放射学治理，包括质量和安全。我们会 增强一组预先存在的有限实施信息技术支持的功能和工作流程 在MGB范围扩展以解决多种类型的诊断错误(包括那些导致丢失的错误)之前， 诊断不正确或延迟。增强功能将改善电子病历--整合、监测和学习 我们的临床仪表板能够更好地解决健康差距，帮助推动公平知情 弹性系统和相关工作流程。另一个同伴学习系统也将实施，以 诊断成像中的目标解释错误。最后，我们将召集一个由临床医生组成的多专业团队 就诊断和处理可能导致肺部疾病的发现的建议达成共识， 前列腺癌、胰腺癌和肾上腺癌，基于现有证据，使用改进的德尔福方法。 商定的证据将被嵌入临床决策支持系统，该系统将被集成 有电子健康记录的人。系统和工作流程的所有规范、共识结果、 吸取的经验教训将通过国家会议和公共会议广泛传播 网站、临床实践和机构网络以及社交媒体。

Abstract We plan to establish a Diagnostic Center of Excellence that will focus on reducing diagnostic errors related to diagnostic imaging in two ways. We will: 1) implement a highly reliable and resilient system to enhance safety by reducing failures in timely performance of clinically necessary diagnostic imaging examinations and interpretative errors (Safety 2), and 2) improve diagnostic precision by building consensus using available evidence around four common causes of diagnostic errors – findings that may lead to a diagnosis of lung, prostate, pancreas and adrenal cancer. The DCE will build on strong pre-existing research and operational collaboration between a team of safety scientists, biomedical informaticists and health services researchers at the Massachusetts General Brigham (MGB) Health System. MGB is comprised of 2 tertiary academic hospitals, 7 community acute care hospitals, 3 specialty hospitals, multiple ambulatory care and outpatient imaging facilities serving patients in ambulatory, inpatient and ED settings, with a provider network of over 10,000 employed and affiliated primary care and specialty care physicians. Recent integration at MGB has prioritized clinical integration, creating a single Office of the Chief Operating Officer, a single Office of the Chief Medical Officer, and a single Enterprise Radiology governance including for quality and safety. We will enhance a set of pre-existing limited implementation information technology-enabled functions and workflows before MGB-wide expansion to address multiple types of diagnostic errors, including those leading to missed, incorrect, or delayed diagnoses. Enhancements will improve EHR-integration, monitoring and learning capabilities of our Clinical Dashboard to better address health disparities, to help advance an equity-informed resilient system and associated workflows. Another system for Peer Learning will also be implemented to target interpretive errors in diagnostic imaging. Finally, we will convene a multispecialty team of clinicians to build consensus on recommendations for diagnosis and management of findings that may lead to lung, prostate, pancreatic and adrenal cancer based on available evidence using a Modified Delphi process. Evidence that are agreed upon will be embedded in a clinical decision support system that will be integrated with the electronic health record. All specifications for systems and workflow processes, consensus results, and lessons learned will be disseminated broadly through national conferences and meetings, a public website, networks of clinical practice and institutions, and social media.