Averting Diagnostic Error Through Improved Recognition of Child Abuse

项目总结/摘要 博士伊里特河Rasooly的目标是成为一名独立的临床科学家，致力于促进准确， 及时公正的儿科诊断为了进一步发展应用数据驱动所需的新技能， 系统知情的方法，以改善诊断，博士拉苏里的职业发展计划纳入 指导临床信息学，纵向分析，人因工程， 实施科学和创伤知情护理。她将由经验丰富的调查人员指导， 她建立了富有成效的合作关系：克里斯托弗·P·博纳菲德博士（小学） 导师）是在患者的交叉点制定，评估和实施干预措施的专家 安全和技术创新。Joanne N.伍德（共同导师）是一个专家在儿童身体虐待 其奖学金的研究重点是种族差异和虐待评估的变化。凯西医生 Shaw（Co-Mentor）是患者安全科学和诊断错误的国家和直觉领导者。的 费城儿童医院和宾夕法尼亚大学非常支持拉苏里博士的工作 并提供无与伦比的研究培训环境。漏诊虐待儿童，其中虐待 损伤未被识别或被错误归因于意外创伤，是儿科最严重的例子之一。 诊断错误和严重威胁儿科健康。电子健康记录（EHR）临床决策 在提高及时性和减少滥用诊断的差异方面， 在急诊室环境中，迫切需要支持初级保健诊断的策略， 那里提供了大多数儿科护理，那里可能有机会在儿童持续 重伤为了为创建CDS奠定基础，以改善初级保健中的虐待诊断， 这项工作的目标是应用EHR数据和系统分析，为确定战略提供信息， 支持在初级保健中诊断儿童身体虐待。具体目标是：（1）检测和验证标记 在纵向，集群，EHR衍生的数据，以区分遭受虐待的幼儿身体虐待 （2）通过以下方式确定初级保健中滥用相关诊断错误的原因： 基于EHR的高保真人因工程仿真，以及（3）识别和优先级排序 通过协商一致的方法制定可行、可接受和适当的CDS策略。调查结果将告知 CDS的开发将在未来的多中心、R 01资助的临床试验中进行测试。完成建议 研究和培训将使Rasooly博士能够开展独立的研究事业， 卓越的诊断和减少初级保健中的健康差距，从而解决多个AHRQ 优先研究领域。

Project Summary/Abstract Dr. Irit R. Rasooly’s goal is to become an independent clinician scientist dedicated to promoting accurate, timely, and equitable pediatric diagnosis. To further develop the novel skillset necessary to apply data-driven, systems-informed approaches to improve diagnosis, Dr. Rasooly’s career development plan incorporates mentored research and training in clinical informatics, longitudinal analysis, human factors engineering, implementation science, and trauma informed care. She will be mentored by experienced investigators with whom she has established, productive collaborative relationships: Dr. Christopher P. Bonafide (Primary Mentor) is an expert in developing, evaluating, and implementing interventions at the intersection of patient safety and technological innovation. Dr. Joanne N. Wood (Co-Mentor) is an expert in child physical abuse research whose scholarship has focused on racial disparities and variation in abuse evaluations. Dr. Kathy Shaw (Co-Mentor) is a national and intuitional leader in patient safety science and diagnostic error. The Children’s Hospital of Philadelphia and University of Pennsylvania are deeply supportive of Dr. Rasooly’s work and provide an unparalleled research training environment. Missed diagnosis of child abuse, in which abusive injury goes unrecognized or is misattributed to accidental trauma, is among the gravest examples of pediatric diagnostic error and a serious threat to pediatric health. While electronic health record (EHR) clinical decision support (CDS) has shown promise in improving timeliness and reducing disparities in abuse diagnosis in emergency department settings, there is a critical need for strategies to support diagnosis in primary care, where most pediatric care is delivered and where there may be opportunity to intervene before children sustain serious injuries. To lay the groundwork for creation of CDS to improve abuse diagnosis in primary care, the objective of this work is to apply EHR data- and systems-analysis to inform identification of strategies to support diagnosis of child physical abuse in primary care. Specific aims are to: (1) Detect and validate markers of physical abuse in longitudinal, clustered, EHR-derived data to distinguish young children experiencing abuse from matched controls, (2) Determine causes of abuse-related diagnostic error in primary care by conducting scenario-based high-fidelity human factors engineering EHR simulations, and (3) Identify and prioritize feasible, acceptable, and appropriate CDS strategies through a consensus approach. Findings will inform development of CDS to be tested in a future multi-center, R01 funded clinical trial. Completion of the proposed research and training will position Dr. Rasooly to launch an independent research career advancing pediatric diagnostic excellence and reducing health disparities in primary care, thereby addressing multiple AHRQ research priority areas.