Averting Diagnostic Error Through Improved Recognition of Child Abuse

项目摘要/摘要 Rasooly博士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、公平的儿科诊断。为了进一步开发应用数据驱动所需的新技能集， 改善诊断的系统知情方法，Rasooly博士的职业发展计划包括 临床信息学、纵向分析、人因工程、 实施科学和创伤知情护理。她将得到经验丰富的调查人员的指导， 她建立了富有成效的合作关系：克里斯托弗·P·博纳德博士(主要 Mentor)是开发、评估和实施患者交叉点干预措施的专家 安全和技术创新。乔安妮·N·伍德博士(共同导师)是儿童身体虐待方面的专家 这项研究的学术重点是种族差异和虐待评估的差异。凯西医生 Shaw(共同导师)是在患者安全科学和诊断错误方面的全国性和直觉性领导者。这个 费城儿童医院和宾夕法尼亚大学对Rasooly博士的工作深表支持 并提供无与伦比的科研培训环境。儿童虐待的漏诊，其中虐待 伤害没有被认识到或被误认为是意外创伤，是儿科最严重的例子之一 诊断错误，严重威胁儿科健康。同时电子健康记录(EHR)临床决策 支持(CDS)在提高及时性和减少在以下方面的滥用诊断差异方面显示出希望 在急诊科环境中，迫切需要制定战略来支持初级保健的诊断， 在那里提供了大多数儿科护理，在儿童持续生存之前可能有机会进行干预 伤势严重。为了为建立CDS奠定基础，以改进初级保健中的虐待诊断， 这项工作的目标是应用电子病历数据和系统分析来确定战略 支持初级保健中对儿童身体虐待的诊断。具体目标是：(1)检测和验证标记 在纵向的、聚集的、EHR派生的数据中进行身体虐待的评估，以区分遭受虐待的幼儿 从配对的对照中，(2)通过以下方式确定初级保健中与虐待相关的诊断错误的原因 基于场景的高保真人因工程EHR模拟，以及(3)确定和优先顺序 通过协商一致的方法制定可行、可接受和适当的CDS战略。调查结果将告知 CDS的开发将在未来的多中心、R01资助的临床试验中进行测试。完成拟议的 研究和培训将使Rasooly博士开始独立的研究生涯，推动儿科 提高诊断水平，减少初级保健方面的健康差距，从而解决多个AHRQ问题 研究重点领域。

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.