Closing the Feedback Loop to Improve Diagnostic Quality

描述（由申请人提供）：该项目旨在开发关闭门诊诊断回路的方法，以提高门诊环境中诊断和治疗决策的质量。我们将有四个站点-三个门诊设置和一个急诊室设置。这些网站都有不同的电子医疗记录和不同的患者人群，包括患有各种急性和慢性疾病的所有年龄段的患者，包括特殊需要的患者（艾滋病毒和CP）。目标专业人员包括居民和研究员，主治医生，护士和专职医疗保健专业人员在初级保健和专业实践。 干预措施包括制定主动跟踪和持续快速监测的自动化流程， 将重点放在衡量诊断质量上。在诊所环境中，我们还将评估药物处方的质量。所有三个诊所的重点将是自动化系统的后续行动，并反馈给医生，谁是门诊治疗的病人。急诊医学网站的重点是对入院患者的诊断进行随访并反馈给急诊室医生。 方法包括修改所有研究中心的电子病历和信息系统， 捕获MD指定的诊断和预后预测以及随访间隔，允许数据收集并向医生提供直接反馈。在这三个诊所就诊的病人将接到电话，以评估他们的健康状况和对药物的反应。电话呼叫过程以及数据收集和反馈过程将自动化。在急诊室，将开发获得入院患者的入院和出院诊断并将此信息提供给最初护理这些患者的急诊室医生的自动化方法。将评估提供者对反馈的反应以及提供者对反馈过程的满意度。 对于所有环境，评估的结局包括对诊断和治疗质量的影响， 采用该系统，利用医生的反馈进行质量改进。对于临床试验机构，需要评估的其他结局包括患者满意度和对医疗费用的影响。

DESCRIPTION (Provided by the Applicant): This project is aimed at developing ways to close the loop of outpatient diagnosis in an effort to improve the quality of diagnostic and therapeutic decision making in ambulatory settings. We will have four sites-three ambulatory clinic settings and one Emergency Room setting. These sites all have different electronic medical records and different patient populations, including patients of all ages with a variety of acute and chronic conditions, including special needs patients (HIV and CP). The targeted professionals include residents and fellows, attending physicians, nurses, and allied health professionals in both primary care and specialty practice. The intervention involves developing automated processes of proactive follow-up and ongoing rapid feedback to physicians and will focus on measuring the quality of diagnoses. In the clinic settings we will also assess the quality of medication prescribing. The focus in all three of the clinic sites will be on automating systematic follow-up of, and feedback to physicians on, patients who are treated on an outpatient basis. The focus in the emergency medicine site will be on folIow-up and feedback to the Emergency Room physicians on the diagnoses of patients admitted to the hospital. Methods include modification of the electronic medical records and information systems in all sites to capture MD-designated diagnosis and prognosis predictions and follow-up intervals, permit data collection and provide direct feedback to physicians. Patients seen in the three clinics will receive phone calls to assess their health status and response to medication. The phone call process as well as the data collection and feedback processes will be automated. In the Emergency Room, automated methods of obtaining the admission and discharge diagnoses of admitted patients and providing this information to the emergency room physician who initially cared for these patients will be developed. Providers' response to the feedback will be assessed as well as provider satisfaction with the feedback process. For all settings, outcomes to be assessed include impact on diagnostic and therapeutic quality, extent of adoption of the system, use of the feedback by physicians for quality improvement. For the clinic sites, additional outcomes to be assessed include patient satisfaction and impact on healthcare costs.