Safety II Together: Coupling teaming science with patient engagement and health information transparency to coproduce diagnostic excellence

动态诊断错误是一个令人烦恼的问题，因为随着团队的轮换，事件会随着时间的推移而展开 会员。准确和及时的诊断依赖于让患者和医疗保健专业人员(HCP)保持畅通 同样的页面，无论是在诊所就诊期间还是在就诊之间。专家呼吁共享诊断的心理模型(SMM) 流程(DXP)，因为研究表明它们在有效的团队沟通和协调方面发挥着核心作用。 然而，关于患者和HCP如何发展和维持SMM，尤其是在动态环境中，人们知之甚少 DxP的。虽然我们在安全-I研究中有很多诊断错误的例子，但很少有模型 使用Safe-II镜头的《看起来像什么》因为卓越的诊断依赖于各种因素和相互作用 除了任何单一的HCP，进展将需要确定特定的团队行为，以帮助患者和 HCP在已知的DXP风险点共同产生安全。我们将弥合这一基础知识差距。我们会 然后开发和传播工具，积极支持患者、护理合作伙伴、口译员和临床医生 通过3个合作的国家组织为DXP作出贡献。在我们目前的AHRQ拨款中，我们了解到 患者对DXP有独到的见解，包括识别“诊断盲点”--事件或 与DXP安全有关的条件，即HCP或系统可能不遵守的条件。其中包括发生的事件 由于患者和HCP之间缺乏SMM而导致的就诊、遗漏和错位。 有趣的是，在线访问访问笔记(“开放笔记”)-现在几乎普遍到2021年联邦立法 -可能有助于SMM的发展，因为患者可以获得关于HCP观点和潜在差距的背景 通过阅读笔记来加深他们的理解。一个发人深省的发现是，导致 患者报告的诊断错误感觉不到。基于这些数据，我们设计了一个在线工具-- OurDX-引出患者的优先顺序、病史和潜在的担忧。我们发现，英语水平有限的患者 熟练程度(LEP)报告没有被听到的可能性是5倍，健康状况较差的年龄较大的患者 很可能识别出诊断盲点。工作的团队需要新的方法来分享信息，倾听， 并做出回应，特别是在利用每个成员的独特知识(包括早期的 识别其他未被检测到的盲点)可以增加系统的弹性。我们的诊断中心 卓越--Safety2gether--是建立在创新和纪律严明的科学与患者合作的基础上的 参与共同制作诊断安全，重点放在安全-II原则和优先人群：LEP 以及老年慢性病患者和他们的护理伙伴。Safety2gether将与患者合作，培训 学员，定义未来的研究问题，促进协作，并通过3个项目共享多方利益相关者工具 国家组织既要向其他发展中国家学习，也要作为其他发展中国家的资源。我们的团队特别是 在团队合作、诊断安全和患者参与方面拥有十多年的专业知识，并且是独一无二的 准备通过以证据为基础强调倾听和弹性来帮助建立安全公平。

Ambulatory diagnostic error is a vexing problem because events unfold across time with shifting team members. Accurate and timely diagnosis relies on keeping patients and health care professionals (HCPs) on the same page, both in and between clinic visits. Experts urge shared mental models (SMMs) of the diagnostic process (DxP), because research shows their central role for effective team communication and coordination. Yet little is known about how patients and HCPs develop and sustain SMMs, especially in the dynamic setting of the DxP. While we have many examples of diagnostic errors in Safety-I research, there are few models of “what good looks like” using a Safety-II lens. Since diagnostic excellence relies on factors and interactions beyond any single HCP, progress will require identifying specific teaming behaviors that help patients and HCPs to coproduce safety at known DxP risk points. We will close this foundational knowledge gap. We will then develop and disseminate tools to support patients, care partners, interpreters and clinicians as active contributors to the DxP through 3 partnering national organizations. In our current AHRQ grant, we learned that patients have unique insights about the DxP, including identification of “diagnostic blindspots” – events or conditions pertaining to DxP safety that HCPs or systems may not observe. These include events occurring between visits, omissions, and misalignments stemming from lack of a SMM between patients and HCPs. Interestingly, online access to visit notes (“open notes”) – now nearly universal through 2021 federal legislation – may help development of SMMs because patients can gain context on HCP perspectives and potential gaps in their understanding by reading notes. One sobering finding was that the most common contributing factor to patient-reported diagnostic error was not feeling heard. Based on these data, we designed an online tool – OurDX – to elicit patient priorities, histories, and potential concerns. We found that patients with limited English proficiency (LEP) were 5x as likely to report not feeling heard, and older patients with poorer health were more likely to identify a diagnostic blindspot. Teams that work need new approaches to share information, to listen, and to respond, especially since harnessing the unique knowledge of each member (including early identification of otherwise undetected blindspots) can increase system resilience. Our diagnostic center of excellence – Safety2gether – is based on innovative and disciplined coupling of teaming science with patient engagement to coproduce diagnostic safety, with a focus on safety-II principles and priority populations: LEP and elderly patients with chronic illness and their care partners. Safety2gether will partner with patients, train learners, define future research questions, foster collaborations, and share multistakeholder tools through 3 national organizations to both learn from, and serve as a resource for, other DCEs. Our team is specifically curated with over a decade of expertise in teaming, diagnostic safety and patient engagement, and is uniquely poised to help build safety equity through an evidence-based emphasis on listening and resilience.