The Epidemiology of Diagnostic Error in Emergency Care in the United States and the Association with Patient Outcomes and Healthcare Costs

诊断错误被认为是常见的、代价高昂的，并与患者的实质性伤害有关 在美国(美国)医疗研究和质量机构最近的一份报告 (AHRQ)强调了解决紧急护理中诊断错误的重要性，并呼吁 关于考察美国紧急情况下当代诊断错误率的其他研究 部门(EDS)。去急诊室就诊很常见，五分之一的美国人去就诊，导致超过 每年有1.3亿人次到急症室就诊。对紧急情况的诊断准确性对于 最佳的患者结果。然而，急诊室的本质，包括不可预测的患者 数量、有限的时间和可用的信息，以及频繁的中断，可能会使 急诊室诊断的准确性具有挑战性。虽然已经有相当多的关注 在急诊护理质量的差异方面，关于 急诊室的诊断安全性，AHRQ最近的报告强调了这一点。该项目将使用 具有代表性的国家索赔数据，以提供关于诊断情况的详细证据 美国编辑中的错误。我们将量化高危紧急情况的诊断错误率 以及与这些疾病相关的常见症状。此外，我们还将检查 紧急护理中的诊断错误与患者伤害相关的程度。我们会 确定与更大的诊断错误风险相关的患者、临床医生和医院因素。 最后，我们将检查在ED诊断错误后进行动态随访是否可以 减轻与误诊相关的危害。这项全国性的研究将使前线 临床医生和政策制定者了解美国EDS和EDS诊断错误的程度 可能成为质量改进努力目标的因素，以满足这一重要公众 健康问题。

Diagnostic error is thought to be common, costly, and associated with substantial patient harm in the United States (U.S.). A recent report by the Agency for Healthcare Research and Quality (AHRQ) highlighted the importance of addressing diagnostic error in emergency care and called for additional research examining contemporary diagnostic errors rates in U.S. emergency departments (EDs). ED visits are common, with 1 in 5 Americans visiting the ED, leading to over 130 million ED visits annually. Diagnostic accuracy for emergency conditions is essential for optimal patient outcomes. Yet, the very nature of the ED, including unpredictable patient volume, limited time and available information, as well as frequent interruptions, can make diagnostic accuracy in the ED challenging. While there has been substantial attention paid to the variation in the quality of emergency care, there has been relatively less research on diagnostic safety in the ED, as highlighted by the recent AHRQ report. This project will use representative national claims data to provide detailed evidence on the landscape of diagnostic error in U.S. EDs. We will quantify the rate of diagnostic error for high-risk emergency conditions as well as the common symptoms associated with these diseases. Additionally, we will examine the degree to which diagnostic error in emergency care is associated with patient harm. We will identify the patient, clinician, and hospital factors associated with greater risk of diagnostic error. Finally, we will examine if having an ambulatory follow-up visit after an ED diagnostic error can mitigate the harms associated with misdiagnosis. This national study will enable frontline clinicians and policymakers to understand the extent of diagnostic error in U.S. EDs and the factors that may be targeted for quality improvement efforts to address this important public health problem.