Center to Improve Clinical Diagnosis

翻译后摘要：诊断错误是常见的，往往非常严重。不幸的是， 对于各种问题的诊断标准和最佳诊断实践是稀缺的。的重点 改善临床诊断中心将使用数据和共识驱动来解决诊断问题 approach.该中心的目标是：（a）组建一个多元化、多学科的团队， 关于标准和最佳做法;（B）实施一项4步战略， （c）通过制定一套政策、方法、未来议程， 我们组织内外的合作伙伴关系。我们的中心将完全融入一个更大的健康服务 大学医院卫生系统内的研究中心。我们的一般4步开发过程 建议的做法包括（1）确定常见的问题，与高发病率有关 诊断错误，以及缺乏指导，并确定当前的诊断实践（或 （2）确定诊断实践的结果;（3）与 诊断专家小组，审查有关实践和结果的数据，并提出建议;（4） 执行建议并监测其影响。我们选择了三个问题作为示范 根据项目的普遍性和严重性以及我们研究团队的专业知识和经验： (1)识别和评估成人无意减肥的最佳方法;（2）最佳方法 使用家用BP设备对非裔美国青少年进行高血压筛查;（3）改善诊断 社区急诊科（艾德）环境中儿童和社区（艾德）成人中败血症的发生率， 通过实施和最重要的是，完善电子脓毒症触发工具。 我们相信，我们的系统方法，为这些和未来的问题制定标准和最佳做法 将为急需的诊断指导提供一个系统，对患者、临床医生和健康都很有用 系统.

Abstract: Diagnostic errors are common and frequently extremely serious. Unfortunately, strategies to identify diagnostic standards and best diagnostic practices for a variety of problems are scarce. The focus of the Center to Improve Clinical Diagnosis will be to tackle diagnostic problems using a data and consensus driven approach. The goals of the Center are to (a) assemble a diverse, multidisciplinary team to provide formal input about standards and best practices; (b) to implement a 4-step strategy to develop recommended diagnostic practices; and (c) to sustain the Center by creating a set of policies, methods, a future agenda, and partnerships within and outside our organization. Our Center will be fully integrated into a larger health services research center within University Hospitals Health System. Our general 4-step process to develop recommended practices includes (1) identifying problems which are common, associated with high rates of diagnostic error, and for which guidance is lacking and identify current diagnostic practice (or practices in response to diagnostic interventions) (2) identify outcomes of diagnostic practices; (3) in collaboration with a panel of diagnosticians, review data about practice and outcomes and formulate recommendations; (4) implement recommendations and monitor their impact. We have chosen three problems as demonstration projects based on how common and serious they are and the expertise and experience of our research team: (1) The best approach to identifying and evaluating unintentional weight loss in adults; (2) The best approach to screening for hypertension in African American adolescents using home-BP devices; (3) Improved diagnosis of sepsis in children in community emergency department (ED) settings, and adults in community (ED) and inpatient settings through implementation and most importantly, refinement of electronic sepsis trigger tools. We believe our systematic approach to developing standards and best practices for these and future problems will provide a system for badly needed diagnostic guidance that is useful for patients, clinicians, and health systems.