Re-engineering for Accurate, Timely, and Communicated Diagnosis of Cardiovascular Disease in Women (DREAM Lab)

项目总结 心血管疾病(CVD)，包括心脏病和中风，是我们国家最昂贵和最 毁灭性的慢性疾病，并充满了诊断错误。尽管取得了突破性的进展， 通过多年的临床和生物学研究解决心血管疾病，诊断、治疗、 与心血管疾病的沟通对女性的影响不成比例。女性患病的可能性几乎是男性的两倍。 心脏病发作后得到错误的初步诊断，中风症状的可能性增加30% 在急诊科(ED)误诊。即使被准确诊断，女性也不太可能 及时接受循证治疗。美国国家医学科学院报告称， 医疗保健将诊断错误定义为“未能(A)建立准确和及时的 患者的健康问题(S)或(B)向患者传达这一解释“。在每一个维度上 根据定义，患有心血管疾病的女性比男性更糟糕，性别和种族的结合甚至更致命。 跨学科团队利用系统工程，使用新的策略和严格的评估 技术被定位为成功地缓解这一复杂问题。我们的患者安全学习 实验室(PSLL)将致力于重新设计，以实现准确、及时和沟通的诊断 女性心血管疾病：(梦想)实验室。我们将采用一种混合方法系统 用工程学方法了解导致心血管疾病诊断错误的因素的复杂相互作用 在门诊护理环境中的妇女，并共同设计和评估适应性解决方案。我们的人口健康 方法将评估各种因素，包括但不限于自然环境、社会和经济 决定因素、临床护理、健康信息技术和健康行为。梦想实验室将： A.找出导致心血管疾病诊断错误和临床处理不当的促成因素 并制定务实的业绩和改进措施。 提出、确定优先顺序并共同设计以人为中心的解决方案，以降低诊断风险。 C.评估以人为中心的解决方案对心血管疾病诊断的结构、过程和结果影响， 临床管理，以及在模拟和临床环境中的沟通。 拟议的工作建立了一条通向临床实施的明确途径。通过系统地评估 在模拟环境中以人为中心的解决方案，临床医生和患者的意见作为 最终用户，然后在临床环境中对前景看好的解决方案进行试点测试，我们提供 现成的解决方案。梦想实验室的影响，特别是对弱势患者的影响 心脏病发作和中风，有可能影响大范围的变化，破坏现状，导致 显著改善了妇女和医疗保健系统的护理成本、质量、体验和价值。

PROJECT SUMMARY Cardiovascular disease (CVD), including heart disease and stroke, is our nation’s costliest and most devastating chronic disease, and is fraught with diagnostic error. Despite ground-breaking progress in addressing CVD through years of clinical and biological research, errors in the diagnosis, treatment, and communication of CVD disproportionately impact women. Women are nearly twice as likely as men to receive the wrong initial diagnosis following a heart attack and 30% more likely to have stroke symptoms misdiagnosed in the emergency department (ED). Even when accurately diagnosed, women are less likely to receive timely evidence-based treatments. The National Academy of Medicine report Improving Diagnosis in Healthcare defined diagnostic error as “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient”. On every dimension of that definition, women with CVD fare worse than men and the combination of gender and race is even more lethal. Transdisciplinary teams leveraging systems engineering, using novel tactics and rigorous evaluation techniques are positioned to successfully mitigate this complex problem. Our Patient Safety Learning Laboratory (PSLL) will address Re-engineering for Accurate, Timely, and Communicated Diagnosis of Cardiovascular Diseases in Women: the (DREAM) Lab. We will apply a mixed-methods systems engineering approach to understand the complex interplay of factors contributing to CVD diagnostic error in women in the ambulatory care setting, and co-design and evaluate adaptive solutions. Our population health approach will evaluate factors including but not limited to the physical environment, social and economic determinants, clinical care, health information technology, and health behaviors. The DREAM Lab will: a. Identify the contributing factors leading to diagnostic errors and inappropriate clinical management of CVD in women and develop pragmatic performance and improvement measures. b. Propose, prioritize, and co-design human-centered solutions to mitigate diagnostic risk. c. Evaluate the structure, process, and outcome effects of human-centered solutions on CVD diagnosis, clinical management, and communication in simulated and clinical environments. The proposed work sets up a clear pathway toward clinical implementation. By systematically evaluating human-centered solutions in a simulated environment with input from practicing clinicians and patients as the end-users, followed by pilot testing promising solutions in the clinical environment, we provide operationally ready solutions. The DREAM Lab’s impact, particularly for vulnerable patients disproportionately impacted by heart attacks and stroke, has the potential to influence broad-scale change and disrupt the status-quo, yielding significant improvements in care cost, quality, experience, and value for women and the healthcare system.