Answering the call to engage patients and families in the diagnostic process: A new patient-centered approach using health information transparency to identify diagnostic breakdowns in ambulatory care

门诊护理中的诊断错误提出了一个令人烦恼的挑战，至少部分原因是有限的 测量以识别随时间和空间展开的事件（各种医疗保健交互）。虽然 NAM报告强调患者的观点，传统的诊断错误措施没有。新数据 这表明，患者诊断错误的经历反映了当前指标中几乎没有的主题： 忽视患者知识、不尊重患者等不专业行为和沟通障碍。 缺乏以患者为中心的指标会截断组织学习和更有意义地 防止未来的诊断错误，这给病人带来了巨大的负担，特别是最严重的病人 儿童和成人。幸运的是，随着健康信息透明度的普及， 患者在诊断过程中通过患者门户网站与患者共享访视记录， 他们的流动经验的书面记录，并代表了丰富的，但相对未开发的现有 为患者提供信息来源，以帮助识别诊断和护理中的故障。越来越多的证据表明， 患者的独特知识和他们识别此类故障的能力。超过4000万患者 美国现在可以打开笔记。研究表明， 开放式笔记，特别是在更脆弱的患者中。直接参与执行工作， 在过去十年中，我们的团队对共享访问记录的影响进行了细致入微的测量， 了解几乎每个医疗领域与透明票据相关的机遇和挑战。 我们还创新了两种新方法，使患者能够a）向笔记投稿，B）报告 潜在的笔记错误。我们的研究表明，频繁的患者报告的故障与诊断相关， 过程与患者/家庭，卫生服务研究人员和诊断错误专家合作，我们 现在，它将以独特的姿态：1a）建立一个与患者/家属共同设计的以患者为中心的新框架 和护理伙伴来测量和分类患者报告的诊断故障（PRDB），以及B） 应用这一新的分析工具，以确定珠三角区域开发银行的发病率、类型和影响因素， 使用2个大型和独特的现有数据库的门诊护理; 2）开发和实施新的EHR门户网站- 基于方法，使慢性病患者及其家属能够a）为访问记录做出贡献， 诊断过程和B）使用现有EHR数据识别和报告诊断故障;以及3） 评估该方法在诊断过程中的使用和影响，以测量安全性（发生率/类型 慢性病患者中的PRDBs）、实施和利益相关者经验结果。我们的研究结果 将提高我们对门诊诊断故障的理解，并建立一种新的方法， 组织在诊断过程中系统地与患者合作。研究结果将提供 基金会最终设计和测试干预措施，以减少门诊诊断错误。

Diagnostic errors in ambulatory care present a vexing challenge, at least in part because of limited measurements to identify events that unfold over time and space (various healthcare interactions). Although the NAM report emphasizes the patient perspective, traditional diagnostic error measures do not. New data suggest that patient experiences of diagnostic error reflect themes virtually absent from current metrics: ignoring patient knowledge, disrespect, and other unprofessional behavior and communication barriers. Lack of patient-centered metrics truncates organizational learning and the ability to more meaningfully prevent future diagnostic errors, which levy an enormous burden on patients -- particularly the sickest children and adults. Fortunately, as health information transparency spreads, there are new ways to engage patients in the diagnostic process. Sharing visit notes with patients through the patient portal provides them with a written record of their ambulatory experiences, and represents a rich but relatively untapped existing source for patients to help identify breakdowns in diagnosis and care. Growing evidence demonstrates the unique knowledge of patients and their ability to identify such breakdowns. Over 40 million patients across the US can now access open notes. Studies demonstrate patient safety and engagement benefits from open notes, especially among more vulnerable patients. Working firsthand on implementation and measurement of the effects of shared visit notes over the last decade, our team has gained a nuanced understanding of opportunities and challenges related to transparent notes in virtually every medical field. We have also innovated two new approaches, enabling patients to a) contribute to notes and b) to report on potential note errors. Our research shows frequent patient-reported breakdowns related to the diagnostic process. Partnering with patients/families, health services researchers, and diagnostic error experts, we are now uniquely poised to: 1a) Establish a new patient-centered framework co-designed with patients/families and care partners to measure and categorize patient-reported diagnostic breakdowns (PRDBs), and b) apply this new analytic tool to establish the incidence, types, and contributing factors to PRDBs in ambulatory care using 2 large and unique existing databases; 2) Develop and implement a new EHR portal- based method enabling chronically ill patients and their families to a) contribute to the visit note and diagnostic process and b) identify and report diagnostic breakdowns using existing EHR data; and 3) Assess the use and impact of this method on the diagnostic process measuring safety (incidence/types of PRDBs among chronically ill patients), implementation, and stakeholder experience outcomes. Our findings will improve our understanding of ambulatory diagnostic breakdowns and establish a new method for organizations to systematically partner with patients in the diagnostic process. Study results will provide the foundation to ultimately design and test interventions to reduce ambulatory diagnostic errors.