Factors that Enhance Diagnostic Imaging Safety in the Ambulatory Setting

提高门诊诊断成像安全性的因素

基本信息

批准号：
9927588
负责人：
Ronilda Lacson
金额：
$ 34.05万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-01 至 2022-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9927588
关键词：
Factors Enhance Diagnostic Imaging Safety

项目摘要

A recent 15-year study of six large integrated health systems estimated 1.18 imaging tests per patient per year were performed in the United States, which amounts to an estimated 400 million imaging tests performed each year, at a cost of approximately $100 billion annually. Three quarters of these tests are performed in the ambulatory setting and although diagnostic imaging is predominantly non-invasive, it carries safety risks that could potentially harm patients. In addition, diagnostic errors are magnified when diagnostic imaging is utilized inappropriately and/or when there is no closed-loop system to monitor diagnostic follow-up. Thus, identifying contributing factors to diagnostic imaging failures in ambulatory care is of utmost importance. Cancer is one of the most common leading missed diagnoses in diagnostic litigation cases. Lung cancer is the leading cause of cancer deaths in the United States, followed by breast cancer in women. The most common suspicious abnormality for lung cancer on CT scan include lung nodules. Thus, standardized follow-up of lung nodules impacts early cancer detection, which provides the best chance for survival in lung cancer patients. Similarly, breast cancer screening is a mainstay of public health in the country with over 33 million women receiving mammograms each year. Recommendation for Breast Imaging Reporting and Data System (BIRADS) category 3 breast findings typically includes 6-month follow-up imaging. We therefore plan to assess suboptimal follow-up for patients with lung nodules and BIRADS category 3 breast findings. We propose a project that assesses diagnostic failures that are related to diagnostic imaging from two sources: (1) safety events related to all modalities of diagnostic imaging from an electronic safety reporting system, and (2) the institution's Patient Safety Net Initiative (PSNI), which combines Health Information Technology (HIT) and Care Coordination approaches for monitoring imaging follow-up. We focus on two specific aims to identify, characterize and evaluate contributing factors to diagnostic failures. These include (1) To measure the incidence of safety events that are related to diagnostic imaging from safety reports submitted to an electronic safety reporting system; and (2) To measure the incidence of suboptimal follow-up and comprehensively assess the impact of socio-technical factors on suboptimal diagnostic exam follow-up care in the ambulatory setting, specifically for two clinically significant findings with follow-up requirements: lung nodules and BIRADS category 3 breast findings. Diagnostic imaging in the ambulatory setting is influenced by socio-technical factors that contribute to performance of inappropriate exams as well as suboptimal follow-up care, all leading to diagnostic imaging failures. This study will identify these factors and assess their impact on diagnostic exam follow-up care in the ambulatory setting using the Patient Safety Net Initiative.

最近对六个大型综合卫生系统的15年研究估计每年患者每年1.18次成像测试是在美国进行的，每个估计进行了4亿个成像测试一年，每年的费用约为1000亿美元。这些测试的四分之三是在卧床环境，尽管诊断成像主要是非侵入性的，但它具有安全风险可能会损害患者。此外，使用诊断成像时会放大诊断错误不适当的和/或没有闭环系统来监视诊断随访。因此，识别为卧床护理中的诊断成像失败的贡献因素至关重要。癌症是诊断诉讼案件中最常见的主要遗体诊断之一。肺癌是在美国，癌症死亡的主要原因，其次是女性乳腺癌。最常见的 CT扫描中肺癌的可疑异常包括肺结节。因此，肺的标准化随访结节会影响早期癌症检测，这为肺癌患者提供了最佳机会。同样，乳腺癌筛查是该国公共卫生的支柱，有超过3300万妇女每年接受乳房X线照片。乳房成像报告和数据系统的建议（Birads）类别3乳房发现通常包括6个月的随访成像。因此，我们计划评估肺结节和Birads患者的次级随访3类乳腺癌。我们提出了一个评估与来自两个来源诊断成像有关的诊断失败的项目：（1）与电子安全报告系统的所有诊断成像方式有关的安全事件，（2）结合健康信息技术（HIT）的机构的患者安全网计划（PSNI）和护理协调方法，用于监视成像随访。我们专注于两个具体目标，以识别，表征和评估诊断失败的因素。这些包括（1）测量安全事件的发病率与提交给电子的安全报告有关的诊断成像有关安全报告系统；（2）测量次优随访的发生率和全面评估社会技术因素对卧床中次优诊断检查随访的影响设置，特别适用于两个具有后续要求的临床上有意义的发现：肺结节和Birads 3类乳房发现。在门诊环境中的诊断成像受社会技术因素的影响，有助于不当考试的表现以及次优的随访护理，都导致诊断成像失败。这项研究将确定这些因素，并评估其对诊断检查的影响使用患者安全网计划的门诊。