DECODE: Diagnostic Excellence Center on Diagnostic Error

DECODE：诊断错误诊断卓越中心

• 批准号: 10641651
• 负责人: Ramin Khorasani
• 金额: $ 99.29万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2026-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10641651
• 关键词: DECODE; Diagnostic; Excellence; Center; Error

Abstract We plan to establish a Diagnostic Center of Excellence that will focus on reducing diagnostic errors related to diagnostic imaging in two ways. We will: 1) implement a highly reliable and resilient system to enhance safety by reducing failures in timely performance of clinically necessary diagnostic imaging examinations and interpretative errors (Safety 2), and 2) improve diagnostic precision by building consensus using available evidence around four common causes of diagnostic errors – findings that may lead to a diagnosis of lung, prostate, pancreas and adrenal cancer. The DCE will build on strong pre-existing research and operational collaboration between a team of safety scientists, biomedical informaticists and health services researchers at the Massachusetts General Brigham (MGB) Health System. MGB is comprised of 2 tertiary academic hospitals, 7 community acute care hospitals, 3 specialty hospitals, multiple ambulatory care and outpatient imaging facilities serving patients in ambulatory, inpatient and ED settings, with a provider network of over 10,000 employed and affiliated primary care and specialty care physicians. Recent integration at MGB has prioritized clinical integration, creating a single Office of the Chief Operating Officer, a single Office of the Chief Medical Officer, and a single Enterprise Radiology governance including for quality and safety. We will enhance a set of pre-existing limited implementation information technology-enabled functions and workflows before MGB-wide expansion to address multiple types of diagnostic errors, including those leading to missed, incorrect, or delayed diagnoses. Enhancements will improve EHR-integration, monitoring and learning capabilities of our Clinical Dashboard to better address health disparities, to help advance an equity-informed resilient system and associated workflows. Another system for Peer Learning will also be implemented to target interpretive errors in diagnostic imaging. Finally, we will convene a multispecialty team of clinicians to build consensus on recommendations for diagnosis and management of findings that may lead to lung, prostate, pancreatic and adrenal cancer based on available evidence using a Modified Delphi process. Evidence that are agreed upon will be embedded in a clinical decision support system that will be integrated with the electronic health record. All specifications for systems and workflow processes, consensus results, and lessons learned will be disseminated broadly through national conferences and meetings, a public website, networks of clinical practice and institutions, and social media.

抽象的 我们计划建立一个卓越诊断中心，该中心将重点降低与 通过两种方式进行诊断成像。我们将：1）实施高度可靠且弹性的系统以提高安全性 通过减少及时临床必要诊断成像检查的及时性能的失败和 解释性错误（安全2）和2）通过使用可用的建立共识来提高诊断精度 关于诊断错误的四个常见原因的证据 - 可能导致肺部诊断的发现， 前列腺，胰腺和肾上腺癌。 DCE将以强大的先前研究和运营为基础 安全科学家，生物医学信息学家和卫生服务研究人员之间的合作 马萨诸塞州杨百翰（MGB）卫生系统。 MGB完成了2个三级学术 医院，7家社区急诊医院，3家专科医院，多个门诊和门诊病人 在门诊，住院和ED设置中为患者提供服务的成像设施，提供了一个提供商网络 10,000名员工和会员初级保健和专科医生。 MGB最近的集成 优先考虑临床整合，建立了首席运营官的单个办公室，酋长的一个办公室 医务人员和单一企业放射学治理，包括质量和安全。我们将 增强一组现有的有限的实施信息信息技术和工作流程 在MGB范围扩展之前，以解决多种类型的诊断错误，包括导致错过的诊断错误， 不正确或延迟诊断。增强功能将改善EHR的整合，监视和学习 我们的临床仪​​表板的功能更好地解决健康分布，以帮助提高股票信息 弹性系统和相关的工作流程。同行学习的另一个系统也将实施 诊断成像中的目标解释错误。最后，我们将召集一个多专业团队的临床医生团队 建立对可能导致肺的发现的建议和管理的建议， 前列腺，胰腺癌和肾上腺癌基于可用证据，使用改良的Delphi过程。 商定的证据将嵌入将集成的临床决策支持系统中 具有电子健康记录。系统和工作流程过程的所有规格，共识结果， 经验教训将通过民族会议和会议广泛传播 网站，临床实践和机构以及社交媒体网络。