R18 Closed Loop Diagnostics : AHRQ R18 Patient Safety Learning Laboratories

R18 闭环诊断：AHRQ R18 患者安全学习实验室

• 批准号: 10015291
• 负责人: JAMES C BENNEYAN
• 金额: $ 61.15万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10015291
• 关键词: R18; Closed; Loop; Diagnostics; AHRQ

Abstract Diagnostic errors in primary care often are due to failures to follow up (“close the loop”) on diagnostic tests, referrals, and symptoms. More specifically, (1) diagnostic tests and referrals often are not completed, (2) results of diagnostic tests and referrals often are not conveyed to patients and their primary care physicians, and (3) primary care physicians frequently are not informed when symptoms evolve that could alter a diagnosis. To address these gaps, our multidisciplinary team of clinicians, systems engineers, and patients will use an engineering life cycle to design systems to decrease the number of associated diagnostic errors by preventing each of these types of failures in a large primary care practice. Our proposed research employs innovative evidenced-based system engineering (SE) methods to develop highly reliable and robust processes in other industries, but not yet widely adopted in healthcare. Our specific aims are as follows: (Aim 1) Design, develop, and refine highly reliable “closed loop” systems for diagnostic tests and referrals that ensure these occur within clinically- and patient-important timeframes; (Aim 2) Design, develop, and refine a highly reliable “closed loop” symptom monitoring system to ensure clinicians receive information about evolving symptoms of concern; and (Aim 3) Ensure broader generalizability of results of Aims 1 and 2 by ensuring these new processes are effective in a community health center in an underserved community, a large telemedicine system, and a representative range of simulated other health system settings and populations. Our research hypothesis is that a methodical systems approach to closing loops on diagnostic processes will measurably improve timely completion of ordered tests, referrals, and symptom reports, leading to reductions in diagnostic errors. Key innovations of our project are the use of high reliability and human factors methods, inclusion of patients and clinicians from other practices throughout the engineering process, and combined use of statistical, qualitative, and computer modeling methods to estimate improvements both in our primary site and more broadly. Projected results include increased completion of high-risk diagnostic tests, referrals, and concerning symptoms, in turn resulting in reduced diagnostic errors, negative health outcomes, and associated costs. Learning outcomes include improved understanding of closed loop diagnostic and monitoring problems in primary care, patient engagement in solutions to such problems, and the utility of systems engineering to important healthcare problems. Our project responds to 4 of the 8 Institute of Medicine recommendations from their Improving Diagnosis in Healthcare report, the President's Council of Advisors on Science and Technology recommendation that systems engineering be applied to primary care problems, and the PSLL solicitation emphases on value-based care, safety, patient engagement, and provider burden.

抽象的 初级保健中的诊断错误通常是由于未能跟进（“闭环”）诊断测试而导致的， 更具体地说，(1) 诊断测试和转诊通常未完成，(2) 诊断测试和转诊的结果通常不会传达给患者及其初级保健医生， (3) 当症状出现可能改变病情时，初级保健医生经常不会被告知 为了解决这些差距，我们的信徒、系统工程师和患者组成的多学科团队将 使用工程生命周期来设计系统，以减少相关诊断错误的数量 我们提出的研究采用了预防大型初级保健实践中的每一种失败的方法。 创新的循证系统工程 (SE) 方法可开发高度可靠且稳健的流程 在其他行业，但尚未在医疗保健领域广泛采用，我们的具体目标如下： （目标 1）设计、开发和完善高度可靠的“闭环”系统，用于诊断测试和转诊 确保这些发生在对临床和患者重要的时间范围内； （目标2）设计、开发和完善一个高度可靠的“闭环”症状监测系统，以确保 边境接收有关不断变化的关注症状的信息；以及 （目标 3）通过确保这些新流程得到满足，确保目标 1 和 2 的结果具有更广泛的普遍性 在服务不足的社区的社区卫生中心、大型远程医疗系统和 模拟其他卫生系统环境和人群的代表性范围。 我们的研究假设是，一种有条理的系统方法来关闭诊断过程的循环将 显着提高有序测试、转诊和症状报告的及时完成率，从而减少 我们项目的关键创新是使用高可靠性和人为因素方法， 在整个工程过程中纳入来自其他实践的患者和追随者，并结合使用 统计、定性和计算机建模方法来估计我们主站点的改进 更广泛地说，预计结果包括增加高风险诊断测试、转诊和完成率。 关注症状，进而减少诊断错误、负面健康结果和相关的 学习成本包括提高对闭环诊断和监控问题的理解。 在初级保健中，患者参与解决此类问题，以及系统工程的效用 我们的项目响应了医学研究所 8 项建议中的 4 项。 总统科学技术顾问委员会的《改善医疗保健诊断》报告 建议将系统工程应用于初级保健问题，以及 PSLL 征集 强调基于价值的护理、安全、患者参与和提供者负担。