J Pediatr Health Care. 2018 Jan-Feb;32(1):53-62. doi: 10.1016/j.pedhc.2017.07.004. Epub 2017 Sep 12.
The purpose of our study was to determine the impact of an educational program on a provider's knowledge related to diagnostic errors and diagnostic reasoning strategies.
A quasi-experimental interventional study with a multimedia approach, case study discussion, and trigger-generated medical record review at two time points was conducted. Measurement tools included a test developed by the National Patient Safety Foundation, Reducing Diagnostic Errors: Strategies for Solutions Quiz, additional diagnostic reasoning questions, and a trigger-generated process to analyze medical records.
Knowledge related to diagnostic errors statistically improved from the pretest to posttest scores with sustained 60-day differences (p < .025). Although there was a decline in the proportion of patients returning with the same chief complaint within 14 days, this was not statistically significant (p < .15). When providers were confronted with an unrecognizable clinical presentation, they reported an increased use of a "diagnostic timeout" (p < .038).
Providers developed an increased awareness of the presence of diagnostic errors in the primary care setting, the contributing risk factors for a diagnostic error, and possible strategies to reduce diagnostic errors. These factors had an unexpected impact on changing the primary care practice model to enhance the continuity of patient care.
我们研究的目的是确定一个教育项目对提供者与诊断错误和诊断推理策略相关的知识的影响。
采用准实验干预研究方法，采用多媒体方法、案例研究讨论和触发式病历回顾，在两个时间点进行。测量工具包括国家患者安全基金会开发的测试、减少诊断错误：解决方案测验、额外的诊断推理问题以及触发式分析病历的流程。
与诊断错误相关的知识从预测试到后测试分数均有统计学上的提高，且持续 60 天存在差异（p<.025）。尽管在 14 天内同一主诉患者的比例有所下降，但这并不具有统计学意义（p<.15）。当提供者遇到无法识别的临床症状时，他们报告说增加了“诊断暂停”的使用（p<.038）。
提供者提高了对初级保健环境中诊断错误的存在、导致诊断错误的风险因素以及减少诊断错误的可能策略的认识。这些因素对改变初级保健实践模式以增强患者护理的连续性产生了意外影响。
