H. Singh is chief, Health Policy, Quality, and Informatics Program, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, and professor of medicine, Baylor College of Medicine, Houston, Texas.
D.K. Upadhyay is researcher-in-residence and program manager, Division of Quality, Safety and Patient Experience, Geisinger, Danville, Pennsylvania.
Acad Med. 2020 Aug;95(8):1172-1178. doi: 10.1097/ACM.0000000000003062.
Reducing errors in diagnosis is the next big challenge for patient safety. Diagnostic safety improvement efforts should become a priority for health care organizations, payers, and accrediting bodies; however, external incentives, policies, and practical guidance to develop these efforts are largely absent. In this Perspective, the authors highlight ways in which health care organizations can pursue learning and exploration of diagnostic excellence (LEDE). Building on current evidence and their recent experiences in developing such a learning organization at Geisinger, the authors propose a 5-point action plan and corresponding policy levers to support development of LEDE organizations. These recommendations, which are applicable to many health care organizations, include (1) implementing a virtual hub to coordinate organizational activities for improving diagnosis, such as identifying risks and prioritizing interventions that cross intra-institutional silos while promoting a culture of learning and safety; (2) participating in novel scientific initiatives to generate and translate evidence, given the rapidly evolving "basic science" of diagnostic excellence; (3) avoiding the "tyranny of metrics" by focusing on measurement for improvement rather than using measures to reward or punish; (4) engaging clinicians in activities for improving diagnosis and framing missed opportunities positively as learning opportunities rather than negatively as errors; and (5) developing an accountable culture of engaging and learning from patients, who are often underexplored sources of information. The authors also outline specific policy actions to support organizations in implementing these recommendations. They suggest this action plan can stimulate scientific, practice, and policy progress needed for achieving diagnostic excellence and reducing preventable patient harm.
降低诊断错误是患者安全的下一个重大挑战。诊断安全改进工作应成为医疗保健组织、支付方和认证机构的优先事项；然而，外部激励措施、政策和实际指导方针在很大程度上缺乏开发这些工作的手段。在本观点中，作者强调了医疗保健组织可以追求卓越诊断学习和探索（LEDE）的方法。基于当前的证据以及他们在 Geisinger 开发此类学习型组织的近期经验，作者提出了一个 5 点行动计划和相应的政策杠杆，以支持 LEDE 组织的发展。这些建议适用于许多医疗保健组织，包括：（1）实施虚拟中心，以协调改善诊断的组织活动，例如识别风险和优先考虑跨机构孤岛的干预措施，同时促进学习和安全文化；（2）参与新颖的科学举措，以生成和转化证据，鉴于卓越诊断的“基础科学”正在迅速发展；（3）避免“指标暴政”，重点是改进的衡量标准，而不是使用衡量标准来奖励或惩罚；（4）让临床医生参与改善诊断的活动，并将错失的机会积极地视为学习机会，而不是将其视为错误；（5）培养一种负责任的文化，让患者参与并从患者身上学习，而患者往往是信息的一个未被充分利用的来源。作者还概述了支持组织实施这些建议的具体政策行动。他们认为，该行动计划可以激发实现卓越诊断和减少可预防的患者伤害所需的科学、实践和政策进展。
