School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Diagnosis (Berl). 2020 Oct 5;8(2):187-192. doi: 10.1515/dx-2020-0014. Print 2021 May 26.
The National Academy of Medicine identified diagnostic error as a pressing public health concern and defined failure to effectively communicate the diagnosis to patients as a diagnostic error. Leveraging Patient's Experience to improve Diagnosis (LEAPED) is a new program for measuring patient-reported diagnostic error. As a first step, we sought to assess the feasibility of using LEAPED after emergency department (ED) discharge.
We deployed LEAPED using a cohort design at three EDs within one academic health system. We enrolled 59 patients after ED discharge and queried them about their health status and understanding of the explanation for their health problems at 2-weeks, 1-month, and 3-months. We measured response rates and demographic/clinical predictors of patient uptake of LEAPED.
Of those enrolled (n=59), 90% (n=53) responded to the 2-week post-ED discharge questionnaire (1 and 3-month ongoing). Of the six non-responders, one died and three were hospitalized at two weeks. The average age was 50 years (SD 16) and 64% were female; 53% were white and 41% were black. Over a fifth (23%) reported they were not given an explanation of their health problem on leaving the ED, and of those, a fourth (25%) did not have an understanding of what next steps to take after leaving the ED.
Patient uptake of LEAPED was high, suggesting that patient-report may be a feasible method of evaluating the effectiveness of diagnostic communication to patients though further testing in a broader patient population is essential. Future research should determine if LEAPED yields important insights into the quality and safety of diagnostic care.
美国国家医学院将诊断错误确定为一个紧迫的公共卫生问题，并将未能有效地将诊断结果传达给患者定义为诊断错误。利用患者的经验来改善诊断（LEAPED）是一个新的衡量患者报告的诊断错误的项目。作为第一步，我们试图评估在急诊科（ED）出院后使用 LEAPED 的可行性。
我们在一个学术医疗系统内的三个 ED 中使用队列设计部署了 LEAPED。我们在 ED 出院后招募了 59 名患者，并在 2 周、1 个月和 3 个月时询问他们的健康状况和对其健康问题解释的理解。我们测量了 LEAPED 的患者参与率和人口统计学/临床预测因素。
在入组的患者中（n=59），90%（n=53）对 ED 出院后 2 周的问卷做出了回应（1 和 3 个月仍在进行中）。在 6 名未回复者中，1 人死亡，3 人在 2 周时住院。平均年龄为 50 岁（标准差 16），64%为女性；53%为白人，41%为黑人。超过五分之一（23%）的人报告说他们离开 ED 时没有得到对其健康问题的解释，其中四分之一（25%）对离开 ED 后应采取的下一步骤没有理解。
LEAPED 的患者参与率很高，这表明患者报告可能是评估向患者传达诊断结果的有效性的一种可行方法，尽管在更广泛的患者群体中进行进一步测试是必要的。未来的研究应确定 LEAPED 是否能为诊断护理的质量和安全提供重要的见解。
