Division of General Internal Medicine, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA.
Hennepin Healthcare, Minneapolis, USA.
J Gen Intern Med. 2021 May;36(5):1404-1406. doi: 10.1007/s11606-021-06611-0. Epub 2021 Feb 11.
Diagnostic errors are a source of unacceptable harm in health care. However, improvement efforts have been hampered by the lack of valid measures reflecting the quality of the diagnostic process. At the same time, it has become apparent that the healthcare work system, particularly in primary care, is chaotic and stressful, leading to clinician burnout and patient harm. We propose a new construct that health systems and researchers can use to measure the quality and safety of the diagnostic process that is sensitive to the context of the health care work system. This model focuses on three measurable practices: considering "don't miss" diagnoses, looking for red flags, and ensuring that clinicians avoid common diagnostic pitfalls. We believe that the performance of clinicians with respect to these factors is sensitive to the health care work system, allowing for context-dependent measurement and improvement of the diagnostic process. Such process measures will enable more rapid improvements rather than exclusively measuring outcomes related to "correct" or "incorrect" diagnoses.
诊断错误是医疗保健中不可接受的伤害源。然而，由于缺乏反映诊断过程质量的有效措施，改进工作受到了阻碍。与此同时，很明显医疗保健工作系统（尤其是在初级保健中）混乱且压力大，导致临床医生倦怠和患者受到伤害。我们提出了一个新的概念，医疗系统和研究人员可以用它来衡量诊断过程的质量和安全性，这个概念对医疗保健工作系统的背景敏感。这个模型侧重于三个可衡量的实践：考虑“不要遗漏”的诊断、寻找危险信号以及确保临床医生避免常见的诊断陷阱。我们相信，临床医生在这些因素方面的表现对医疗保健工作系统敏感，允许进行基于上下文的测量和诊断过程的改进。这种过程测量将能够实现更快的改进，而不仅仅是测量与“正确”或“错误”诊断相关的结果。
