Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Am Med Inform Assoc. 2023 Mar 16;30(4):692-702. doi: 10.1093/jamia/ocad003.
Patients and families are key partners in diagnosis, but methods to routinely engage them in diagnostic safety are lacking. Policy mandating patient access to electronic health information presents new opportunities. We tested a new online tool ("OurDX") that was codesigned with patients and families, to determine the types and frequencies of potential safety issues identified by patients/families with chronic health conditions and whether their contributions were integrated into the visit note.
Patients/families at 2 US healthcare sites were invited to contribute, through an online previsit survey: (1) visit priorities, (2) recent medical history/symptoms, and (3) potential diagnostic concerns. Two physicians reviewed patient-reported diagnostic concerns to verify and categorize diagnostic safety opportunities (DSOs). We conducted a chart review to determine whether patient contributions were integrated into the note. We used descriptive statistics to report implementation outcomes, verification of DSOs, and chart review findings.
Participants completed OurDX reports in 7075 of 18 129 (39%) eligible pediatric subspecialty visits (site 1), and 460 of 706 (65%) eligible adult primary care visits (site 2). Among patients reporting diagnostic concerns, 63% were verified as probable DSOs. In total, probable DSOs were identified by 7.5% of pediatric and adult patients/families with underlying health conditions, respectively. The most common types of DSOs were patients/families not feeling heard; problems/delays with tests or referrals; and problems/delays with explanation or next steps. In chart review, most clinician notes included all or some patient/family priorities and patient-reported histories.
OurDX can help engage patients and families living with chronic health conditions in diagnosis. Participating patients/families identified DSOs and most of their OurDX contributions were included in the visit note.
患者及其家属是诊断过程中的重要伙伴，但目前缺乏能让他们常规参与诊断安全工作的方法。而要求患者获取电子健康信息的政策则带来了新的机会。我们测试了一种新的在线工具（“OurDX”），它是与患者及其家属共同设计的，旨在确定患有慢性疾病的患者/家属可能发现的安全问题的类型和频率，以及他们的意见是否被纳入就诊记录。
邀请美国 2 个医疗地点的患者/家属通过在线就诊前调查来提供信息：（1）就诊重点，（2）近期病史/症状，以及（3）潜在的诊断问题。两名医生审查患者报告的诊断问题，以验证并分类诊断安全机会（DSO）。我们进行了病历回顾，以确定患者的意见是否被纳入记录。我们使用描述性统计来报告实施结果、验证 DSO 和病历回顾结果。
在儿科专科就诊中，18129 名符合条件的患者中有 7075 名（39%）完成了 OurDX 报告（地点 1），706 名符合条件的成年患者中有 460 名（65%）完成了 OurDX 报告（地点 2）。在报告诊断问题的患者中，有 63%被确认为可能的 DSO。在儿科和成年患者/家属中，分别有 7.5%和 6.5%存在潜在健康问题的患者/家属报告了可能的 DSO。最常见的 DSO 类型是患者/家属感觉未被倾听；检查或转诊存在问题/延误；以及解释或后续步骤存在问题/延误。在病历回顾中，大多数临床医生的记录都包含了所有或部分患者/家属的重点和患者报告的病史。
OurDX 可以帮助患有慢性疾病的患者及其家属参与诊断。参与的患者/家属确定了 DSO，他们的大多数 OurDX 意见都被纳入了就诊记录。
