Algarin Perneth Sandra, Perez Rodriguez Garcia Gilberto, Brito Juan P, Gandhi Tejal, Bylund Carma L, Hargraves Ian G, Singh Ospina Naykky
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Diagnosis (Berl). 2024 Dec 10;12(1):45-52. doi: 10.1515/dx-2024-0132. eCollection 2025 Feb 1.
Diagnostic reconciliation is the collaborative process between patients and clinicians to create and reconcile evidence-based, feasible, and desirable care plans. However, the specific components of this process remain unclear. The objective of this study was to develop the first comprehensive framework to elucidate the diagnostic reconciliation process.
We followed a multi-step and iterative approach to develop the framework, including a focused systematic review of diagnostic conversations, quantitative evaluation of recordings of real-life clinical visits recordings, and stakeholder engagement (e.g., patients, clinicians, researchers).
We identified 17 potential components to the process of diagnostic reconciliation through literature review and stakeholder engagement. After review of 56 clinical visits and further stakeholder engagement, we developed a final framework including four categories: 1) understanding the need for a test/referral, 2) logistics of test/referral scheduling, 3) test/referral information, and 4) test/referral results.
The proposed framework lays the foundation for evaluation and improvement of diagnostic conversations in practice. Clinicians can enhance patient-centered diagnosis by co-creating diagnostic plans of care in practice and using the components described in the novel diagnostic reconciliation framework.
诊断协调是患者与临床医生之间的协作过程，旨在制定并协调基于证据、可行且理想的护理计划。然而，这一过程的具体组成部分仍不明确。本研究的目的是开发首个全面框架以阐明诊断协调过程。
我们采用多步骤迭代方法来开发该框架，包括对诊断对话进行重点系统综述、对实际临床诊疗记录进行定量评估以及让利益相关者（如患者、临床医生、研究人员）参与其中。
通过文献综述和利益相关者参与，我们确定了诊断协调过程的17个潜在组成部分。在对56次临床诊疗进行审查并进一步让利益相关者参与后，我们制定了一个最终框架，包括四个类别：1）理解检查/转诊需求，2）检查/转诊安排的后勤事宜，3）检查/转诊信息，4）检查/转诊结果。
所提出的框架为在实践中评估和改进诊断对话奠定了基础。临床医生可通过在实践中共同制定诊断护理计划并使用新的诊断协调框架中描述的组成部分，来加强以患者为中心的诊断。
