Tran Alberta, Blackall Leah, Hill Mary A, Gallagher William
MedStar Institute for Quality and Safety, MedStar Health Research Institute, Columbia, MD, United States.
Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada.
Front Health Serv. 2025 Jan 13;4:1474195. doi: 10.3389/frhs.2024.1474195. eCollection 2024.
Adults over the age of 65 are at a higher risk for diagnostic errors due to a myriad of reasons. In primary care settings, a large contributor of diagnostic errors are breakdowns in information gathering and synthesis throughout the patient-provider encounter. Diagnostic communication interventions, such as the Agency for Healthcare Research and Quality's "Be the Expert on You" note sheet, may require adaptations to address older adults' unique needs.
We recruited and partnered with older adult patients ( = 6) in focus group sessions to understand their perspectives on diagnostic communication and the existing AHRQ note sheet. A two-page communication and clinic workflow tool was developed and implemented over a 6-month period using three Plan-Do-Check-Act cycles. Physicians, nurses, staff, and patients were surveyed.
Most older adult patients ( = 31) found the tailored diagnostic communication note sheet to be easy-to-use, helpful for provider communication, and would recommend its use to other patients. Physicians and staff members were satisfied with the note sheet and described few challenges in using it in practice.
Our findings contribute to the growing body of evidence around diagnostic safety interventions and patient engagement by demonstrating the feasibility and benefits of actively involving older adult patients in quality initiatives.
65岁以上的成年人由于多种原因面临更高的诊断错误风险。在初级保健环境中，诊断错误的一个主要原因是在患者与医疗服务提供者接触过程中信息收集和综合方面的失误。诊断沟通干预措施，如医疗保健研究与质量局的“成为自己的专家”便签，可能需要进行调整以满足老年人的独特需求。
我们招募了6名老年患者并与他们合作开展焦点小组会议，以了解他们对诊断沟通及现有的医疗保健研究与质量局便签的看法。我们开发了一个两页的沟通和诊所工作流程工具，并在6个月内通过三个计划-执行-检查-行动循环进行实施。对医生、护士、工作人员和患者进行了调查。
大多数老年患者（31名）发现量身定制的诊断沟通便签易于使用，有助于与医疗服务提供者沟通，并会向其他患者推荐使用。医生和工作人员对便签感到满意，并表示在实际使用中遇到的问题很少。
我们的研究结果通过展示让老年患者积极参与质量改进计划的可行性和益处，为围绕诊断安全干预措施和患者参与的越来越多的证据做出了贡献。
