دورية أكاديمية
أعرض في EDS

Patient and family contributions to improve the diagnostic process through the OurDX electronic health record tool: a mixed method analysis.

التفاصيل البيبلوغرافية
العنوان: Patient and family contributions to improve the diagnostic process through the OurDX electronic health record tool: a mixed method analysis.
المؤلفون: Bell SK; Department of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA sbell1@bidmc.harvard.edu.; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA., Harcourt K; Department of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA., Dong J; Department of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA., DesRoches C; Department of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA., Hart NJ; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA., Liu SK; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA., Ngo L; Department of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.; Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA., Thomas EJ; Department of Internal Medicine, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas, USA.; UT Houston-Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, USA., Bourgeois FC; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
المصدر: BMJ quality & safety [BMJ Qual Saf] 2023 Aug 21. Date of Electronic Publication: 2023 Aug 21.
Publication Model: Ahead of Print
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 101546984 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2044-5423 (Electronic) Linking ISSN: 20445415 NLM ISO Abbreviation: BMJ Qual Saf
أسماء مطبوعة: Original Publication: London : BMJ Pub. Group
مستخلص: Background: Accurate and timely diagnosis relies on sharing perspectives among team members and avoiding information asymmetries. Patients/Families hold unique diagnostic process (DxP) information, including knowledge of diagnostic safety blindspots-information that patients/families know, but may be invisible to clinicians. To improve information sharing, we co-developed with patients/families an online tool called 'Our Diagnosis (OurDX)'. We aimed to characterise patient/family contributions in OurDX and how they differed between individuals with and without diagnostic concerns.
Method: We implemented OurDX in two academic organisations serving patients/families living with chronic conditions in three subspecialty clinics and one primary care clinic. Prior to each visit, patients/families were invited to contribute visit priorities, recent histories and potential diagnostic concerns. Responses were available in the electronic health record and could be incorporated by clinicians into visit notes. We randomly sampled OurDX reports with and without diagnostic concerns for chart review and used inductive and deductive qualitative analysis to assess patient/family contributions.
Results: 7075 (39%) OurDX reports were submitted at 18 129 paediatric subspecialty clinic visits and 460 (65%) reports were submitted among 706 eligible adult primary care visits. Qualitative analysis of OurDX reports in the chart review sample (n=450) revealed that participants contributed DxP information across 10 categories, most commonly: clinical symptoms/medical history (82%), tests/referrals (54%) and diagnosis/next steps (51%). Participants with diagnostic concerns were more likely to contribute information on DxP risks including access barriers, recent visits for the same problem, problems with tests/referrals or care coordination and communication breakdowns, some of which may represent diagnostic blindspots.
Conclusion: Partnering with patients and families living with chronic conditions through OurDX may help clinicians gain a broader perspective of the DxP, including unique information to coproduce diagnostic safety.
(© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
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معلومات مُعتمدة: R01 HS027367 United States HS AHRQ HHS
فهرسة مساهمة: Keywords: communication; diagnostic errors; healthcare quality improvement; patient safety; patient-centred care
تواريخ الأحداث: Date Created: 20230821 Latest Revision: 20240222
رمز التحديث: 20240222
مُعرف محوري في PubMed: PMC10879445
DOI: 10.1136/bmjqs-2022-015793
PMID: 37604678
قاعدة البيانات: MEDLINE
الوصف
تدمد:2044-5423
DOI:10.1136/bmjqs-2022-015793