R18HS029366

Achieving Diagnostic Excellence Through Prevention and Teamwork (ADEPT) - Project Summary/Abstract

Many factors contribute to diagnostic errors, but key among them are foundational issues in healthcare: complex and fragmented care systems, the limited time available to providers trying to ascertain a firm diagnosis, and the work systems and cultures that support or impede improvements in diagnostic performance.

While approaches to identifying diagnostic errors exist, few studies have linked identification of underlying systemic and structural causes of errors to existing quality improvement programs in hospitals. Even fewer have applied resilience theories or positive deviance approaches to characterize the features of cases where the diagnostic process is optimal and then use those findings to frame health system improvement.

This application builds directly on our currently funded study - Utility of Predictive Systems in Diagnostic Errors (UPSIDE) - which is defining risk factors, underlying causes, and prevalence of diagnostic errors among patients admitted to hospitals participating in our 55-hospital research collaborative, the Hospital Medicine Reengineering Network (HOMERUN). UPSIDE has developed reference standard approaches to adjudication of diagnostic errors, defined factors associated with errors, and created collaborations with our sites and national organizations, providing a uniquely powerful opportunity to transform how diagnostic process evaluation programs can be used to improve patient safety.

The overall goal of this center is to turn our highly successful multicenter network into a diagnostic error learning health system that will integrate diagnostic error assessments into existing quality and safety programs, provide support and expertise needed to reduce diagnostic errors, and catalyze scientific, personnel, and infrastructure changes which will last beyond the duration of this grant.

To achieve our overall goals, we will:

1) Implement a case review infrastructure which can accurately identify diagnostic errors and characterize diagnostic processes among patients suffering inpatient deaths, ICU transfers, or rapid-response team calls taking place at hospitals associated with the Hospital Medicine Reengineering Network.

2) Develop site-level audit and feedback and group-wide benchmarking reports of error rates, diagnostic process faults, diagnostic process resilience features, and use these data to frame collaboration between existing safety and quality programs at our sites.

3) Use our data and collaborative model to develop and pilot test interventions based on highest priority findings.

4) Develop understanding of our program's reach, adoption, implementation, and maintenance, as well as feasibility and initial experience with pilot interventions.

This project will establish a learning health system which can achieve excellence in diagnosis as an ongoing part of care, a system which can be a model for others as well.

San Francisco Regents Of The University Of California

TO SUPPORT RESEARCH AND EVALUATIONS, DEMONSTRATION PROJECTS, RESEARCH NETWORKS, AND MULTIDISCIPLINARY CENTERS AND TO DISSEMINATE INFORMATION ON HEALTH CARE AND ON SYSTEMS FOR THE DELIVERY OF SUCH CARE INVOLVING: (1) THE QUALITY, EFFECTIVENESS, EFFICIENCY, APPROPRIATENESS AND VALUE OF HEALTH CARE SERVICES, (2) QUALITY MEASUREMENT AND IMPROVEMENT, (3) THE OUTCOMES, COST, COST-EFFECTIVENESS, AND USE OF HEALTH CARE SERVICES AND ACCESS TO SUCH SERVICES, (4) CLINICAL PRACTICE, INCLUDING PRIMARY CARE AND PRACTICE-ORIENTED RESEARCH, (5) HEALTH CARE TECHNOLOGIES, FACILITIES AND EQUIPMENT, (6) HEALTH CARE COSTS, PRODUCTIVITY, ORGANIZATION, AND MARKET FORCES, (7) HEALTH PROMOTION AND DISEASE PREVENTION, INCLUDING CLINICAL PREVENTIVE SERVICES, (8) HEALTH STATISTICS, SURVEYS, DATABASE DEVELOPMENT, AND EPIDEMIOLOGY, (9) DIGITAL HEALTHCARE RESEARCH, AND (10) PATIENT SAFETY RESEARCH, INCLUDING HEALTHCARE-ASSOCIATED INFECTIONS. IN SUPPORT OF THIS RESEARCH, THE AGENCY HAS A SPECIAL INTEREST IN HEALTH CARE AND ITS DELIVERY IN THE INNER CITY, IN RURAL AREAS, AND FOR PRIORITY POPULATIONS (LOW-INCOME GROUPS, MINORITY GROUPS, WOMEN, CHILDREN, THE ELDERLY, AND INDIVIDUALS WITH SPECIAL HEALTH CARE NEEDS).

93.226 - Research on Healthcare Costs, Quality and Outcomes

Division of Grants Management [HHS - AHRQ]

Center for Quality Improvement and Patient Safety (CQuIPS) [HHS - AHRQ]

San Francisco, California 941432206 United States

Single Zip Code

Diagnostic Centers of Excellence: Partnerships to Improve Diagnostic Safety and Quality (R18) (RFA-HS-22-008)

Amendment Since initial award the total obligations have increased 296% from $989,769 to $3,916,854.