Baylor College of Medicine researchers are teaming with Pennsylvania-based integrated health system Geisinger to develop a systematic approach to measure and improve diagnostic performance.
The “Safer Dx Learning Lab” will be made possible by a three-year, $3.5 million grant from the Gordon and Betty Moore Foundation as part of the foundation’s Patient Care Program, which aims to improve the experience and outcomes people have with their care.
In a news item posted on the Baylor College of Medicine web site, Hardeep Singh, M.D., principal investigator, said that the Safer Dx Learning Lab offers a perfect opportunity to work with health system leaders and clinical teams to translate research into meaningful care improvements. Singh, chief of the Health Policy, Quality and Informatics Program at the Houston VA Center for Innovations in Quality, Effectiveness and Safety, is also an associate professor of medicine at Baylor.
The partnership with Geisinger will be facilitated by a “Safer Dx Researcher-in-Residence,” who will act as a catalyst connecting the research team in Houston and the clinical operations team on the ground at Geisinger.
Dennis Torretti, M.D., associate chief medical officer at Geisinger Medical Center in Danville, Pa., said the health system has developed a Committee to Improve Clinical Diagnosis to target vulnerabilities in the diagnostic process and sustain a culture of diagnostic excellence.
In addition to analyzing data on missed diagnostic opportunities by leveraging Geisinger’s data warehouse, the team will evaluate how best to gather diagnostic safety concerns directly from patients and clinicians. Lessons learned will be translated to solutions that can be implemented to improve care delivery related to the diagnostic process, the partners said.
“Tools, strategies, innovations and lessons from this project would enable other health systems to learn from our experience and help scale up this program to other sites in the future,” said Singh, who is also a recipient of the 2012 Presidential Early Career Award for Scientists and Engineers for his work on patient safety and diagnostic errors.
Last year, Healthcare Informatics interviewed Dr. Singh about his work at the VA Medical Center in Houston to study diagnostic errors and cases where abnormal test results get lost in follow-up:
“We have used EHR data in order to identify patients who may be falling through the cracks of the healthcare system,” Singh said. So if a patient goes to primary care and then gets admitted to the hospital unexpectedly within 10 days, they look for patients who may have had a diagnostic error on the first visit. They call these trigger algorithms. The second example is more like a prospective trigger — when someone has an abnormal test result, and you would expect that to be followed up on, but it doesn’t happen. They might have a chest x-ray that shows a nodule in the chest. “At the VA, we code the data so it is already flagged,” Singh said. “If you don’t see a CT scan within 30 days, or a bronchoscopy or biopsy within 30 days, the computer knows that there is no action, that can get flagged. We have used longitudinal data to look for diagnostic and follow-up errors.”
