Pneumonia diagnosis performance in the emergency department: a mixed-methods study about clinicians' experiences and exploration of individual differences and response to diagnostic performance feedback.

IF 4.7 2区 医学 Q1 COMPUTER SCIENCE, INFORMATION SYSTEMS Journal of the American Medical Informatics Association Pub Date : 2024-06-20 DOI:10.1093/jamia/ocae112
Jorie M Butler, Teresa Taft, Peter Taber, Elizabeth Rutter, Megan Fix, Alden Baker, Charlene Weir, McKenna Nevers, David Classen, Karen Cosby, Makoto Jones, Alec Chapman, Barbara E Jones
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Abstract

Objectives: We sought to (1) characterize the process of diagnosing pneumonia in an emergency department (ED) and (2) examine clinician reactions to a clinician-facing diagnostic discordance feedback tool.

Materials and methods: We designed a diagnostic feedback tool, using electronic health record data from ED clinicians' patients to establish concordance or discordance between ED diagnosis, radiology reports, and hospital discharge diagnosis for pneumonia. We conducted semistructured interviews with 11 ED clinicians about pneumonia diagnosis and reactions to the feedback tool. We administered surveys measuring individual differences in mindset beliefs, comfort with feedback, and feedback tool usability. We qualitatively analyzed interview transcripts and descriptively analyzed survey data.

Results: Thematic results revealed: (1) the diagnostic process for pneumonia in the ED is characterized by diagnostic uncertainty and may be secondary to goals to treat and dispose the patient; (2) clinician diagnostic self-evaluation is a fragmented, inconsistent process of case review and follow-up that a feedback tool could fill; (3) the feedback tool was described favorably, with task and normative feedback harnessing clinician values of high-quality patient care and personal excellence; and (4) strong reactions to diagnostic feedback varied from implicit trust to profound skepticism about the validity of the concordance metric. Survey results suggested a relationship between clinicians' individual differences in learning and failure beliefs, feedback experience, and usability ratings.

Discussion and conclusion: Clinicians value feedback on pneumonia diagnoses. Our results highlight the importance of feedback about diagnostic performance and suggest directions for considering individual differences in feedback tool design and implementation.

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急诊科肺炎诊断表现:一项关于临床医生经验的混合方法研究,探讨个体差异和对诊断表现反馈的反应。
目的:我们试图(1)描述急诊科诊断肺炎的过程;(2)研究临床医生对诊断不一致反馈工具的反应:我们试图(1)描述急诊科(ED)诊断肺炎的过程;(2)研究临床医生对面向临床医生的诊断不一致反馈工具的反应:我们设计了一种诊断反馈工具,利用急诊科临床医生的患者电子健康记录数据来确定急诊科诊断、放射学报告和出院诊断之间的一致性或不一致性。我们就肺炎诊断和对反馈工具的反应对 11 名急诊室临床医生进行了半结构化访谈。我们进行了问卷调查,测量个体在心态信念、反馈舒适度和反馈工具可用性方面的差异。我们对访谈记录进行了定性分析,并对调查数据进行了描述性分析:主题结果显示:(1) 急诊室肺炎诊断过程的特点是诊断不确定性,而且可能是治疗和处置患者的次要目标;(2) 临床医生的诊断自我评估是一个零散、不一致的病例回顾和随访过程,而反馈工具可以填补这一空白;(3) 对反馈工具的描述是好的,任务和规范反馈利用了临床医生对高质量患者护理和个人卓越的价值观;(4) 对诊断反馈的强烈反应从隐性信任到对一致性指标有效性的深刻怀疑不等。调查结果表明,临床医生在学习和失败信念、反馈经验和可用性评级方面存在个体差异:临床医生重视肺炎诊断的反馈。我们的研究结果强调了诊断结果反馈的重要性,并提出了在设计和实施反馈工具时考虑个体差异的方向。
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来源期刊
Journal of the American Medical Informatics Association
Journal of the American Medical Informatics Association 医学-计算机:跨学科应用
CiteScore
14.50
自引率
7.80%
发文量
230
审稿时长
3-8 weeks
期刊介绍: JAMIA is AMIA''s premier peer-reviewed journal for biomedical and health informatics. Covering the full spectrum of activities in the field, JAMIA includes informatics articles in the areas of clinical care, clinical research, translational science, implementation science, imaging, education, consumer health, public health, and policy. JAMIA''s articles describe innovative informatics research and systems that help to advance biomedical science and to promote health. Case reports, perspectives and reviews also help readers stay connected with the most important informatics developments in implementation, policy and education.
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