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Principal Investigators:

• Jeffrey A Gold, Oregon Health and Science University
• David W. Bates, Brigham and Women's Hospital
• Raj M. Ratwani, MedStar Health Research Institute 

Grant Number: 1R18HS029345-01

Project Aims:

1. Expand on our preliminary work in ambulatory care and analyze data from two national patient safety event databases (Collaborative Healthcare Patient Safety Organization, Patient Safety Authority) and medical malpractice reports (CRICO) to create a taxonomy to classify the contribution of electronic health records (EHRs) to diagnostic error that spans all major specialties and care environments.
2. Integrate the taxonomy into currently deployed event reporting systems.
3. Use data gathered from error reporting to facilitate implementation of a multiparameter strategy that improves EHR use to promote diagnostic excellence.

Principal Investigators:

• David Newman-Toker, Johns Hopkins University
• Kathryn Mack McDonald, Johns Hopkins University

Grant Number: 1R18HS029350-01

Project Aims:

1. Target immediate efforts to address the top causes of serious misdiagnosis-related harms in the ED.
2. Partner and share knowledge with other entities both within and beyond the network of centers of diagnostic excellence.
3. Develop a Johns Hopkins organizational framework for growth and sustainability of the center for diagnostic excellence mission.

Principal Investigators:

• Gordon David Schiff, Brigham and Women’s Hospital
• Thomas Henry Gallagher, University of Washington Medical Center

Grant Number: 1R18HS029344-01

Project Aims:

1. Create a center of diagnostic excellence that will design and implement a program to identify and learn from patients with delays in diagnosis of four leading cancers.
2. Engage and deeply learn from patients who have experienced delayed cancer diagnoses.
3. Advance, implement, and evaluate generalizable interventions to improve the cancer diagnostic process.

Principal Investigators:

• Ramin Khorasani, Brigham and Women’s Hospital
• Ronilda Lacson, Brigham and Women’s Hospital

Grant Number: 1R18HS029348-01

Project Aims:

1. Develop a multidisciplinary diagnostic excellence center to address diagnostic errors.
2. Design enhancements to a pilot implementation of a highly reliable and resilient system, accelerate its implementation in a large healthcare system, and evaluate its impact on diagnostic errors using a mixed-methods analysis.
3. Improve diagnostic precision and management by building consensus using available evidence.
4. Disseminate all DECODE methods and tools, including specifications for information technology systems and workflow processes.

Principal Investigators:

• Kristen Elizabeth Miller, MedStar Health Research Institute
• Traber L. Giardina, Baylor College of Medicine
• Kelly Michelle Smith, University of Toronto

Grant Number: 1R18HS029356-01

Project Aims:

1. Create and execute research in four workstreams of the center that detect and address the contributing factors leading to diagnostic errors, informed by patient partners.
2. Propose, prioritize, and codesign patient-centered solutions to mitigate diagnostic errors.
3. Evaluate the structure, process, and outcome effects of human-centered solutions on diagnostic error in simulated and clinical environments, disseminate solutions, and develop a sustainability plan.

Principal Investigators:

• Goutham Rao, University Hospitals of Cleveland
• Mary Dolansky, Case Western Reserve University
• Marlene Rosemary Miller, University Hospitals
• Peter J. Pronovost, University Hospitals

Grant Number: 1R18HS029358-01

Project Aims:

1. Identify current evidence, diagnostic practices, and outcomes for the problems of unintentional weight loss, high blood pressure, and sepsis.
2. Develop recommendations for improved diagnostic practices for the clinical problems above, based on analysis of EHR data; existing evidence, including from a home blood pressure monitoring screening study; and input and consensus among clinicians and patients.
3. Disseminate and implement recommendations through a multifaceted approach using quality improvement principles and evaluating key outcomes including timeliness, accuracy, and resource use associated with diagnosis.

Principal Investigators:

• Eric J. Thomas, University of Texas Health Science Center, Houston
• Sigall Bell, Beth Israel Deaconess Medical Center

Grant Number: 1R18HS029362-01

Project Aims:

1. Conduct diagnostic ecosystem mapping, using qualitative methods and a Safety-II lens, guided by teaming science principles and known patient-identified blindspots.
2. Elevate less heard voices in the diagnostic process at the frontlines of care, including patients with limited English proficiency and older patients with chronic illness, through teaming tools.
3. Build capacity to sustain and expand multistakeholder diagnostic Safety-II contributions through a novel center of diagnostic excellence program: "Safety2gether."

Principal Investigators:

• Andrew D. Auerbach, University of California, San Francisco
• Jeffrey Lawrence Schnipper, Brigham and Women's Hospital

Grant Number: 1R18HS029366-01

Project Aims:

1. Implement an enhanced case review infrastructure that can accurately identify diagnostic errors and characterize diagnostic processes among patients who experience inpatient deaths, ICU transfers, or rapid-response team calls taking place at hospitals associated with UPSIDE.
2. Develop site-level and groupwide benchmarking reports of error rates, diagnostic processes, and diagnostic performance and incorporate them into sites’ safety and quality programs.
3. Use Aim 2 infrastructure to identify and pilot Safety-I and Safety-II interventions.
4. Carry out a comprehensive program evaluation, including analysis of rates of diagnostic errors and process faults before and after implementation of our Aim 1 and 2 programs and analysis of reach, effectiveness, adoption, implementation, and maintenance of Aim 1 and 2 programs and Aim 3 pilot interventions.

Principal Investigators:

• Kathleen Elizabeth Walsh, Boston Children’s Hospital
• Christopher Paul Landrigan, Boston Children's Hospital

Grant Number: 1R18HS029346-01

Project Aims:

1. Characterize the diagnostic journey, focusing on successes, errors, and patient/family and clinician communication.
2. Adapt PFC I-PASS to create Outpatient PFC I-PASS, a structured communication intervention for patients/families and clinicians in the outpatient setting.
3. Evaluate the effectiveness of PFC I-PASS (discharge and outpatient) to improve patient/family and clinician communication and experience and to reduce errors and harm throughout the diagnostic journey.

Principal Investigator: Hardeep Singh, Baylor College of Medicine
Grant Number: 1R18HS029347-01

Project Aims:

1. Create tools, strategies, and methods to implement e-trigger algorithms for diagnostic error surveillance and prevention in LEDE (Learning and Exploration of Diagnostic Excellence) organizations.
2. Develop and evaluate Safety-I- and Safety-II-related methods for providing clinicians and healthcare organizations with rapid diagnostic performance feedback.
3. Synthesize implementation experiences to develop a safety surveillance system, “Safer Dx e-Watch,” to facilitate large-scale implementation efforts in U.S. health systems.