Improving the diagnostic process and preventing errors are the focus of two studies funded by the U.S. Department of Health and Human Services (HHS) and led by Eric Thomas, MD, associate dean for health care quality with McGovern Medical School at UTHealth Houston.
Both grants were funded through the Agency for Healthcare Research and Quality of HHS.
The first grant for $1.3 million centers on improving the follow-up diagnostic process for patients whose lab results showed anemia or reduced kidney function. Both results can often point to an underlying condition that requires additional evaluation to identify or diagnose a potentially serious disease, or whether an adverse drug reaction is present. Identifying patients with abnormal lab results and connecting them to a clinical pathologist and a nurse navigator can allow for communication with the patient’s primary physician and additional testing to discover what the lab results mean. This can result in early diagnosis and prevention of emergency room visits or hospitalization.
“There are conditions like cancer that are presented as anemia. Oftentimes, it is the initial and only sign that we have that somebody has a serious underlying condition. We want to make sure we promptly diagnose what that condition is to get the right treatment,” said Thomas, who is the director of the Center for Healthcare Quality and Safety at UTHealth Houston and Memorial Hermann-TMC.
Four schools at UTHealth Houston are collaborating on this research project, including co-investigators specializing in patient engagement at Cizik School of Nursing, implementation science researchers at the School of Public Health, and faculty staff assisting with identifying abnormal lab results at McWilliams School of Biomedical Informatics.
By using an experimental study design that involves intervention and control groups at 13 UT Physicians clinics, Thomas will determine the best team-based diagnostic process and how to successfully implement it. Thomas hopes it will eventually be used across all UT Physician clinics.
The second five-year grant, for $3.9 million, is aimed at improving communication among all stakeholders in the outpatient diagnostic process.
“By increasing information sharing through the electronic health record system during clinics and by other means, we will close a foundational knowledge gap and support patients and clinicians. We will help patients become a member of the diagnostic team so they can share and receive the information needed to eventually receive the correct diagnosis,” Thomas said.
This approach to diagnosis is necessary, in part, because providers in the ambulatory setting have diagnostic blind spots, or circumstances where they do not have all of the information a patient has about evolving symptoms or the results of evaluations completed by other clinicians.
The research team will focus on two vulnerable populations: the elderly with chronic medical conditions and patients who prefer to speak Spanish. “It's especially hard for these patients to negotiate this process. We’re interviewing them and gaining understanding about how communication is maintained and information is shared,” Thomas said.
The multi-institutional project consists of collaborative partners including co-investigators at Rice University, Harvard Beth Israel Deaconess Medical Center, and the Group for Organizational Effectiveness.
“We have colleagues who are helping us with the team science aspect. In a couple of years, we should have interviewed enough people while using the development tools to help patients and clinicians communicate better and avoid prolonged or mistaken diagnostic processes,” Thomas said.
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