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STUDY PROTOCOL article

Front. Med.
Sec. Family Medicine and Primary Care
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1414892
This article is part of the Research Topic The Epidemiology of Missed and Delayed Medical Diagnosis: Implications for Health Equity and Public Health View all 8 articles

Developing methods to identify resilience and improve communication about diagnosis in pediatric primary care

Provisionally accepted
Irit R. Rasooly Irit R. Rasooly 1,2,3*Trisha Marshall Trisha Marshall 4,5Christina L. Cifra Christina L. Cifra 6,7Ken Catchpole Ken Catchpole 8Nicholas C. Kuzma Nicholas C. Kuzma 10,9Patrick W. Brady Patrick W. Brady 11,4,5Katherine Melton Katherine Melton 12Alisa Khan Alisa Khan 12,7Alyna T. Chien Alyna T. Chien 12,7Ellen A. Lipstein Ellen A. Lipstein 11,4Christopher P. Landrigan Christopher P. Landrigan 12,13,14Kathleen E. Walsh Kathleen E. Walsh 12,7
  • 1 Children's Hospital of Philadelphia, Philadelphia, United States
  • 2 Clinical Futures, Children's Hospital of Philadelphia, Philadephia, Pennsylvania, United States
  • 3 Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • 4 Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
  • 5 Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • 6 Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
  • 7 Departments of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
  • 8 Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, United States
  • 9 College of Medicine, Drexel University, Philadelphia, Pennsylvania, United States
  • 10 Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, United States
  • 11 James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • 12 Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, United States
  • 13 Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
  • 14 Department of Pediatrics, Department of Medicine, and Division of Sleep Medicine, Harvard Medical School, Boston, United States

The final, formatted version of the article will be published soon.

    Communication underlies every stage of the diagnostic process. The Dialogue Study aims to characterize the pediatric diagnostic journey, focusing on communication as a source of resilience, in order to ultimately develop and test the efficacy of a structured patient-centered communication intervention in improving outpatient diagnostic safety. In this manuscript, we will describe protocols, data collection instruments, methods, analytic approaches, and theoretical frameworks to be used in to characterize the patient journey in the Dialogue Study. Our approach to characterization of the patient journey will attend to patient and structural factors, like race and racism, and language and language access, before developing interventions. Our mixed-methods approach is informed by the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework (which describes the sociotechnical system underpinning diagnoses within the broader context of multiple interactions with different care settings over time) and the Safety II framework (which seeks to understand successful and unsuccessful adaptations to ongoing changes in demand and capacity within the healthcare system). We will assess the validity of different methods to detect diagnostic errors along the diagnostic journey. In doing so, we will emphasize the importance of viewing the diagnostic process as the product of communications situated in systems-of-work that are constantly adapting to everyday challenges.

    Keywords: diagnosis, Diagnostic process, Patient Safety, safety II, Pediatrics, Communication, Primary Care, Ambulatory Care

    Received: 02 May 2024; Accepted: 13 Sep 2024.

    Copyright: © 2024 Rasooly, Marshall, Cifra, Catchpole, Kuzma, Brady, Melton, Khan, Chien, Lipstein, Landrigan and Walsh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Irit R. Rasooly, Children's Hospital of Philadelphia, Philadelphia, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.