Mobile health follow-up screening to risk stratify patients in need of further care in a low resource setting: Results from a prospective multisite implementation study.
Mobile health follow-up screening to risk stratify patients in need of further care in a low resource setting: Results from a prospective multisite implementation study.
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DOI：
10.1097/ta.0000000000003991
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发表时间：
2023-11-01
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我们证明，移动电话可以用来提供受伤患者的后续分类，这是敏感的识别病人的风险较差的结果裁定由喀麦隆医师考试的黄金标准。在创伤发病率和死亡率最高的低收入和中等收入国家，对出院后的受伤患者进行常规的现场随访是不可行的。移动技术筛查有助于早期发现并发症和及时治疗。在这项前瞻性、多地点实施的研究中，我们交叉验证了喀麦隆一种手机筛查工具的性能，该工具用于对出院后需要进一步护理的创伤患者进行风险分层。在2019年6月至2022年8月期间，研究助理在创伤患者出院两周后通过手机联系他们，进行了一项有14个问题的随访调查。所有被调查的患者都被要求返回进行身体检查。对调查结果不知情的医生将患者分为低风险、中度风险或高风险（HR），因为预后不佳，无需进一步治疗。逻辑回归检验了每个调查问题与医生检查之间的关联。预测性调查问题产生了一个初步模型，对识别需要进一步护理的患者具有高灵敏度。在1712个成功联系的病人家庭中，96%（1643）参加了电话分诊，而33%（560）的人返回医生检查。医生指定39%（220）为HR。在多元逻辑回归中，13个候选分诊问题中有8个与HR独立相关。在由此产生的8个问题屏幕上，积极的调查反应对HR的敏感性为89.2%，假阴性率为10.8%。根据分诊风险评分对变量重要性进行加权，39%的分诊患者被筛选为低风险，39%为中度风险，22%为高风险。高风险（优势比为5.9）或中度风险（优势比为1.9，均p < 0.01）的患者发生HR的可能性显著增加。在喀麦隆，手机分诊为出院后需要进一步护理的患者提供了敏感的风险分层。鉴于回返率低，有限的资源应高度优先考虑遣返筛查为不良结果高风险的患者。治疗和护理管理;第三层次。
We demonstrate that cellular telephone can be used to provide follow-up triage of injured patients that is sensitive in identifying patients at risk of poor outcomes as adjudicated by the gold standard of Cameroonian physician exam. #mHealthinCameroon #Trauma #FIC #NIH #PASEUCLA Routine in-person follow-up for injured patients after hospital discharge is unfeasible in low- and middle-income countries where trauma morbidity and mortality are the highest. Mobile technology screening may facilitate early detection of complications and timely treatment. In this prospective, multisite implementation study, we cross-validate the performance of a cellphone screening tool developed to risk stratify trauma patients in need of further care after discharge in Cameroon. Between June 2019 and August 2022, research assistants contacted trauma patients by cellphone 2 weeks after discharge to administer a 14-question follow-up survey. All surveyed patients were asked to return for a physical examination. Physicians blinded to survey results categorized patients as low or moderate or high risk (HR) for poor outcomes without further care. Logistic regression tested associations between each survey question and physician examination. Predictive survey questions generated a preliminary model with high sensitivity for identifying patients in need of further care. Of 1,712 successfully contacted patient households, 96% (1643) participated in telephone triage compared with 33% (560) who returned for physician examination. Physicians designated 39% (220) as being HR. On multiple logistic regression, 8 of 13 candidate triage questions were independently associated with HR. Positive survey response on the resultant eight question screen yielded 89.2% sensitivity for HR with a 10.8% false negative rate. Weighted for variable importance based on triage risk scores, 39% of triaged patients screened as low risk, 39% as moderate risk, and 22% as high risk for HR. Likelihood of HR was significantly greater for patients screening as high (odds ratio, 5.9) or moderate risk (odds ratio, 1.9; both p < 0.01). Cellphone triage provides sensitive risk stratification of patients in need of further care after hospital discharge in Cameroon. Given low in-person return rates, limited resources should highly prioritize efforts to repatriate patients screening as high risk for poor outcomes. Therapeutic/Care Management; Level III.