Evaluation of laboratory information systems in resource-poor settings

描述(申请人提供)：在资源匮乏的环境中，耐多药结核病(MDR-TB)患者在开始适当治疗方面经历了很大的延迟，并且由于卫生保健系统负担过重、通信延迟以及丢失或容易出错的数据而经常得不到适当的监测。这会增加患者的发病率，并进一步传播这种致命的疾病。这项建议是在资源贫乏的情况下，为有无互联网的机构开发、实施和正式评估医疗信息系统。我们假设，应用这些技术将减少延误和通信错误，以改善受这种再次出现的传染病影响的人的健康。在这项研究中，我们建议创建并定量评估两个实验室信息系统。第一个在联网的机构集团内提供结核病(TB)实验室信息的电子通信和报告，以 减少实验室结果的传达次数，加快高危患者治疗的开始，减少差错频率。第二个系统建立了一个从物理分布的非联网实验室组中收集结核病实验室信息的电子系统，以减少延误、错误和成本。这两个互补的系统试图在两种类型的资源匮乏情景中验证相同的假设，即有互联网和没有互联网的情景。有六个具体目标。1)开发和实施基于手持设备的数据系统，从缺乏互联网的多个地点收集结核病细菌学结果。2)通过进行随机前瞻性和历史队列研究，评估该电子系统对收集过程的延迟、错误、用户感知和成本的影响。3)开发和实施基于网络的结核病实验室信息系统，使卫生中心能够获取国家和区域实验室的检测结果。4)通过进行随机前瞻性和历史队列研究，评估与当前纸质系统相比，该实验室系统在成果和成本沟通方面的影响。5)探讨该系统对高危患者临床结局的影响。6)使用标准化调查工具评估用户对这一系统的看法及其在国家一级的潜在使用情况。这项研究将提供电子信息系统，以降低结核病的发病率。结核病是一种新出现的传染病，每年导致150多万人死亡。它将对这些系统进行评估，以正式证明它们对有互联网和没有互联网的地点的好处。这将为世界各地实施这些技术的其他项目提供指导。

DESCRIPTION (provided by applicant): Multi-drug resistant tuberculosis (MDR-TB) patients in resource-poor settings experience large delays in starting appropriate therapy and are often not monitored appropriately due to an overburdened health care system, communication delays, and missing or error-prone data. This causes increased morbidity to patients, as well as further transmission of this deadly disease. This proposal is to develop, implement and formally evaluate medical information systems in a resource poor setting for institutions with and without internet. We hypothesize that applying these technologies will decrease delays and communications error to improve the health of those affected by this re-emerging infectious disease. In this study, we propose to create and quantitatively evaluate two laboratory information systems. The first provides electronic communication and reporting of tuberculosis (TB) laboratory information within a networked group of institutions to reduce the communication times of laboratory results, accelerate the startof treatment of high-risk patients and decrease the frequency of errors. The second creates a system of electronic collection of TB laboratory information from a physically distributed group of non-networked laboratories to reduce delays, errors and costs. These two complementary systems seek to verify the same hypothesis in two types of resource-poor scenarios, those with and without internet. There are six specific aims. 1) To develop and implement a handheld-based data system to collect TB bacteriological results from multiple sites lacking internet. 2) To evaluate the impact of this electronic system on the delays, errors, user perception and costs of the collection process by performing a randomized prospective and historical cohort study. 3) To develop and implement a web-based TB laboratory information system to enable health centers to access test results from the national and regional laboratories. 4) To evaluate the impact of this laboratory system on communication of results and costs compared to the current paper system by performing a randomized prospective and historical cohort study. 5) To investigate the impact of this system on the clinical outcome of high-risk patients. 6) To assess users' perception of this system and its potential use at a national level using a standardized survey instrument. This research will provide electronic information systems to decrease the morbidity of tuberculosis, a reemerging infectious disease which kills over 1.5 million people annually. It will evaluate these systems to formally prove their benefits for locations with and without internet. This will provide guidelines for other programs worldwide to implement these technologies.