142nd APHA Annual Meeting and Exposition

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296361
Use of decision support in a public pediatric hospital in Monrovia, Liberia to decrease variance in diagnosis and treatment for malaria and pneumonia

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 12:30 PM - 12:42 PM

Wilson Wang, MD MPH MPA , EMAS, Save the Children - USA, jakarta, Indonesia
Augustine Koryon , Health Unit, International Rescue Committee, Monrovia, Liberia
OBJECTIVE

Clinicians often diagnose and treat disease without cross checking decisions against established protocols. This habit leads to medical errors with dire consequences, particularly in children with killers such as malaria and pneumonia.

We introduced decision support tools (DST) for pediatric patients at JDJ hospital in Monrovia, Liberia. These tools present proper diagnosis and treatment of common diseases in an easy to follow check-list form. We measured the effect of DST.

METHODS

We implemented DST at JDJ April 2012.  Three months later, we reviewed charts of patients admitted to JDJ with malaria and pneumonia and compared them with cohorts admitted one year earlier.  We documented proportion recording a positive rapid diagnostic test (RDT) or blood smear for malaria and tachypnea or retractions for pneumonia.  We documented proportion recording proper administration of anti-malarials and antibiotics. We used a simple test of significance to determine if DST resulted in more accurate diagnosis and treatment of malaria and pneumonia.

RESULTS

72 patients were admitted to JDJ with malaria  August 2011 and 72 patients August 2012.  In both periods, 93% were admitted with confirmed RDT or blood smear, but only 3% of patients in 2011 were treated according to standard versus 78% in 2012. (P<0.01)

93 patients were admitted with pneumonia July-August 2011 but only 46 patients July-August 2012.  During the 2011 period, 37.8% of charts noted tachypnea or retractions as part of criteria for admission versus 94.6% in 2012 (P<0.01).  7.5% of cases during the 2011 period were treated with antibiotics according to protocol versus 84.8% in 2012. (P<0.01)

Learning Areas:

Implementation of health education strategies, interventions and programs
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe the use of decision support tools in resource poor hospitals to increase the accuracy of diagnosis and treatment for killer pediatric diseases.

Keyword(s): International Health, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I directed health programs for the International Rescue Committee, Liberia 2011-2012. I am qualified to be an abstract Author because I personally oversaw this intervention in one of our six hospitals, devoting the proper resources to both its implementation and evaluation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.