A Mobile Phone-based Triage Tool to Identify Discharged Trauma Patients in Need of Further Care in Cameroon

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Investigator: Catherine Juillard, MD, MPH
Sponsor: NIH John F. Fogarty International Center

Location(s): Cameroon

Description

The proposed research is relevant to public health because the mobile phone-based triage tool we will develop and test aims to prevent post-discharge morbidity and mortality among traumatically injured patients in low- and middle-income countries. This simple and potentially effective approach would shift existing clinical practice patterns in this context. The research is relevant to NIH’s mission because it seeks to lengthen the lives of these patients and to reduce or eliminate any subsequent disabilities.

As injuries become an increasingly important public health priority in low- and middle-income settings, including sub-Saharan Africa (SSA), context-appropriate methods for improving trauma care are lacking. Cameroon appears to be more affected by injury than other countries in the region. While over 60% of injured patients in Cameroon seek formal care, there is no mechanism to follow these patients for further care after they are discharged from the hospital. The growing network of mobile phones in Cameroon presents a novel opportunity to reach populations that have been previously lost to follow up. A mobile phone-administered tool that could reliably identify patients who would most benefit from further care would maximize the use of health care resources currently directed towards treating injury and potentially decrease the disability and mortality associated with injury. Our long-term goal is to reduce the burden associated with injury in Cameroon through our established multi-disciplinary collaboration with Cameroonian hospitals and the University of Buea. Our overall objective is to improve timely medical follow-up for injured patients in Cameroon to reduce the impact of injury. Common sequelae of injury, such as infection, thromboembolic events, osseous malunion, poor wound healing, neurologic disability, or others, could be intervened upon in a timely fashion before they become life- or limb-threatening, resulting in long-term disability or death. We hypothesize that a telephone-based triage tool is a feasible and effective method of timely identification of trauma patients in Cameroon who would benefit from further follow up after they are discharged from the hospital. To accomplish this objective, we will pursue three specific aims: 1) Establish the feasibility of mobile phones as a follow-up tool for hospitalized trauma patients after discharge in Cameroon; 2) Cross-validate a mobile phone-based assessment tool to identify trauma patients who would benefit from further medical care; 3) Characterize the impact of timely follow-up on long-term disability and socioeconomic consequences associated with trauma in Cameroon. Understanding the feasibility of mobile phones as a follow-up tool for trauma patients will enhance our understanding of how mobile phones can be used across multiple other health sectors. Validation of an innovative triage tool to identify high-risk patients will allow resources to be focused on ensuring that those patients get timely medical care, reducing the health and socioeconomic consequences of injury. Embedded in our approach is the training of clinicians in process health systems research, giving them the tools to continue to strengthen care in Cameroon. This research initiative is the vital step towards improving care of injured patients in Cameroon and developing a network of individuals who can create a culture of research-based improvements in the care of the injured.