309376
Using Electronic Medical Record Information for Quality Improvement of Malaria Diagnosis and Management in Uganda
An increasing number of low-income countries are implementing electronic medical records (EMR) as part of their health care system. EMR can be a powerful tool to improve quality of care (QC) by evaluating adherence to standards of care and targeting interventions accordingly. This study assesses the QC provided by a rural Ugandan clinic by examining malaria diagnosis and treatment patterns and local community treatment practices documented in their EMR.
Methods:
A retrospective chart review of 1001 patients seen at a rural clinic in Uganda in a 12-month period was conducted to determine the rates of diagnosis and treatment of malaria. De-identified data on demographics, presenting symptoms, given diagnoses, medications, blood smear results, and management decisions was analyzed. QC measures were extracted from Ugandan national clinical guidelines including initiation on appropriate first- or second-line medicine after malaria diagnosis, correct treatment of severe or persistent infection, and treatment for special groups.
Results:
Several areas of deviance from national guidelines were identified. For example, of the 21 patients started on second-line quinine-based treatment, only 11 (52.4%) had a documented, appropriate indication. Additionally, several weaknesses were identified in the quality of EMR information. This included failure to specify mode of medication delivery and length of time on previous treatment.
Discussion:
EMR can provide insight into the QC of malaria diagnosis and treatment in Uganda. This study identified areas of improvement in the quality of EMR documentation and decision support systems and suggests the need for further training in appropriate management of malaria infection.
Learning Areas:
Clinical medicine applied in public healthConduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Learning Objectives:
Evaluate the quality of care of malaria treatment in Uganda based on electronic medical record information when assessed against national clinical guidelines.
Identify areas of improvement in clinical training for better malaria care and in the quality of information and decision support within electronic medical records.
Keyword(s): Quality Improvement, Technology
Qualified on the content I am responsible for because: I have a long history of research focusing on global health issues in low-income countries including design and evaluation of programming. Additionally, as a resident physician, I have the clinical training to critically assess treatment guidelines and experience in quality improvement.
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.