Mobile Phone-administered Triage Tool to Followup on Discharged Trauma Patients

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

After being admitted to and then discharged from a hospital in Cameroon for having experienced an injury, there is no established way for the health system to check in on how the discharged person is doing. The investigators have developed a set of questions with the hope that asking these questions--over the phone--to those who have been discharged from the hospital will allow them to determine which post-discharge patients would benefit from further care. The investigators believe that asking these questions over the phone is a good way of determining which post-discharge trauma patients would benefit from further care.

Study Overview

• Status: Completed
• Conditions: Wounds and Injury
• Intervention / Treatment: Other: Mobile Phone-based Triage Tool

Detailed Description

Broadly, this study aims to answer three questions. (1) Is it feasible to call discharged trauma patients on their mobile phones to check up on them? (2) Can a defined set of questions help determine which discharged trauma patients require further medical care (and which discharged trauma patients do not require further medical care)? (3) Will checking in on discharged trauma patients reduce their experience of disability and economic consequences?

If an individual was a trauma patient who was admitted at and then discharged from one of the study's partner hospitals in Cameroon, the discharged individual (hereafter referred to as "the participant') will be receiving phone calls from one of the study's research assistants at the following post-discharge timepoints: 2 weeks, 1 month, 3 months, and 6 months. Whether the research assistant administers the defined set of questions developed by the study's investigators (see question 2, above) will depend on when the participant was discharged from the hospital. Regardless, all participants will be asked other important questions about the injury and any associated disabilities and economic consequences.

• Study Type: Interventional
• Enrollment (Actual): 3990
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Cameroon
  • Douala, Cameroon
    • Laquintinie Hospital
  • Edea, Cameroon
    • Edea Regional Hospital
  • Limbe, Cameroon
    • Limbé Regional Referral Hospital
  • Pouma, Cameroon
    • Pouma Catholic Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• All trauma registry patients at participating hospitals who provided cellphone numbers and are alive at hospital discharge are eligible for inclusion regardless of age, injury severity, or hospital disposition status.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: No Mobile Phone-administered Triage Tool; For each hospital site: Baseline data will be collected for six months. **This extended beyond 6 months due to the COVID pandemic***
Experimental: Mobile Phone-administered Triage Tool; For each hospital site: After the first six months of baseline data collection, the mobile phone-administered triage tool (or "Mobile Phone-based Triage Tool") will be implemented for a year. **This extended beyond 1 year due to the COVID pandemic***	Other: Mobile Phone-based Triage Tool; The proposed intervention is a mobile phone-administered survey. Participants that have been admitted to participating hospitals for treatment of injury will be contacted by mobile phone approximately two weeks after discharge. A seven-question survey will be administered over the phone to each participant. Cross-validation with a separately administered in-person physical exam will be performed to assess the survey tool's prediction of who needs further care for treatment of their injury.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of Successful Contacts	The number of successful contacts will be divided by the total number of contacts. A "successful" contact is when an enrolled patient answered the phone, and consented to the research assistant administering the questionnaire(s) planned for that phone call.	2 weeks after enrollment
Median Number of Attempts Required to Achieve a Successful Contact	This is the median number of call attempts made until a research assistant is able to successfully administer the questionnaire(s) planned for that phone call.	2 weeks after enrollment
Median Cost Associated With Personnel Time	This measure is median monthly costs incurred to pay the research assistant for the time s/he spends making the required phone calls per patient.	At the end of the study (2 weeks after the 2-year intervention phase (extended due to COVID))
Median Cost Associated With Telephone Time	This measure is the median costs incurred to make phone calls per patient in each study phase.	At the end of the study (2 weeks after the 2-year intervention phase (extended due to COVID))
Telephone Triage Tool Administration Time	This measure will be calculated based on how much time it takes to administer the telephone triage tool.	After administration of the telephone triage tool (i.e. about 2 weeks after enrollment)
Physician Assessment of Whether a Patient Would Benefit From Further Services	This is a binary measure. After a physician examines a participant, s/he will determine whether s/he thinks the participant would benefit from further services (including additional follow-up care, and/or diagnostic or therapeutic interventions).	Immediately after the physician administers the physical exam (i.e. about 3 weeks after enrollment)
Physician Assessment of Whether a Patient Was at Moderate to High Risk for a Poor Outcome (HR) Without Additional Intervention	After a physician examines a participant, s/he will determine whether s/he thinks the participant is at low, moderate or high risk for a poor outcome (HR) without additional intervention using subjective clinical assessment.	Immediately after the physician administers the physical exam (i.e. about 3 weeks after enrollment)
Triage Risk Score (TRS)	To develop a sensitive model capable of risk stratifying triaged patients for high risk (HR), all candidate questions from the telephone triage tool found to associate with HR on univariate regression were weighted by their predictive coefficient and added to generate a triage risk score (TRS) ranging from a minimum score of 0 (lowest risk) to a maximum possible score of 43.9 (highest risk). Triage Risk Score (TRS) less than or equal to 1.3 (1st quartile) was designated as low risk, TRS 1.4 to 4.0 (2nd & 3rd quartile) as moderate risk, and TRS greater than or equal to 4.1 (fourth quartile) as high risk.	At the end of intervention phase (about 1 year after enrollment).
Acceptability Score of Mobile Phones as a Follow-up Tool	This is a numerical measure that represents the sum of the positive responses that participants give to each question that assesses the acceptability of mobile phones as a follow-up tool. The scale for the acceptability score of mobile phones as a follow-up tool ranges from 0 to 6, where 0 means the participant's responses indicate the participant believes mobile phones are definitely not an acceptable follow-up tool and 6 means the participant's responses indicate the participant believes mobile phones are definitely an acceptable follow-up tool.	2 weeks after enrollment
Proportion of Injured Patients Who Seek Clinical Follow-up Evaluation	This will be calculated as follows: The denominator will be the number of discharged trauma patients enrolled in the study. The numerator will be the number of discharged trauma patients enrolled in the study who seek any clinical follow-up evaluation at the 2 weeks post-discharge phonecall.	After the 2week post-discharge phonecall.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Glasgow Outcomes Scale-Extended (GOSE) Disability Level	The GOSE disability level that participants in the study report. For each participant, GOSE disability level will be determined using the augmented GOSE (aGOSE) instrument, which assesses factors like the participant's independence inside and outside the home, work, social and leisure activities, family and friendship, etc. Each time after administration of the aGOSE instrument, the participant's GOSE disability level will be calculated. The aGOSE score is reported for the 2-week post-discharge timepoint. The Glasgow Outcome Scale (GOS) is a global scale for functional outcome that rates patient status into one of five categories (worse to best respectively): Dead, Vegetative State, Severe Disability, Moderate Disability or Good Recovery. The Extended GOS (GOSE) which was used in this study provides more detailed categorization into eight categories by subdividing the categories of severe disability, moderate disability and good recovery into a lower and upper category.	At the 2week post-discharge telephone phonecall.
Economic Consequences of Injury: Did it Become More Difficult for the Family to Afford Expenses Such as Food and Rent?	Participants were asked if following the injury it became more difficult for the family to afford expenses such as food and rent.	At the 2week post-discharge telephone phonecall.
Economic Consequences of Injury: Did the Family Spend Saved Money?	Participants were asked if following the injury the family had to spend their savings.	At the 2week post-discharge telephone phonecall.
Economic Consequences of Injury: Did the Family Borrow Money?	Participants were asked if following the injury the family had to borrow money to meet up with expenses.	At the 2week post-discharge telephone phonecall.

Collaborators and Investigators

• Sponsor: University of California, Los Angeles
• Collaborators: University of Buea
• Investigators: Principal Investigator: Catherine Juillard, MD, MPH, University of California, Los Angeles

Study record dates

Study Major Dates

• Study Start (Actual): August 5, 2019
• Primary Completion (Actual): August 31, 2022
• Study Completion (Actual): September 14, 2022

Study Registration Dates

• First Submitted: January 11, 2019
• First Submitted That Met QC Criteria: January 14, 2019
• First Posted (Actual): January 16, 2019

Study Record Updates

• Last Update Posted (Actual): November 27, 2024
• Last Update Submitted That Met QC Criteria: November 14, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Keywords: Telemedicine; Africa South of the Sahara; Aftercare
• Additional Relevant MeSH Terms: Wounds and Injuries
• Other Study ID Numbers: GRANT12763845

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: De-identified individual participant data for all primary and secondary outcome measures will be made available upon reasonable request.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No