Results from one-year use of an electronic Clinical Decision Support System in a post-conflict context: An implementation research

BackgroundIn 2017, the Adamawa State Primary Healthcare Development Agency introduced ALMANACH, an electronic clinical decision support system based on a modified version of IMCI. The target area was the Federal State of Adamawa (Nigeria), a region recovering after the Boko Haram insurgency. The aim of this implementation research was to assess the improvement in terms of quality care offered after one year of utilization of the tool.MethodsWe carried out two cross-sectional studies in six Primary Health Care Centres to assess the improvements in comparison with the baseline carried out before the implementation. One survey was carried out inside the consultation room and was based on the direct observation of 235 consultations of children aged from 2 to 59 months old. The second survey questioned 189 caregivers outside the health facility for their opinion about the consultation carried out through using the tablet, the prescriptions and medications given.ResultsIn comparison with the baseline, more children were checked for danger signs (60.0% vs. 37.1% at baseline) and in addition, children were actually weighed (61.1% vs. 27.7%) during consultation. Malnutrition screening was performed in 35.1% of children (vs. 12.1%). Through ALMANACH, also performance of preventive measures was significantly improved (pConclusionsOur findings highlight major improvements in terms of quality of care despite many questions still pending to be answered in relation to a full integration of the tool in the Adamawa health system.研究背景 2017年，阿达马瓦州初级卫生保健发展局推出了ALMANACH——一款基于改良版儿童疾病综合管理（Integrated Management of Childhood Illness, IMCI）的电子临床决策支持系统。本研究覆盖区域为尼日利亚阿达马瓦州，该地区正处于博科圣地叛乱后的恢复阶段。本实施性研究的目的为评估该工具使用一年后，所提供的医疗服务质量的提升情况。 研究方法 本研究在6家初级卫生保健中心开展两项横断面研究，以对照实施前的基线数据评估服务质量的提升情况。第一项调查在诊室内部开展，通过直接观察235例年龄为2至59个月的儿童就诊过程完成数据收集。第二项调查在医疗机构外对189名照护者进行访谈，了解其对使用平板设备开展的就诊流程、开具的处方及配发药物的评价。 研究结果 与基线数据相比，就诊期间接受危险体征检查的儿童占比显著提升（60.0% vs. 基线37.1%）；同时，儿童体重测量的完成率也有所提高（61.1% vs. 基线27.7%）。儿童营养不良筛查的实施率为35.1%（基线为12.1%）。借助ALMANACH，预防性措施的执行率同样得到显著提升（p 研究结论 本研究结果表明，医疗服务质量已实现显著提升，但该工具在阿达马瓦州卫生系统中的全面整合仍存在诸多待解答的问题。