Reducing communication delays and improving quality of care with a tuberculosis laboratory information system in resource poor environments: a cluster randomized controlled trial.
BACKGROUND
Lost, delayed or incorrect laboratory results are associated with delays in initiating treatment. Delays in treatment for Multi-Drug Resistant Tuberculosis (MDR-TB) can worsen patient outcomes and increase transmission. The objective of this study was to evaluate the impact of a laboratory information system in reducing delays and the time for MDR-TB patients to culture convert (stop transmitting).


METHODS



METHODS
78 primary Health Centers (HCs) in Lima, Peru. Participants lived within the catchment area of participating HCs and had at least one MDR-TB risk factor. The study design was a cluster randomized controlled trial with baseline data. The intervention was the e-Chasqui web-based laboratory information system. Main outcome measures were: times to communicate a result; to start or change a patient's treatment; and for that patient to culture convert.


RESULTS
1671 patients were enrolled. Intervention HCs took significantly less time to receive drug susceptibility test (DST) (median 11 vs. 17 days, Hazard Ratio 0.67 [0.62-0.72]) and culture (5 vs. 8 days, 0.68 [0.65-0.72]) results. The time to treatment was not significantly different, but patients in intervention HCs took 16 days (20%) less time to culture convert (p = 0.047).


CONCLUSIONS
The eChasqui system reduced the time to communicate results between laboratories and HCs and time to culture conversion. It is now used in over 259 HCs covering 4.1 million people. This is the first randomized controlled trial of a laboratory information system in a developing country for any disease and the only study worldwide to show clinical impact of such a system.


BACKGROUND
ClinicalTrials.gov NCT01201941.
Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; eHealth Systems, Santiago, Chile.
Joaquín A
JA
Blaya
Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
Sonya S
SS
Shin
Instituto Nacional de Salud, Lima, Peru.
Martin
M
Yagui
Socios en Salud Sucursal Peru, Lima, Peru.
Carmen
C
Contreras
Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Peter
P
Cegielski
DISA V Lima Ciudad, Lima, Peru.
Gloria
G
Yale
DISA IV Lima Este, Lima, Peru.
Carmen
C
Suarez
Instituto Nacional de Salud, Lima, Peru.
Luis
L
Asencios
Socios en Salud Sucursal Peru, Lima, Peru.
Jaime
J
Bayona
Division of Biomedical Informatics, University of California San Diego, La Jolla, California, United States of America.
Jihoon
J
Kim
Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Partners In Health, Boston, Massachusetts, United States of America; University of Leeds, Leeds, United Kingdom.
Hamish S F
HS
Fraser
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002984:Clinical Laboratory Information Systems / Q000458:organization & administration*; D003142:Communication; D016208:Databases, Factual; D003906:Developing Countries; D005260:Female; D006801:Humans; D007753:Laboratories / Q000458:organization & administration; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008826:Microbial Sensitivity Tests / Q000592:standards; D008875:Middle Aged; D010568:Peru; D011203:Poverty; D016016:Proportional Hazards Models; D011446:Prospective Studies; D058996:Quality Improvement; D011787:Quality of Health Care; D012107:Research Design; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy; D055815:Young Adult
D000995:Antitubercular Agents