scholarly journals Effectiveness of Smartphone-Based Community Case Management on Urgent Referral, Re-Consultation and Hospitalization of Children Under-5 in Malawi: Results of a Cluster-Randomized, Stepped-Wedge Trial

2020 ◽  
Author(s):  
Griphin Baxter Chirambo ◽  
Matthew Thompson ◽  
Victoria Hardy ◽  
Nicole Ide ◽  
Phillip H. Hwang ◽  
...  
Keyword(s):  
Case Management ◽  
Stepped Wedge ◽  
Community Case Management ◽  
Urgent Referral ◽  
Cluster Randomized ◽  
Stepped Wedge Trial ◽  
Children Under 5

scholarly journals Effectiveness of smartphone-based Community Case Management on urgent referral, re-consultation and hospitalization of children under-5 in Malawi: Results of a cluster-randomized, stepped-wedge trial (Preprint)

2020 ◽  
Author(s):  
Griphin Supporting LIFE ◽  
Griphin Baxter Chirambo ◽  
Matthew Thompson ◽  
Victoria Hardy ◽  
Nicole Ide ◽  
...  
Keyword(s):  
Case Management ◽  
Hospital Admissions ◽  
Digital Health ◽  
Random Effect ◽  
Stepped Wedge ◽  
Community Case Management ◽  
Calendar Time ◽  
Intervention Phase ◽  
Cluster Randomized ◽  
The Impact

BACKGROUND Integrated community case management (CCM) has led to reductions in child mortality in Malawi from illnesses such as malaria, pneumonia and diarrhoea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and outcomes. OBJECTIVE We determined the impact of an electronic version of CCM (eCCM) application on referral, re-consultation and hospitalization rates of children presenting to village clinics in Malawi. METHODS A stepped-wedge cluster-randomized trial compared paper-based CCM (control) with and without use of an eCCM app on smartphones from November 2016 to April 2017.A total of 102 village clinics from two districts in Northern Malawi were assigned to one of six clusters which were randomized to the sequencing of crossover from the control to the intervention phases, as well as the duration of exposure in each phase. Children ≥2 months to <5 years presenting with acute illness were enrolled consecutively by Health Surveillance Assistants (HSAs). The primary outcome of urgent referrals to higher-level facilities was evaluated using multi-level mixed effects models. A logistic regression model with random effect of cluster and fixed effect for each step was fitted. Adjustment for potential confounders included baseline factors, such as patient’s age, sex, and geographical location of village clinics. Calendar time was adjusted for in the analysis. RESULTS A total of 6965 children were recruited, 3421 in the control and 3544 in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility compared with children in the control phase (OR 2.02, 95% CI 1.27-3.23; p<0.01). Overall, children in the intervention arm had lower odds of attending a repeat HSA consultation (OR 0.45, 95% CI 0.34-0.59; p<0.01) or hospital admission (OR 0.75, 95% CI 0.62-0.90; p<0.01), but after adjusting for time these differences were not significant (p>0.05). CONCLUSIONS Addition of eCCM decision support led to a greater proportion of children being referred to higher-level facilities, with no apparent increase in hospital admissions or repeat consultations in village clinics. Our findings provide support for the implementation of eCCM tools in Malawi and other Low and Middle Income Countries (LMIC), with a need for ongoing assessment of effectiveness and integration with national digital health strategies. CLINICALTRIAL ClinicalTrials.gov; NCT02763345. Registered 3 May 2016

scholarly journals Effectiveness of smartphone-based Community Case Management on urgent referral, re-consultation and hospitalization of children under-5 in Malawi: Results of a cluster-randomized, stepped-wedge trial

2020 ◽  
Author(s):  
Griphin Baxter Chirambo ◽  
John Martin Odonoghue ◽  
Matthew Thompson ◽  
Adamson S Muula ◽  
Ciara Heavin ◽  
...  
Keyword(s):  
Case Management ◽  
Hospital Admissions ◽  
Digital Health ◽  
Random Effect ◽  
Stepped Wedge ◽  
Community Case Management ◽  
Calendar Time ◽  
Intervention Phase ◽  
Cluster Randomized ◽  
The Impact

Background: Integrated community case management (CCM) has led to reductions in child mortality in Malawi from illnesses such as malaria, pneumonia and diarrhea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and outcomes. We determined the impact of an electronic version of CCM (eCCM) application on referral, re-consultation and hospitalization rates of children presenting to village clinics in Malawi. Methods: A stepped-wedge cluster-randomized trial compared paper-based CCM (control) with and without use of an eCCM app on smartphones from November 2016 to April 2017.A total of 102 village clinics from two districts in Northern Malawi were assigned to one of six clusters which were randomized to the sequencing of crossover from the control to the intervention phases, as well as the duration of exposure in each phase. Children ≥2 months to <5 years presenting with acute illness were enrolled consecutively by Health Surveillance Assistants (HSAs). The primary outcome of urgent referrals to higher-level facilities was evaluated using multi-level mixed effects models. A logistic regression model with random effect of cluster and fixed effect for each step was fitted. Adjustment for potential con-founders included baseline factors, such as patients age, sex, and geographical location of village clinics. Calendar time was adjusted for in the analysis. Results: A total of 6965 children were recruited, 3421 in the control and 3544 in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility compared with children in the control phase (OR 2.02, 95% CI 1.27-3.23; p<0.01). Overall, children in the intervention arm had lower odds of attending a repeat HSA consultation (OR 0.45, 95% CI 0.34-0.59; p<0.01) or hospital admission (OR 0.75, 95% CI 0.62-0.90; p<0.01), but after adjusting for time these differences were not significant (p>0.05). Conclusions: Addition of eCCM decision support led to a greater proportion of children being referred to higher-level facilities, with no apparent increase in hospital admissions or repeat consultations in village clinics. Our findings provide support for the implementation of eCCM tools in Malawi and other Low and Middle Income Countries (LMIC), with a need for ongoing assessment of effectiveness and integration with national digital health strategies.

scholarly journals Safety and effectiveness of a non-electric infant warmer for hypothermia in Rwanda: A cluster-randomized stepped-wedge trial

2021 ◽  
pp. 100842
Author(s):  
Josee Uwamariya ◽  
Christian Mazimpaka ◽  
Leana May ◽  
Alphonse Nshimyiryo ◽  
Henry A Feldman ◽  
...  
Keyword(s):  
Stepped Wedge ◽  
Cluster Randomized ◽  
Stepped Wedge Trial

scholarly journals Pressure ulcer multidisciplinary teams via telemedicine: a pragmatic cluster randomized stepped wedge trial in long term care

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Anita Stern ◽  
Nicholas Mitsakakis ◽  
Mike Paulden ◽  
Shabbir Alibhai ◽  
Josephine Wong ◽  
...  
Keyword(s):  
Pressure Ulcer ◽  
Long Term Care ◽  
Multidisciplinary Teams ◽  
Stepped Wedge ◽  
Term Care ◽  
Cluster Randomized ◽  
Stepped Wedge Trial

scholarly journals Implementation of a Cost-Effective Physical Therapy Approach (Coach2Move) to Improve Physical Activity in Community-Dwelling Older Adults With Mobility Problems: Protocol for a Cluster-Randomized, Stepped Wedge Trial

2019 ◽  
Vol 100 (4) ◽  
pp. 653-661 ◽  
Author(s):  
Ward Heij ◽  
Steven Teerenstra ◽  
Lieke Sweerts ◽  
J Bart Staal ◽  
Maria W G Nijhuis-van der Sanden ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Physical Therapy ◽  
Physical Therapist ◽  
Community Dwelling ◽  
Stepped Wedge ◽  
Cluster Randomized ◽  
Community Dwelling Older Adults ◽  
Stepped Wedge Trial ◽  
Insight Into

Abstract Background Coach2Move is a personalized treatment strategy by physical therapists to elicit physical activity in community-dwelling older adults with mobility problems. Objective The primary objective of this study is to assess the effectiveness and cost-effectiveness of the implementation of Coach2Move compared with regular care physical therapy in daily clinical practice. Design, Setting, Participants, and Intervention A multicenter cluster-randomized stepped wedge trial is being implemented in 16 physical therapist practices (4 clusters of 4 practices in 4 steps) in the Netherlands. The study aims to include 400 older adults (≥70 years) living independently with mobility problems and/or physically inactive lifestyles. The intervention group receives physical therapy conforming to the Coach2Move strategy; the usual care group receives typical physical therapist care. Measurements Measurements are taken at baseline and 3, 6, and 12 months after the start of treatment. The primary outcomes for effectiveness are the amount of physical activity (LASA Physical Activity Questionnaire) and functional mobility (Timed Up and Go test). Trial success can be declared if at least 1 parameter improves while another does not deteriorate. Secondary outcomes are level of frailty (Evaluative Frailty Index for Physical Activity), perceived effect (Global Perceived Effect and Patient Specific Complaints questionnaire), quality of life (EQ-5D-5 L), and health care expenditures. Multilevel linear regression analyses are used to compare the outcomes between treatment groups according to an intention-to-treat approach. Alongside the trial, a mixed-methods process evaluation is performed to understand the outcomes, evaluate therapist fidelity to the strategy, and detect barriers and facilitators in implementation. Limitations An important limitation of the study design is the inability to blind treating therapists to study allocation. Discussion The trial provides insight into the effectiveness and cost-effectiveness of the Coach2Move strategy compared with usual care. The process evaluation provides insight into influencing factors related to outcomes and implementation.

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