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Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes

BACKGROUND: Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidi...

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Autores principales: Chamberlain, Stacey, Stolz, Uwe, Dreifuss, Bradley, Nelson, Sara W., Hammerstedt, Heather, Andinda, Jovita, Maling, Samuel, Bisanzo, Mark
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388510/
https://www.ncbi.nlm.nih.gov/pubmed/25849960
http://dx.doi.org/10.1371/journal.pone.0122559
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author Chamberlain, Stacey
Stolz, Uwe
Dreifuss, Bradley
Nelson, Sara W.
Hammerstedt, Heather
Andinda, Jovita
Maling, Samuel
Bisanzo, Mark
author_facet Chamberlain, Stacey
Stolz, Uwe
Dreifuss, Bradley
Nelson, Sara W.
Hammerstedt, Heather
Andinda, Jovita
Maling, Samuel
Bisanzo, Mark
author_sort Chamberlain, Stacey
collection PubMed
description BACKGROUND: Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients. METHODS: Nurses participated in a two-year training program to become midlevel providers called Emergency Care Practitioners at a rural district hospital. This is a retrospective analysis of the Emergency Department’s quality assurance database, including three-day follow-up data. Case fatality rates (CFRs) are reported as the percentage of cases with a specific diagnosis that died within three days of their Emergency Department visit. FINDINGS: Overall, three-day mortality was 2.0%. The most common diagnoses of patients who died were malaria (n=60), pneumonia (n=51), malnutrition (n=21), and trauma (n=18). Overall and under-five CFRs were as follows: malaria, 2.0% and 1.9%; pneumonia, 5.5% and 4.1%; and trauma, 1.2% and 1.6%. Malnutrition-related fatality (all cases <18 years old) was 6.5% overall and 6.8% for under-fives. INTERPRETATION: This study describes the outcomes of emergency patients treated by midlevel providers in a resource-limited setting. Our fatality rates are lower than previously published regional rates. These findings suggest this model of task-shifting can be successfully applied to acute care in order to address the shortage of emergency care services in similar settings as part of an integrated approach to health systems strengthening.
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spelling pubmed-43885102015-04-21 Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes Chamberlain, Stacey Stolz, Uwe Dreifuss, Bradley Nelson, Sara W. Hammerstedt, Heather Andinda, Jovita Maling, Samuel Bisanzo, Mark PLoS One Research Article BACKGROUND: Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients. METHODS: Nurses participated in a two-year training program to become midlevel providers called Emergency Care Practitioners at a rural district hospital. This is a retrospective analysis of the Emergency Department’s quality assurance database, including three-day follow-up data. Case fatality rates (CFRs) are reported as the percentage of cases with a specific diagnosis that died within three days of their Emergency Department visit. FINDINGS: Overall, three-day mortality was 2.0%. The most common diagnoses of patients who died were malaria (n=60), pneumonia (n=51), malnutrition (n=21), and trauma (n=18). Overall and under-five CFRs were as follows: malaria, 2.0% and 1.9%; pneumonia, 5.5% and 4.1%; and trauma, 1.2% and 1.6%. Malnutrition-related fatality (all cases <18 years old) was 6.5% overall and 6.8% for under-fives. INTERPRETATION: This study describes the outcomes of emergency patients treated by midlevel providers in a resource-limited setting. Our fatality rates are lower than previously published regional rates. These findings suggest this model of task-shifting can be successfully applied to acute care in order to address the shortage of emergency care services in similar settings as part of an integrated approach to health systems strengthening. Public Library of Science 2015-04-07 /pmc/articles/PMC4388510/ /pubmed/25849960 http://dx.doi.org/10.1371/journal.pone.0122559 Text en © 2015 Chamberlain et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Chamberlain, Stacey
Stolz, Uwe
Dreifuss, Bradley
Nelson, Sara W.
Hammerstedt, Heather
Andinda, Jovita
Maling, Samuel
Bisanzo, Mark
Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes
title Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes
title_full Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes
title_fullStr Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes
title_full_unstemmed Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes
title_short Mortality Related to Acute Illness and Injury in Rural Uganda: Task Shifting to Improve Outcomes
title_sort mortality related to acute illness and injury in rural uganda: task shifting to improve outcomes
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388510/
https://www.ncbi.nlm.nih.gov/pubmed/25849960
http://dx.doi.org/10.1371/journal.pone.0122559
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