Mapping patient pathways and understanding clinical decision-making in dengue management to inform the development of digital health tools
Abstract Background Dengue is a common viral illness and severe disease results in life-threatening complications. Healthcare services in low- and middle-income countries treat the majority of dengue cases worldwide. However, the clinical decision-making processes which result in effective treatment...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Medical Informatics and Decision Making |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12911-023-02116-4 |
| _version_ | 1811171734019112960 |
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| author | Quang Huy Nguyen Damien K. Ming An Phuoc Luu Ho Quang Chanh Dong Thi Hoai Tam Nguyen Thanh Truong Vo Xuan Huy Bernard Hernandez Jennifer Ilo Van Nuil Chris Paton Pantelis Georgiou Nguyet Minh Nguyen Alison Holmes Phan Vinh Tho Sophie Yacoub the Vietnam ICU Translational Applications Laboratory (VITAL) investigators |
| author_facet | Quang Huy Nguyen Damien K. Ming An Phuoc Luu Ho Quang Chanh Dong Thi Hoai Tam Nguyen Thanh Truong Vo Xuan Huy Bernard Hernandez Jennifer Ilo Van Nuil Chris Paton Pantelis Georgiou Nguyet Minh Nguyen Alison Holmes Phan Vinh Tho Sophie Yacoub the Vietnam ICU Translational Applications Laboratory (VITAL) investigators |
| author_sort | Quang Huy Nguyen |
| collection | DOAJ |
| description | Abstract Background Dengue is a common viral illness and severe disease results in life-threatening complications. Healthcare services in low- and middle-income countries treat the majority of dengue cases worldwide. However, the clinical decision-making processes which result in effective treatment are poorly characterised within this setting. In order to improve clinical care through interventions relating to digital clinical decision-support systems (CDSS), we set out to establish a framework for clinical decision-making in dengue management to inform implementation. Methods We utilised process mapping and task analysis methods to characterise existing dengue management at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. This is a tertiary referral hospital which manages approximately 30,000 patients with dengue each year, accepting referrals from Ho Chi Minh city and the surrounding catchment area. Initial findings were expanded through semi-structured interviews with clinicians in order to understand clinical reasoning and cognitive factors in detail. A grounded theory was used for coding and emergent themes were developed through iterative discussions with clinician-researchers. Results Key clinical decision-making points were identified: (i) at the initial patient evaluation for dengue diagnosis to decide on hospital admission and the provision of fluid/blood product therapy, (ii) in those patients who develop severe disease or other complications, (iii) at the point of recurrent shock in balancing the need for fluid therapy with complications of volume overload. From interviews the following themes were identified: prioritising clinical diagnosis and evaluation over existing diagnostics, the role of dengue guidelines published by the Ministry of Health, the impact of seasonality and caseload on decision-making strategies, and the potential role of digital decision-support and disease scoring tools. Conclusions The study highlights the contemporary priorities in delivering clinical care to patients with dengue in an endemic setting. Key decision-making processes and the sources of information that were of the greatest utility were identified. These findings serve as a foundation for future clinical interventions and improvements in healthcare. Understanding the decision-making process in greater detail also allows for development and implementation of CDSS which are suited to the local context. |
| first_indexed | 2024-04-10T17:18:57Z |
| format | Article |
| id | doaj.art-fa3fea578062412aa61d827330288b00 |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-04-10T17:18:57Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-fa3fea578062412aa61d827330288b002023-02-05T12:14:54ZengBMCBMC Medical Informatics and Decision Making1472-69472023-02-012311910.1186/s12911-023-02116-4Mapping patient pathways and understanding clinical decision-making in dengue management to inform the development of digital health toolsQuang Huy Nguyen0Damien K. Ming1An Phuoc Luu2Ho Quang Chanh3Dong Thi Hoai Tam4Nguyen Thanh Truong5Vo Xuan Huy6Bernard Hernandez7Jennifer Ilo Van Nuil8Chris Paton9Pantelis Georgiou10Nguyet Minh Nguyen11Alison Holmes12Phan Vinh Tho13Sophie Yacoub14the Vietnam ICU Translational Applications Laboratory (VITAL) investigatorsCentre for Tropical Medicine, Oxford University Clinical Research UnitCentre for Antimicrobial Optimisation (CAMO), Imperial College LondonCentre for Tropical Medicine, Oxford University Clinical Research UnitCentre for Tropical Medicine, Oxford University Clinical Research UnitCentre for Tropical Medicine, Oxford University Clinical Research UnitHospital for Tropical DiseasesHospital for Tropical DiseasesCentre for BioInspired Technology, Imperial College LondonCentre for Tropical Medicine, Oxford University Clinical Research UnitDepartment of Information Science, University of OtagoCentre for BioInspired Technology, Imperial College LondonCentre for Tropical Medicine, Oxford University Clinical Research UnitCentre for Antimicrobial Optimisation (CAMO), Imperial College LondonHospital for Tropical DiseasesCentre for Tropical Medicine, Oxford University Clinical Research UnitAbstract Background Dengue is a common viral illness and severe disease results in life-threatening complications. Healthcare services in low- and middle-income countries treat the majority of dengue cases worldwide. However, the clinical decision-making processes which result in effective treatment are poorly characterised within this setting. In order to improve clinical care through interventions relating to digital clinical decision-support systems (CDSS), we set out to establish a framework for clinical decision-making in dengue management to inform implementation. Methods We utilised process mapping and task analysis methods to characterise existing dengue management at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. This is a tertiary referral hospital which manages approximately 30,000 patients with dengue each year, accepting referrals from Ho Chi Minh city and the surrounding catchment area. Initial findings were expanded through semi-structured interviews with clinicians in order to understand clinical reasoning and cognitive factors in detail. A grounded theory was used for coding and emergent themes were developed through iterative discussions with clinician-researchers. Results Key clinical decision-making points were identified: (i) at the initial patient evaluation for dengue diagnosis to decide on hospital admission and the provision of fluid/blood product therapy, (ii) in those patients who develop severe disease or other complications, (iii) at the point of recurrent shock in balancing the need for fluid therapy with complications of volume overload. From interviews the following themes were identified: prioritising clinical diagnosis and evaluation over existing diagnostics, the role of dengue guidelines published by the Ministry of Health, the impact of seasonality and caseload on decision-making strategies, and the potential role of digital decision-support and disease scoring tools. Conclusions The study highlights the contemporary priorities in delivering clinical care to patients with dengue in an endemic setting. Key decision-making processes and the sources of information that were of the greatest utility were identified. These findings serve as a foundation for future clinical interventions and improvements in healthcare. Understanding the decision-making process in greater detail also allows for development and implementation of CDSS which are suited to the local context.https://doi.org/10.1186/s12911-023-02116-4DengueClinical decision-makingDecision supportDigital healthImplementation researchVietnam |
| spellingShingle | Quang Huy Nguyen Damien K. Ming An Phuoc Luu Ho Quang Chanh Dong Thi Hoai Tam Nguyen Thanh Truong Vo Xuan Huy Bernard Hernandez Jennifer Ilo Van Nuil Chris Paton Pantelis Georgiou Nguyet Minh Nguyen Alison Holmes Phan Vinh Tho Sophie Yacoub the Vietnam ICU Translational Applications Laboratory (VITAL) investigators Mapping patient pathways and understanding clinical decision-making in dengue management to inform the development of digital health tools BMC Medical Informatics and Decision Making Dengue Clinical decision-making Decision support Digital health Implementation research Vietnam |
| title | Mapping patient pathways and understanding clinical decision-making in dengue management to inform the development of digital health tools |
| title_full | Mapping patient pathways and understanding clinical decision-making in dengue management to inform the development of digital health tools |
| title_fullStr | Mapping patient pathways and understanding clinical decision-making in dengue management to inform the development of digital health tools |
| title_full_unstemmed | Mapping patient pathways and understanding clinical decision-making in dengue management to inform the development of digital health tools |
| title_short | Mapping patient pathways and understanding clinical decision-making in dengue management to inform the development of digital health tools |
| title_sort | mapping patient pathways and understanding clinical decision making in dengue management to inform the development of digital health tools |
| topic | Dengue Clinical decision-making Decision support Digital health Implementation research Vietnam |
| url | https://doi.org/10.1186/s12911-023-02116-4 |
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