an electronic surgical outcomes database (squad) at ...an electronic surgical outcomes database...

Bridging the data gap in global healthAn electronic surgical outcomes database (SQUAD)

at Mbarara Regional Referral Hospital, Uganda

Gustaf Drevin | Research Associate | Program in Global Surgery and Social Change

Gustaf Drevin @drevinho, Katherine Albutt, Frank Sanyu, Deus Twesigye, Godfrey R. Mugyenyi, Joseph Ngonzi, Stephen S. Ttendo, Paul G. Firth

PROGRAMMATIC

We declare no disclosures.

@drevinho


ABACKGROUNDSurgery & anaesthesia

Data gapUganda

BPURPOSE COGRAM:ONCEPT

DRAM:NGES

EES

ES

F



143 million procedures/year2

5 billion lack access1

x2 perioperative mortality3

GLOBAL SURGERY & ANAESTHESIA DATA GAP

Infrastructure and burden

Computer literacy4

Funding and resources

UGANDA

39 million

~600 procedures/100K

<1 surgical specialist/100K

MBARARA

Teaching hospital: 450 beds

Emergency, OB/GYN, ENT, paediatrics, ICU

4 theatres

Mbarara University of Science and Technology (MUST)


ABACKGROUNDGlobal surgery

Data gapUganda

BPURPOSESQUAD

nise the hospital record high-quality, electronic

earchable database at gional Referral Hospital

CCONCEPTDRAM:

NGESEES

ES

F


PURPOSE (2013-)


Surgical services QUality Assessment Database

Customisable, open software: ”OpenMRS”

Local ownership: committee, author guidelines

Advisory committee: State-side

Electronic register: capture of surgical patients

Structure:

Processes:

Outcomes:

Health system level

Clinical level(treatment, interventions)

Sentinel events(mortality)

ABACKGROUNDGlobal surgery

Data gapUganda

BPURPOSESQUAD

To organise the hospital record system in a high-quality, electronic

searchable database at Mbarara Regional Referral Hospital

CCONCEPTDRAM:

NGESEES

ES

F


DATA COLLECTION


Paediatricsurgical patients

Adult surgical patients

No operation

Operation

DATA YIELD

Patients

Diseases or Conditions

Caregivers

Outcomes

Intervention

DATA USE

Qualityimprovement

Research 160 SQUADvariables

ICD-10ICD-9-CM

Risk-adjusted mortality

ABACKGROUNDBPURPOSE CCONCEPT

DNGES EES

ES

F


CHALLENGES


THE DATAMissing & incomplete filesData entry agreement

COLLABORATIONPast experiencesTradition, priorities

INFRASTRUCTUREFunding, HRRegular blackouts

PRO

SPEC

TIVE

VALI

DATIO

N5

RETROSPECTIVEVALIDATION

EXTERNAL

Capture

Completeness

93%

86%

Agreement k=0.81 ”near perfect”

GENERATOR

QUALITY CONTROLS

LOCAL NEEDS

ABACKGROUNDBPURPOSE CPROGRAM:

CONCEPTDCHALLENGESEES

F


OUTCOMES (2013-17)


Data sharing-Medical Records Dpt & wards-District/national reports-Resident theses

Research T.B.P.

…. to measure and guide expansion and provision of quality surgical care and buildresearch capacity at MRRH.

49,000 SQUAD PATIENTS20,500 OB/GYN

17,000 gen. surgery

11,000 ENT

40 ICU

…etc…

ABACKGROUNDBPURPOSE CPROGRAM:

CONCEPTDPROGRAM:

CHALLENGESEOUTCOMES

F


IMPACT & FUTURE


OUTCOMESMONITORING

QUALITY IMPROVEMENT& PLANNING

RESEARCH NEW PROSPECTIVE

REGISTRY

Capacity-buildingOngoing

TraumaBurnsMotorbike accidentsENT studiesLaparotomiesPaediatric surgeryICU…

Scalable: reproducible, long-term integration

Future

SQUAD is a surgical database in Uganda

One way to bridge the data gap

Gustaf Drevin | Research Associate | Program in Global Surgery and Social Change

@drevinho


AFFILIATIONSMbarara Regional Referral Hospital, Mbarara, Uganda (F Sanyu, D Twesigye, SS Ttendo, GR Mugyenyi, J Ngonzi)Mbarara University of Science and Technology, Mbarara, Uganda (F Sanyu, D Twesigye, SS Ttendo, GR Mugyenyi, J Ngonzi)Massachusetts General Hospital, Boston, MA, USA (K Albutt, PG Firth)Karolinska Institutet, Solna, Sweden (G Drevin)Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA (G Drevin, K Albutt)

REFERENCES1Alkire BC, Raykar NP, Shrime MG, et al.(2015) Global access to surgical care: a modelling studyLancet Glob Health2Meara JG, Leather AJM, Hagander L, et al.(2015) Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development Lancet3Biccard BM, Madiba TE, Kluyts HL, et al.(2018) Perioperative patient outcomes in the African SurgicalOutcomes Study: a 7-day prospective observational cohort study Lancet4Maxwell O. Akanbi ANO, Patricia A. Agaba, Comfort A. Daniyam, Emmanuel I. Agaba, Edith N. Okeke, Christiana O. Ukoli (2012) Use of Electronic Health Records in sub-Saharan Africa- Progress and challenges J Med Trop5 Anderson GA, Ilcisin L, Ngonzi J, et al.(2017) Validation of an Electronic Surgical Outcomes Databaseat Mbarara Regional Referral Hospital, Uganda World J Surg

FUNDINGGE Foundation; Kletjian Foundation; Milton Foundation; Massachusetts General Hospital Department of Anesthesia and Critical Care

an electronic surgical outcomes database (squad) at ...an electronic surgical outcomes database...

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