Outbreak Responder

Outbreak Responder provides clinical decision support on smartphones to improve adherence to World Health Organization (WHO) guidelines for management of uncomplicated diarrheal diseases and to estimate patient weight from age to guide intravenous fluid, azithromycin, and zinc prescribing.

Key Features:

• Guideline Adherence: Facilitates adherence to WHO guidelines for uncomplicated diarrheal disease management by delivering decision-support recommendations.
• Age-Based Weight Estimation: Implements an age-based modality to estimate patient weight where weighing scales are unavailable.
• Clinical Decision Support for Treatment: Supports prescribing decisions for intravenous (IV) fluids, antibiotics (including azithromycin), and zinc supplementation.

Scientific Applications:

• Clinical pilot evaluation: Evaluated during the fall 2015 cholera season in rural Bangladesh at one district and one sub-district hospital that lacked weighing scales.
• Assessment of prescribing and adherence outcomes: Measured effects on prescriptions and adherence, including a decrease in IV fluid prescriptions (p < 0.001), improved adherence to recommended IV fluid volumes when prescribed, increased azithromycin prescriptions (risk ratio (RR) 6.9 at the district hospital and RR 1.6 at the sub-district hospital), and increased zinc supplementation adherence.
• Target population and follow-up: Applied to patients aged ≥2 months with uncomplicated diarrheal disease with a six-week intervention period, six-week pre-intervention period, and a ten-day post-discharge follow-up.

Methodology:

The study used a pre-intervention phase (six weeks) followed by an intervention phase (six weeks) with standard care maintained except for tool use; inclusion criteria were patients aged two months and older with uncomplicated diarrheal disease, and primary outcomes were adherence to IV fluid, antibiotic, and zinc prescribing, with a ten-day post-discharge follow-up.