Implementation of patient-centered medical records for short term mission trips in rural Haiti

Nabil Othman1, Francis Tinney1, Chih Chuang, M.D.1

1Wayne State University School of Medicine

Background Patient Diagnoses RESULTS

The Record SystemDifferent Patient Profiles CONCLUSIONS

The World Health Student Organization (WHSO) of the Wayne State University School of Medicine (WSU-SOM) is committed to providing free health care to underserved areas around the world, utilizing service-learning in global health education and to raise global health awareness. In February and March of 2014 the WHSO sent two teams consisting of medical students and physicians to Morne, Haiti; a rural, mountainous region near the capital of Port-au-Prince.

In rural regions of Haiti, few citizens have access to healthcare. Much of the healthcare is carried out by mission trips, which may or may not communicate with one another. Providers from one group may be unaware of the medications prescribed by previous groups, a problem exacerbated by lack of medical records. The purpose of this study is to describe a medical records system that was implemented across two short-term medical mission trips to Morne which facilitated follow up care across a wide spectrum of medical disorders.

1. This pilot medical record book showed utility as a system to track the blood pressures of hypertensive patients.

2. Medical record booklets keep health records in the hands of the patient population, so any medical mission trip has access to them while treating patients.

3. The low follow up rate could be explained by human error: names could be recorded incorrectly, resulting in an artificially deflated follow up rate. The actual rate is likely higher than reported. Tracking patients by name is likely to be unreliable.

4. It is a potentially effective way to facilitate follow up care for short term medical mission trips .

The record system consisted of a booklet, created by our host organization Rays of Hope and distributed by the WHSO, with the following information:

1. Patient name2. Vital sign measurements: height, weight, temperature,

pulse and blood pressure3. Medical diagnoses4. Medication/therapies administered

In February, the booklet was given to patients after their discharge from the clinic. Those designated as follow up patients were encouraged to return when the second team arrived in March.

• 107 total follow up patients• 13 followed up, confirmed by name on intake form• 9 of 13 patients had high blood pressure as primary diagnosis.• 8 of 9 presented with lower blood pressure• Average blood pressure drop was 25.4 (12.1) mmHg• March mission trip carried out a survey of clinic patients: 95% of

those surveyed (n=40) supported this new record system

World Health Student Organization

All Patients Follow Up Patients

Conditions with n>3. Represents 83.7% of total

follow up diagnoses

Conditions with n>10. Represents 75.6% of total

diagnoses

HTN 52GERD 25Fungal Infection 18Allergy 13Bacterial Infection 10Asthma 9Back Pain 8Headache 7Osteoarthritis 7Generalized Pain 7Diabetes Mellitus-Type 2 6Dry Eyes 6Knee Pain 6UTI 5COPD 4Gastritis 4Hernia 4Insect bite 4Parasitic Infection 4Sciatica 4Catarcts 3Dilated Cardiomyopathy 3Dry Skin 3Dysmenorrhea 3Impetigo 3Joint Pain 3

The average follow up patient had a different diagnosis than the average clinic patient. Follow up patients were chosen based on their clinical diagnoses: those who suffered from chronic conditions that require monitoring, such as diabetes and hypertension, were more likely to be chosen as follow up patients. Overall hypertension was the most common disease among follow up patients, where as in all clinic patients anemia, GERD, parasitic infection and headaches were more common. Of all clinic patients 4.2% were diagnosed with HTN, whereas that percentage increases to 23.5% in follow up patients.

Follow Up Patients

HypertensionBack PainAscites

Anemia 123GERD 113Parasites 86Headache 57HTN 52URI 50Vag Infection 48Allergies 43Tinea Capitis 39Back Pain 33Abd Pain 32UTI 32Scabies 28Fungal infection 20Pneumonia 18Cough 18Dry eyes 16Dysmenorrhea 16Generalized Pain 15Ear infection 15Pregnancy 14Impetigo 14Knee Pain 12Constipation 12Bacterial Vaginosis 11Tinea Corporis 11Asthma 10