Personal digital assistants to collect tuberculosis bacteriology data in Peru reduce delays, errors, and workload, and are acceptable to users: cluster randomized controlled trial

Abstract

Objectives: To evaluate the effectiveness of a personal digital assistant (PDA)-based system for collecting tuberculosis test results and to compare this new system to the previous paper-based system. The PDA- and paper-based systems were evaluated based on processing times, frequency of errors, and number of work-hours expended by data collectors.

Methods: We conducted a cluster randomized controlled trial in 93 health establishments in Peru. Baseline data were collected for 19 months. Districts (n=4) were then randomly assigned to intervention (PDA) or control (paper) groups, and further data were collected for 6 months. Comparisons were made between intervention and control districts and within-districts before and after the introduction of the intervention.

Results: The PDA-based system had a significant effect on processing times (p<0.001) and errors (p=0.005). In the between-districts comparison, the median processing time for cultures was reduced from 23 to 8 days and for smears was reduced from 25 to 12 days. In that comparison, the proportion of cultures with delays >90 days was reduced from 9.2% to 0.1% and the number of errors was decreased by 57.1%. The intervention reduced the work-hours necessary to process results by 70% and was preferred by all users.

Conclusions: A well-designed PDA-based system to collect data from institutions over a large, resource-poor area can significantly reduce delays, errors, and person-hours spent processing data.

Figure 1

Peruvian laboratory structure, and workflow of the bacteriology data collection team with the current paper system (white lines) and with the PDA-based system (red lines).

Figure 2

PDA form example.

Figure 3

Decision support page within the web-based medical record system, PIH-EMR, to automate verification and cross-checking of smear and culture results collected by the bacteriology team.

Figure 4

Cluster randomized controlled trial scheme with within-districts (before and after) and between-districts comparisons.

Figure 5

Definition of processing time.

Figure 6

Box plot for processing time of (a) cultures and (b) smears in log scale (left y-axis) and days (right y-axis). These show that for both culture and smear results there was a statistically significant decrease (p < 0.001) in the processing time with the PDA-based system (intervention districts after) compared to the same districts before the implementation (intervention districts before) and districts with the paper-based system (control districts after). The Kaplan—Meier survival curves for the initial 100 days for (c) culture and (d) smear microscopy show that the PDA-based system was able to drastically decrease the number of outlying results with a processing time of over 90 days.