用于疑似新型冠状病毒肺炎的自我分诊网络应用程序的实施及其对紧急呼叫中心的影响：观察性研究
Implementation of a Self-Triage Web Application for Suspected COVID-19 and Its Impact on Emergency Call Centers: Observational Study.
作者信息
Galmiche Simon, Rahbe Eve, Fontanet Arnaud, Dinh Aurélien, Bénézit François, Lescure François-Xavier, Denis Fabrice
机构信息
Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.
Unité Pasteur-CNAM Risques Infectieux et Emergents (PACRI), Conservatoire National des Arts et Métiers, Paris, France.
出版信息
J Med Internet Res. 2020 Nov 23;22(11):e22924. doi: 10.2196/22924.
BACKGROUND
We developed a self-triage web application for COVID-19 symptoms, which was launched in France in March 2020, when French health authorities recommended all patients with suspected COVID-19 call an emergency phone number.
OBJECTIVE
Our objective was to determine if a self-triage tool could reduce the burden on emergency call centers and help predict increasing burden on hospitals.
METHODS
Users were asked questions about their underlying conditions, sociodemographic status, postal code, and main COVID-19 symptoms. Participants were advised to call an emergency call center if they reported dyspnea or complete loss of appetite for over 24 hours. Data on COVID-19-related calls were collected from 6 emergency call centers and data on COVID-19 hospitalizations were collected from Santé Publique France and the French Ministry of Health. We examined the change in the number of emergency calls before and after the launch of the web application.
RESULTS
From March 17 to April 2, 2020, 735,419 questionnaires were registered in the study area. Of these, 121,370 (16.5%) led to a recommendation to call an emergency center. The peak number of overall questionnaires and of questionnaires leading to a recommendation to call an emergency center were observed on March 22, 2020. In the 17 days preceding the launch of the web application, emergency call centers in the study area registered 66,925 COVID-19-related calls and local hospitals admitted 639 patients for COVID-19; the ratio of emergency calls to hospitalizations for COVID-19 was 104.7 to 1. In the 17 days following the launch of the web application, there were 82,347 emergency calls and 6009 new hospitalizations for COVID-19, a ratio of 13.7 calls to 1 hospitalization (chi-square test: P<.001).
CONCLUSIONS
The self-triage web application launch was followed by a nearly 10-fold increase in COVID-19-related hospitalizations with only a 23% increase in emergency calls. The peak of questionnaire completions preceded the peak of COVID-19-related hospitalizations by 5 days. Although the design of this study does not allow us to conclude that the self-triage tool alone contributed to the alleviation of calls to the emergency call centers, it does suggest that it played a role, and may be used for predicting increasing burden on hospitals.
TRIAL REGISTRATION
ClinicalTrials.gov NCT04331171; https://clinicaltrials.gov/ct2/show/NCT04331171.
背景
我们开发了一款针对新冠症状的自我分诊网络应用程序，该程序于2020年3月在法国推出，当时法国卫生当局建议所有疑似感染新冠病毒的患者拨打紧急电话号码。
目的
我们的目的是确定自我分诊工具是否可以减轻紧急呼叫中心的负担，并帮助预测医院日益增加的负担。
方法
询问用户有关其基础疾病、社会人口统计学状况、邮政编码和主要新冠症状的问题。建议参与者如果报告呼吸困难或食欲不振超过24小时，应拨打紧急呼叫中心。从6个紧急呼叫中心收集与新冠相关的呼叫数据，并从法国公共卫生署和法国卫生部收集新冠住院数据。我们研究了网络应用程序推出前后紧急呼叫数量的变化。
结果
2020年3月17日至4月2日，研究区域内登记了735,419份问卷。其中，121,370份（16.5%）导致建议拨打紧急中心。2020年3月22日观察到总体问卷数量和导致建议拨打紧急中心的问卷数量达到峰值。在网络应用程序推出前的17天里，研究区域内的紧急呼叫中心登记了66,925次与新冠相关的呼叫，当地医院收治了639名新冠患者；新冠紧急呼叫与住院的比例为104.7比1。在网络应用程序推出后的17天里，有82,347次紧急呼叫和6009例新冠新住院病例，呼叫与住院的比例为13.7比1（卡方检验：P<.001）。
结论
自我分诊网络应用程序推出后，新冠相关住院病例增加了近10倍，而紧急呼叫仅增加了23%。问卷完成量的峰值比新冠相关住院病例的峰值提前5天。尽管本研究的设计不允许我们得出仅自我分诊工具就有助于减轻对紧急呼叫中心的呼叫这一结论，但它确实表明该工具发挥了作用，并且可用于预测医院日益增加的负担。
试验注册
ClinicalTrials.gov NCT04331171；https://clinicaltrials.gov/ct2/show/NCT04331171
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