Ballout Ghada, Al-Shorbaji Najeeb, Zeidan Wafaa, Shahin Yousef, Hababeh Majed, Saleh Suha, Albeik Shatha, Seita Akihiro
Department of Health, UNRWA Headquarters Amman, Amman, Jordan.
Independent Consultant in Knowledge Management and e-Health, Amman, Jordan.
Lancet. 2021 Jul;398 Suppl 1:S17. doi: 10.1016/S0140-6736(21)01503-8.
The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides primary-health-care services to more than 5 million Palestinian refugees in five operational fields (Jordan, Syria, Lebanon, West Bank, and Gaza) through 144 health centres. UNRWA developed its electronic health records (e-Health) system to improve monitoring and facilitation of health services provided to Palestinian refugees. By the end of 2017, the system had been deployed in 129 health centres, included the health files of 3 million patients, and managed more than 8 million visits per year. We assessed whether preventive-health-care services had improved following implementation of the system.
This observational study used three key performance indicators to assess preventive-health-care services reported in UNRWA's annual reports in 2012-17: the percentage of targeted people aged 40 years and older screened for diabetes; the percentage of pregnant women with a livebirth who attended at least four antenatal visits; and the prevalence of growth problems (underweight, stunting, wasting, and overweight or obesity) in children younger than 5 years. Simple descriptive analysis was conducted with Microsoft Excel 2010. Ethical approval was obtained from the UNRWA Headquarters Department of Health.
Screening for diabetes significantly increased from 13% in 2012 to 21% in 2017 (p<0·0001) since the e-Health system started sending alerts to clerks at health centres. The percentage of pregnant women with a livebirth who attended at least four antenatal visits, increased from 87% in 2012 to 92% in 2017, when the e-Health System allowed health-care providers to log all pregnant women who missed their appointments to enable follow-up. Additionally, an electronic maternal and child health mobile application, sends regular reminders to mothers about appointments for themselves and their children. The percentages of underweight, stunting, wasting, and overweight or obesity among children younger than 5 years increased respectively from 3%, 4%, 2%, and 2% in 2014 to 5%, 7%, 4%, and 5% in 2017, but this was due to the increased detection of growth problems through the e-Health system.
The e-Health system improved detection and monitoring by UNRWA health-care providers and access to health services for Palestinian refugees in all three indicator categories. This study has several limitations. It is an observational study based on assessing health records of children rather than a prospective study over time. The focus of the study was to assess the impact of the eHealth system on health-care delivery and not to assess the changes in health-care delivery itself. The electronic health records that were reviewed are for the Palestine refugees who are registered at UNRWA health clinics and not for other refugees or residents of the five countries. Strengths of the study are that it is based on electronic health records which contain data recorded by the treating staff; the e-health system used by UNRWA clinics staff is centralised and the data are aggregated agency wide; and the growth monitoring indicators used by UNRWA were derived from the WHO Multi-center Growth Reference Study to assess the growth of children from birth up to age 5 years.
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联合国近东巴勒斯坦难民救济和工程处（近东救济工程处）通过144个保健中心，为五个业务地区（约旦、叙利亚、黎巴嫩、西岸和加沙）的500多万巴勒斯坦难民提供初级保健服务。近东救济工程处开发了其电子健康记录（电子健康）系统，以改善对巴勒斯坦难民提供的保健服务的监测和便利。到2017年底，该系统已在129个保健中心部署，包含300万患者的健康档案，每年管理超过800万次就诊。我们评估了该系统实施后预防性保健服务是否有所改善。
这项观察性研究使用三个关键绩效指标来评估近东救济工程处在2012 - 2017年年度报告中报告的预防性保健服务：40岁及以上目标人群中接受糖尿病筛查的百分比；活产孕妇中至少进行四次产前检查的百分比；以及5岁以下儿童生长问题（体重不足、发育迟缓、消瘦和超重或肥胖）的患病率。使用Microsoft Excel 2010进行简单的描述性分析。获得了近东救济工程处总部卫生部门的伦理批准。
自电子健康系统开始向保健中心的办事员发送警报以来，糖尿病筛查率从2012年的13%显著提高到2017年的21%（p<0.0001）。活产孕妇中至少进行四次产前检查的百分比从2012年的87%增加到2017年的92%，当时电子健康系统允许保健提供者记录所有错过预约的孕妇，以便进行随访。此外，一款电子母婴健康移动应用程序会定期向母亲发送关于她们自己和孩子预约的提醒。5岁以下儿童中体重不足、发育迟缓、消瘦和超重或肥胖的百分比分别从2014年的3%、4%、2%和2%增加到2017年的5%、7%、4%和5%，但这是由于通过电子健康系统对生长问题的检测增加。
电子健康系统改善了近东救济工程处保健提供者的检测和监测，并改善了所有三个指标类别中巴勒斯坦难民获得保健服务的情况。本研究有几个局限性。它是一项基于评估儿童健康记录的观察性研究，而不是一项长期的前瞻性研究。该研究的重点是评估电子健康系统对医疗服务提供的影响，而不是评估医疗服务提供本身的变化。所审查的电子健康记录是针对在近东救济工程处保健诊所登记的巴勒斯坦难民，而不是针对其他难民或这五个国家的居民。该研究的优势在于它基于包含治疗人员记录数据的电子健康记录；近东救济工程处诊所工作人员使用的电子健康系统是集中式的，数据在全机构范围内汇总；并且近东救济工程处使用的生长监测指标源自世界卫生组织多中心生长参考研究，以评估从出生到5岁儿童的生长情况。
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