Web-Based Self-Triage of Influenza-Like Illness During the 2009 H1N1 Influenza Pandemic

Abstract

The sudden emergence of 2009 H1N1 influenza in the spring of that year sparked a surge in visits to emergency departments in New York City and other communities. A larger, second wave of cases was anticipated the following autumn. To reduce a potential surge of health system utilization without denying needed care, we enlisted the input of experts from medicine, public health, nursing, information technology, and other disciplines to design, test, and deploy clinical algorithms to help minimally trained health care workers and laypeople make informed decisions about care-seeking for influenza-like illness. The product of this collaboration, named Strategy for Off-Site Rapid Triage (SORT) was disseminated in 2 forms. Static algorithms, posted on the Centers for Disease Control and Prevention's Web site, offered guidance to clinicians and telephone call centers on how to manage adults and children with influenza-like illness. In addition, 2 interactive Web sites, http://www.Flu.gov and http://www.H1N1ResponseCenter.com, were created to help adults self-assess their condition and make an informed decision about their need for treatment. Although SORT was anchored in a previously validated clinical decision rule, incorporated the input of expert clinicians, and was subject to small-scale formative evaluations during rapid standup, prospective evaluation is lacking. If its utility and safety are confirmed, SORT may prove to be a useful tool to blunt health system surge and rapidly collect epidemiologic data on future disease outbreaks.

The Impact of Medical Terminology in Self-Triage Decision-Making

“…Decision aids, like the strategy for off-site rapid triage, a web-based decision aid designed in response to the 2009 H1N1 influenza pandemic, aim to provide better informed decision-making during times of medical crisis (Kellermann et al, 2010). Dolan et al (2015) demonstrated that user decision outcomes varied with the presentation of labels during decision aid use, suggesting that decision aids need to consider conscious and unconscious biases to be maximally effective.…”

A Ride in the Time Machine: Information Management Capabilities Health Departments Will Need

“…34 Standards facilitating patient downloading and sharing of their EHR information, 35 combined with the ubiquity of smart mobile devices, may enable powerful platforms for public health surveillance, tailored alerting (e.g., notifying asthmatics of air quality problems), and personal health decision support (e.g., when to seek care). 36 Crowdsourcing has already assisted disaster and outbreak management, 37 and many people value opportunities to communicate about potential hazards and events. 38 Online information from outbreak "cases" may replace much future public health interviewing (as it has replaced voice interactions for many purchases, travel reservations, and appointments).…”

Patient and Parent-Reported Signs and Symptoms for Group A Streptococcal Pharyngitis

“…25 This study was limited by the wide spectrum of disease associated with influenza infection because the course tends to be less predictable, with higher morbidity and mortality. Unlike influenza, pharyngitis is usually nonurgent and can typically wait for evaluation without concern for rapid clinical deterioration.…”