At Boston Children’s, Mobile Health and Population Health Team Up To Fight Strep Throat

11-10-2013 8-14-39 PM

Today in time, patients that present to the doctors office with sore throats will typically have their throats swabbed to test for Streptococcal pharyngitis, or strep throat. The test, called a Rapid Strep Test, is cheap, easily administered in the practice, and provides conclusive results in as little as 10 minutes.  Despite its convenience and reliability, researchers at Boston Children’s Hospital are working to improve the way strep tests are administered by leveraging emerging technologies from both mobile health and population health.

The researchers are working to reduce the number of unnecessary visits being conducted for no reason other than to rule out strep in patients that were never very likely candidates for the condition to begin with. While it is important to identify and treat strep,  researchers with Boston Children’s Hospital believe that there may be a way to safely reduce the number of unnecessary office visits by starting to conduct more evidenced-based pre-visit risk assessments.

To start developing these risk assessments, researchers analyzed the records of 70,000 patients who had visited a local outpatient clinic for a strep test. The goal of the research was to identify a set of symptoms that correlated with a higher risk for strep. This information was then used to create a risk assessment to determine if a patients condition justified seeing a doctor to have a physical exam and a strep test.

The researchers found that patients who were experiencing a sore throat and fever, but no cough, were at the highest risk of having strep and that these patients were the best candidates for an office appointment. Patients with lower risk symptoms would not typically warrant an office visit, unless they were living in a community or attending a school that was actively dealing with a high number of strep cases. In that case, the patients risk level is elevated to high risk and they need to be seen. The lowest risk group is comprised of patients with low risk symptoms that live in communities with very little strep activity. These patients are highly unlikely to have strep and, in these cases, a doctors visit can be skipped.

In order to implement a risk assessment capable of taking all of this information into account, researchers  will need to develop a method of tracking the spread of strep, in real time, across the nations schools and communities. This data will then need to be integrated with a mobile risk assessment tool that can be rolled out nationally. Lead researcher Dr. Kenneth Mandl, director of Boston Children’s intelligent health laboratory, says that creating an app to support this should not be hard.

In the past, researchers working with Google Flu Trends have created a platform that successfully tracks the spread of both flu and Dengue fever based only on analysis of geo-located search terms entered by the public. Similarly, during the October government shutdown, ambulatory EHR vendor AthenaHealth repurposed its database of 40 million de-identified patient records to track and publish vaccination rates and the spread of flu at local and national levels. Real time data about strep exposure in each community, researchers say, would help physicians determine who needed to be seen and who could stay home.

Researchers predict that if patients with sore throat did not visit a doctor when the new risk assessment predicted likelihood of strep to be less than 10 percent, 230 000 visits would be avoided in the United States each year.

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