USING DATA-ADAPTIVE METHODS TO OPTIMIZE FOLLOW UP OF INJURED PATIENTS AFTER HOSPITAL DISCHARGE IN CAMEROON.

This is a five-year study to leverage our established research infrastructure in Cameroon to implement the mHealth screening tool on a wider scale, optimize the approach using data-adaptive methods, and to determine factors associated with receipt of follow-up care after injury. This research is in response to the recognition that a critical barrier to improved trauma outcomes in resource-limited SSA contexts is the rapid identification of patients who would benefit from further care and successful retention of these patients through treatment completion. The contribution of the proposed research is the development of an optimized mobile phone-administered screening tool to identify discharged trauma patients who would benefit from further medical care that could be used in Cameroon and other diverse, low-resource settings in SSA. In addition, successful completion of the proposed research will yield a novel, data-adaptive method of intervention optimization that can be used in other settings to optimize mHealth adherence. This contribution will be significant because efficient identification of high-risk, discharged trauma patients will optimize the efficacy and efficiency of health care resources for trauma care in Cameroon and other similar settings. Funneling these existing resources to the patients most in need will decrease the consequences of injury with little additional infrastructure investment. Thus, using an implementation science approach, we will first expand a trauma registry and the mHealth screening tool to 10 hospitals, reaching 4,500 post-discharge trauma patients (Aim 1). To improve efficiency, we will use a machine learning approach with Aim 1 data to better predict the subset of patients most likely to benefit from post-discharge care. This optimized tool will be evaluated in a randomized study of 852 trauma patients (Aim 2). We will then follow patients prospectively to measure factors associated with compliance with follow-up recommendations (Aim 3). Furthermore, a validated tool that is feasible and efficient in Cameroon will likely be generalizable to other similar settings in SSA experiencing growing mobile phone penetration. Ultimately, the goal of our research is to reduce disability and mortality associated with injury.