# Optimizing health care delivery by adapting diagnostics in a low-resource setting: The case of San Miguel Hospital, Sucumbíos, Ecuador

## TL;DR

This study identifies which diagnostic tools provide the most value in a low-resource hospital in the Ecuadorian Amazon, helping improve healthcare delivery.

## Contribution

A data-driven method to evaluate diagnostic tool needs in low-resource hospitals, adaptable to similar settings.

## Key findings

- 66% of diagnoses at San Miguel Hospital were confirmed using existing resources.
- Potassium hydroxide fungal microscopy and rapid tests for chikungunya and influenza provided the highest return on investment.
- The evaluation method can be adapted to improve healthcare delivery in other low-resource settings.

## Abstract

To strategically optimize diagnostic capacity in a low-resource, rural hospital setting, we developed a systematic evaluation of diagnostic tool needs and associated costs. This local data-driven method, accounting for patient characteristics and disease prevalence, can be adapted to other contexts.

A retrospective patient record analysis was conducted at San Miguel Hospital (SMH) in Sucumbíos, Ecuador, which provides outpatient and emergency care to inhabitants of the Ecuadorian and Colombian Amazon basin. Ethics approval was granted retrospectively by the Research Ethics Committee on Human Beings of the Universidad San Francisco de Quito.

Data was retrieved from electronic medical records (EMRs) of the first 796 patients seen after hospital opening. For each of the 1975 diagnoses made, patient characteristics and the presence or absence of appropriate diagnostic tools were recorded. Unavailable tools were further evaluated for accessibility within the local context.

Serving a population primarily of mixed and indigenous ethnicities, SMH confirmed 66 % of diagnoses using existing resources, with potassium hydroxide (KOH) fungal microscopy, chikungunya and influenza rapid tests, and access to anatomical pathology identified as the diagnostic tools offering the highest return on investment.

Data from SMH's EMRs suggest which diagnostic tools would offer the greatest return on investment through increased diagnostic confirmation. This evaluation tool supports improved health care delivery at SMH and, with adaptation, can be applied in comparable health care settings.

N/A.

We evaluated the availability and utilization of diagnostic tools in a rural hospital in Ecuadorian Amazonia using patient data. Our approach identifies high-impact diagnostic resources needed to support clinical decision-making and can be adapted to strengthen health care delivery in similar low-resource settings.