Mixed-method evaluation of an online forward triage tool within the COVID-19 pandemic

The overall purpose of the study is to estimate the effects and assess the utility of an online forward triage tool (OFTT) in epidemic or pandemic situations. We propose a mixed-method sequential explanatory study of the utility and effects of an OFFT for COVID-19 in Switzerland.The current outbreak of the novel Coronavirus termed SARS-CoV2 will likely last for several more month at least and will most likely outrun the capacity of most health systems internationally. Governments worldwide respond with frequently changing policies and guidelines, resulting in uncertainty among the public and health care providers alike. Next to caring for the sick, the health system is thus currently burdened with a large number of persons seeking information, testing and reassurance. When presenting in person, these people put themselves at risk of cross infection and further burden the health systems capacities.In response to this situation, we developed an online forward triage tool (OFTT) to i) screen and reduce the number of people presenting themselves for testing on site that do not fulfil current testing criteria and direct them to the appropriate level of care, ii) provide a reliable and up to date source of information about testing and reporting criteria to both, the public and health professionals, and iii) monitor temporal and regional patterns in testing recommendations and provide authorities with data on the effects of changes in testing criteria and guidelines. Many other providers have set up similar tools. However, it is not clear whether users of an OFTT actually follow the recommendations given and what factors affect their decisions. In addition, it is unknown whether the recommendations given, although based on the most current FOPH testing criteria, are in fact correct. Arguably, the use of an OFTT is only defensible if users have better or at least similar outcomes than non-users. Furthermore, it is unknown whether OFTT appeal to all population groups. For example, the elderly may be less inclined to use online tools to guide their decision making. Likewise, education or socio-economic status may affect whether users turn to an OFTT and to what extend they rely on the tools recommendation. In addition, it is unknown how far people's use of OFTTs is affected by media coverage of a pandemic or epidemic.We propose a mixed-method sequential explanatory study of the utility of the OFTT and the outcomes of using such a tool. Based on large data sets already collected at both, the first OFTT for COVID-19, and the currently largest real-world testing site in Switzerland, we will conduct a survey of users who provided contact details for research purposes. Results of this survey will inform qualitative data collection. In addition, at the synthesis level, quantitative findings will be understood and explained with the aid of qualitative results. Insights gained will be used in the adaptation of existing OFTTs. Findings from this research will result in rapid implementation and the improvement of existing OFTTs with regard to i) user groups reached and not reached, ii) improved adherence to recommendations, iii) easing the burden on the health care system and iv) their ability to inform authorities about the effect of changing testing recommendations.