Comparing a Data Entry Tool to Provider Insights Alone for Assessment of COVID-19 Hospitalization Risk: Pilot Matched Cohort Comparison Study

• Type of Material: Article
• Authors: Gezan Yahya, Emory University; James O'Keefe, Emory University; Miranda Moore, Emory University
• Language: English
• Date: 2023-11-16
• Publisher: JMIR
• Publication Version: Final Published Version
• Copyright Statement: ©Gezan Yahya, James B O'Keefe, Miranda A Moore.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.2196/44250
• Title of Journal or Parent Work: JMIR Formative Research
• Volume: 7
• Start Page: e44250
• Grant/Funding Information: JBO was supported by the Georgia Geriatrics Workforce Enhancement Program COVID-19 Telehealth award, which is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) as part of an award (T1MHP39056) totaling US $90,625, with 0% financed with nongovernmental sources. The contents of this paper are those of the authors and do not necessarily represent the official views of, nor an endorsement by, the HRSA, the HHS, or the US Government. JBO also received grant funding from Regeneron Pharmaceuticals, Inc, for a study of monoclonal antibodies in preventing SARS-CoV-2 infection in household contacts, which is unrelated to this work. MAM reports receiving funding from the HHS and HRSA, US Agency for Healthcare Research and Quality, Ardmore Institute of Health, Georgia State, and the Alzheimer’s Association.
• Keywords: risk algorithm; disease; outpatient; symptoms; hospitalization; telemedicine; algorithm; tool; assessment; risk assessment; community; decision making tool; data; risk; patient; utilization; COVID-19
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Background In March 2020, the World Health Organization declared COVID-19 a global pandemic, necessitating an understanding of factors influencing severe disease outcomes. High COVID-19 hospitalization rates underscore the need for robust risk prediction tools to determine estimated risk for future hospitalization for outpatients with COVID-19. We introduced the “COVID-19 Risk Tier Assessment Tool” (CRTAT), designed to enhance clinical decision-making for outpatients. Objective We investigated whether CRTAT offers more accurate risk tier assignments (RTAs) than medical provider insights alone. Methods We assessed COVID-19–positive patients enrolled at Emory Healthcare's Virtual Outpatient Management Clinic (VOMC)—a telemedicine monitoring program, from May 27 through August 24, 2020—who were not hospitalized at the time of enrollment. The primary analysis included patients from this program, who were later hospitalized due to COVID-19. We retroactively formed an age-, gender-, and risk factor–matched group of nonhospitalized patients for comparison. Data extracted from clinical notes were entered into CRTAT. We used descriptive statistics to compare RTAs reported by algorithm–trained health care providers and those produced by CRTAT. Results Our patients were primarily younger than 60 years (67% hospitalized and 71% nonhospitalized). Moderate risk factors were prevalent (hospitalized group: 1 among 11, 52% patients; 2 among 2, 10% patients; and ≥3 among 4, 19% patients; nonhospitalized group: 1 among 11, 52% patients, 2 among 5, 24% patients, and ≥3 among 4, 19% patients). High risk factors were prevalent in approximately 45% (n=19) of the sample (hospitalized group: 11, 52% patients; nonhospitalized: 8, 38% patients). Approximately 83% (n=35) of the sample reported nonspecific symptoms, and the symptoms were generally mild (hospitalized: 12, 57% patients; nonhospitalized: 14, 67% patients). Most patient visits were seen within the first 1-6 days of their illness (n=19, 45%) with symptoms reported as stable over this period (hospitalized: 7, 70% patients; nonhospitalized: 3, 33% patients). Of 42 matched patients (hospitalized: n=21; nonhospitalized: n=21), 26 had identical RTAs and 16 had discrepancies between VOMC providers and CRTAT. Elements that led to different RTAs were as follows: (1) the provider “missed” comorbidity (n=6), (2) the provider noted comorbidity but undercoded risk (n=10), and (3) the provider miscoded symptom severity and course (n=7). Conclusions CRTAT, a point-of-care data entry tool, more accurately categorized patients into risk tiers (particularly those hospitalized), underscored by its ability to identify critical factors in patient history and clinical status. Clinical decision-making regarding patient management, resource allocation, and treatment plans could be enhanced by using similar risk assessment data entry tools for other disease states, such as influenza and community-acquired pneumonia. The COVID-19 pandemic has accelerated the adoption of telemedicine, enabling remote patient tools such as CRTAT. Future research should explore the long-term impact of outpatient clinical risk assessment tools and their contribution to better patient care.