@Article{info:doi/10.2196/44250,
author="Yahya, Gezan
and O'Keefe, James B
and Moore, Miranda A",
title="Comparing a Data Entry Tool to Provider Insights Alone for Assessment of COVID-19 Hospitalization Risk: Pilot Matched Cohort Comparison Study",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="16",
volume="7",
pages="e44250",
keywords="COVID-19; risk assessment; hospitalization; outpatient; telemedicine; data; tool; risk; assessment; utilization; algorithm; symptoms; disease; community; patient; decision making tool; risk algorithm",
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. ",
issn="2561-326X",
doi="10.2196/44250",
url="https://formative.jmir.org/2023/1/e44250",
url="https://doi.org/10.2196/44250",
url="http://www.ncbi.nlm.nih.gov/pubmed/37903299"
}