Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Oct 16, 2020
Date Accepted: Feb 26, 2021
Date Submitted to PubMed: Mar 5, 2021
Use of a Telemedicine Risk Assessment Tool to Predict the Risk of Hospitalization of 496 Outpatients with COVID-19: Retrospective Analysis
ABSTRACT
Background:
Risk assessment of patients with acute coronavirus disease 2019 (COVID-19) in a telemedicine context is not well described. In the setting of large numbers of patients, a risk assessment tool may guide resource allocation not only for patient care but also for maximum healthcare and public health benefit.
Objective:
Determine whether a coronavirus disease 2019 outpatient risk assessment tool accurately predicts hospitalizations.
Methods:
Design: Retrospective cohort, enrollment from March 24 to May 26, 2020 (final call range March 27 to June 19, 2020) Setting: Telemedicine program at a large medical system in Atlanta, Georgia Participants: 496 patients with COVID-19. Exclusion criteria included: (1) hospitalization prior to enrollment, (2) immediate discharge with no follow-up calls. Exposure: Acute COVID-19 illness Main Outcome and Measures: Hospitalization was the outcome. Days to hospitalization was the metric. Survival analysis using Cox regression was used to determine factors associated with hospitalization.
Results:
Results. The risk-assessment rubric assigned 496 outpatients to tiers: Tier 1, 237 (47.8%); Tier 2, 185 (37.3%); Tier 3, 74 (14.9%). Subsequent hospitalizations numbered 3 (1%), 15 (7%), and 17 (23%) and for Tiers 1-3, respectively. From a Cox regression model with age ≥ 60, gender, and self-reported obesity as covariates, the adjusted hazard ratios using Tier 1 as reference were: Tier 2 HR=3.74 (95% CI, 1.06-13.27; P=0.041); Tier 3 HR=10.87 (95% CI, 3.09-38.27; P<0.001).
Conclusions:
A telemedicine risk assessment tool prospectively applied to an outpatient population with COVID-19 identified both low-risk and high-risk patients with better performance than individual risk factors.
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