ABSTRACT
Accurate prediction of SARS-CoV-2 infection based on symptoms can be a cost-efficient tool for remote screening in healthcare settings with limited SARS-CoV-2 testing capacity. We used a machine learning approach to determine self-reported symptoms that best predict a positive SARS-CoV-2 test result in physician trainees from a large healthcare system in New York. We used survey data on symptoms history and SARS-CoV-2 testing results collected retrospectively from 328 physician trainees in the Mount Sinai Health System, over the period 1 February 2020 to 31 July 2020. Prospective data on symptoms reported prior to SARS-CoV-2 test results were available from the employee health service COVID-19 registry for 186 trainees and analyzed to confirm absence of recall bias. We estimated the associations between symptoms and IgG antibody and/or reverse transcriptase polymerase chain reaction test results using Bayesian generalized linear mixed effect regression models adjusted for confounders. We identified symptoms predicting a positive SARS-CoV-2 test result using extreme gradient boosting (XGBoost). Cough, chills, fever, fatigue, myalgia, headache, shortness of breath, diarrhea, nausea/vomiting, loss of smell, loss of taste, malaise and runny nose were associated with a positive SARS-CoV-2 test result. Loss of taste, myalgia, loss of smell, cough and fever were identified as key predictors for a positive SARS-CoV-2 test result in the XGBoost model. Inclusion of sociodemographic and occupational risk factors in the model improved prediction only slightly (from AUC = 0.822 to AUC = 0.838). Loss of taste, myalgia, loss of smell, cough and fever are key predictors for symptom-based screening of SARS-CoV-2 infection in healthcare settings with remote screening and/or limited testing capacity. [ FROM AUTHOR] Copyright of COVID is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Telehealth drastically reduces the time burden of appointments and increases access to care for homebound patients. During the COVID-19 pandemic, many outpatient practices closed, requiring an expansion of telemedicine capabilities. However, a significant number of patients remain unconnected to telehealth-capable patient portals. Currently, no literature exists on the success of and barriers to remote enrollment in telehealth patient portals. From March 26 to May 8, 2020, a total of 324 patients were discharged from Mount Sinai Beth Israel (MSBI), a teaching hospital in New York City. Study volunteers attempted to contact and enroll patients in the MyChart patient portal to allow the completion of a post-discharge video visit. If patients were unable to enroll, barriers were documented and coded for themes. Of the 324 patients discharged from MSBI during the study period, 277 (85%) were not yet enrolled in MyChart. Volunteers successfully contacted 136 patients (49% of those eligible), and 39 (14%) were successfully enrolled. Inability to contact patients was the most significant barrier. For those successfully contacted but not enrolled, the most frequent barrier was becoming lost to follow-up (29% of those contacted), followed by lack of interest in remote appointments (21%) and patient technological limitations (9%). Male patients, and those aged 40-59, were significantly less likely to successfully enroll compared to other patients. Telehealth is critical for healthcare delivery. Remote enrollment in a telemedicine-capable patient portal is feasible, yet underperforms compared to reported in-person enrollment rates. Health systems can improve telehealth infrastructure by incorporating patient portal enrollment into in-person workflows, educating on the importance of telehealth, and devising workarounds for technological barriers.
ABSTRACT
Telehealth drastically reduces the time burden of appointments and increases access to care for homebound patients. During the COVID-19 pandemic, many outpatient practices closed, requiring an expansion of telemedicine capabilities. However, a significant number of patients remain unconnected to telehealth-capable patient portals. Currently, no literature exists on the success of and barriers to remote enrollment in telehealth patient portals. From March 26 to May 8, 2020, a total of 324 patients were discharged from Mount Sinai Beth Israel (MSBI), a teaching hospital in New York City. Study volunteers attempted to contact and enroll patients in the MyChart patient portal to allow the completion of a post-discharge video visit. If patients were unable to enroll, barriers were documented and coded for themes. Of the 324 patients discharged from MSBI during the study period, 277 (85%) were not yet enrolled in MyChart. Volunteers successfully contacted 136 patients (49% of those eligible), and 39 (14%) were successfully enrolled. Inability to contact patients was the most significant barrier. For those successfully contacted but not enrolled, the most frequent barrier was becoming lost to follow-up (29% of those contacted), followed by lack of interest in remote appointments (21%) and patient technological limitations (9%). Male patients, and those aged 40–59, were significantly less likely to successfully enroll compared to other patients. Telehealth is critical for healthcare delivery. Remote enrollment in a telemedicine-capable patient portal is feasible, yet underperforms compared to reported in-person enrollment rates. Health systems can improve telehealth infrastructure by incorporating patient portal enrollment into in-person workflows, educating on the importance of telehealth, and devising workarounds for technological barriers.