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Automated EHR score to predict COVID-19 outcomes at US Department of Veterans Affairs.
Osborne, Thomas F; Veigulis, Zachary P; Arreola, David M; Röösli, Eliane; Curtin, Catherine M.
  • Osborne TF; US Department of Veterans Affairs, Palo Alto Healthcare System, Palo Alto, California, United States of America.
  • Veigulis ZP; Department of Radiology, Stanford University School of Medicine, Stanford, California, United States of America.
  • Arreola DM; US Department of Veterans Affairs, Central Iowa Health Care System, Des Moines, Iowa, United States of America.
  • Röösli E; US Department of Veterans Affairs, Palo Alto Healthcare System, Palo Alto, California, United States of America.
  • Curtin CM; Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America.
PLoS One ; 15(7): e0236554, 2020.
Article in English | MEDLINE | ID: covidwho-680636
ABSTRACT
The sudden emergence of COVID-19 has brought significant challenges to the care of Veterans. An improved ability to predict a patient's clinical course would facilitate optimal care decisions, resource allocation, family counseling, and strategies for safely easing distancing restrictions. The Care Assessment Need (CAN) score is an existing risk assessment tool within the Veterans Health Administration (VA), and produces a score from 0 to 99, with a higher score correlating to a greater risk. The model was originally designed for the nonacute outpatient setting and is automatically calculated from structured data variables in the electronic health record. This multisite retrospective study of 6591 Veterans diagnosed with COVID-19 from March 2, 2020 to May 26, 2020 was designed to assess the utility of repurposing the CAN score as objective and automated risk assessment tool to promptly enhance clinical decision making for Veterans diagnosed with COVID-19. We performed bivariate analyses on the dichotomized CAN 1-year mortality score (high vs. low risk) and each patient outcome using Chi-square tests of independence. Logistic regression models using the continuous CAN score were fit to assess its predictive power for outcomes of interest. Results demonstrated that a CAN score greater than 50 was significantly associated with the following outcomes after positive COVID-19 test hospital admission (OR 4.6), prolonged hospital stay (OR 4.5), ICU admission (3.1), prolonged ICU stay (OR 2.9), mechanical ventilation (OR 2.6), and mortality (OR 7.2). Repurposing the CAN score offers an efficient way to risk-stratify COVID-19 Veterans. As a result of the compelling statistical results, and automation, this tool is well positioned for broad use across the VA to enhance clinical decision-making.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Risk Assessment / Electronic Health Records Type of study: Diagnostic study / Observational study / Prognostic study Limits: Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2020 Document Type: Article Affiliation country: Journal.pone.0236554

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Risk Assessment / Electronic Health Records Type of study: Diagnostic study / Observational study / Prognostic study Limits: Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2020 Document Type: Article Affiliation country: Journal.pone.0236554