Telehealth care before and during COVID-19: trends and quality in a large health system.

Objective: COVID-19 accelerated telehealth use to ensure care delivery, but there is limited data on the patient perspective. This study aimed to examine telehealth visit uptake before and during COVID-19 and correlates of patient satisfaction and interest in future telehealth visits. Materials and Methods: This was a cross-sectional observational study between October 2019 and April 2020. Participants included patients who completed satisfaction surveys following telehealth visits. Results: A total of 8930 patients completed the satisfaction survey using 4-point Likert Scales. Multivariable, hierarchical, cumulative logit models were constructed to examine correlates of satisfaction with quality of care and interest in future telehealth visits. Most patients were satisfied with the patient portal, video quality, and instructions (92.7%-96.8%). Almost half reported saving 1-2 h (46.9%). Correlates positively associated with quality of care and interest in future telehealth visits were ease of patient portal (odds ratio [OR], 1.43, 95% confidence interval [CI], 1.30-1.58; OR, 1.56, 95% CI, 1.41-1.73, respectively), video quality (OR, 1.62, 95% CI, 1.50-1.75; OR, 1.26, 95% CI, 1.16-1.37, respectively), instructions (OR, 5.62, 95% CI, 5.05-6.26; OR, 1.80, 95% CI, 1.62-2.01, respectively), and time saved (>4 h: OR, 1.69, 95%,CI, 1.22-2.34; OR, 3.49, 95% CI, 2.47-4.93, respectively). Being seen after the COVID-19 surge in telehealth (OR, 0.76, 95% CI, 0.63-0.93) or by providers with higher visit volume (OR, 0.71, 95% CI, 0.60-0.85) was associated with lower interest in future telehealth visits. Conclusions: Patients expressed relatively high satisfaction levels with telehealth. Better technical quality, quality of instructions, and greater time saved were associated with higher satisfaction ratings. To maintain interest in future telehealth use and improve the patient experience, we must enhance the quality of telehealth delivery platforms and instructions provided to patients.

Racial disparities in the SOFA score among patients hospitalized with COVID-19.

BACKGROUND: Sequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic. RESEARCH QUESTION: Are SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients? STUDY DESIGN AND METHODS: Retrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as <6 or ≥6. RESULTS: Of 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11-1.99). INTERPRETATION: Given current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.

DNA polymerase ß decrement triggers death of olfactory bulb cells and impairs olfaction in a mouse model of Alzheimer's disease.

Alzheimer's disease (AD) involves the progressive degeneration of neurons critical for learning and memory. In addition, patients with AD typically exhibit impaired olfaction associated with neuronal degeneration in the olfactory bulb (OB). Because DNA base excision repair (BER) is reduced in brain cells during normal aging and AD, we determined whether inefficient BER due to reduced DNA polymerase-ß (Polß) levels renders OB neurons vulnerable to degeneration in the 3xTgAD mouse model of AD. We interrogated OB histopathology and olfactory function in wild-type and 3xTgAD mice with normal or reduced Polß levels. Compared to wild-type control mice, Polß heterozygous (Polß+/- ), and 3xTgAD mice, 3xTgAD/Polß+/- mice exhibited impaired performance in a buried food test of olfaction. Polß deficiency did not affect the proliferation of OB neural progenitor cells in the subventricular zone. However, numbers of newly generated neurons were reduced by approximately 25% in Polß+/- and 3xTgAD mice, and by over 60% in the 3xTgAD/Polß+/- mice compared to wild-type control mice. Analyses of DNA damage and apoptosis revealed significantly greater degeneration of OB neurons in 3xTgAD/Polß+/- mice compared to 3xTgAD mice. Levels of amyloid ß-peptide (Aß) accumulation in the OB were similar in 3xTgAD and 3xTgAD/Polß+/- mice, and cultured Polß-deficient neurons exhibited increased vulnerability to Aß-induced death. Olfactory deficit is an early sign in human AD, but the mechanism is not yet understood. Our findings in a new AD mouse model demonstrate that diminution of BER can endanger OB neurons, and suggest a mechanism underlying early olfactory impairment in AD.