Excess Patient Visits for Cough and Pulmonary Disease at a Large US Health System in the Months Prior to the COVID-19 Pandemic: Time-Series Analysis
Excess Patient Visits for Cough and Pulmonary Disease at a Large US Health System in the Months Prior to the COVID-19 Pandemic: Time-Series Analysis
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DOI：
10.2196/21562
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发表时间：
2020-09-10
影响因子：
7.4
通讯作者：
Currier, Judith S.
中科院分区：
文献类型：
--
作者：
Elmore, Joann G.;Wang, Pin-Chieh;Currier, Judith S.
背景：准确评估COVID-19等疾病的区域活动对于指导公共卫生干预措施非常重要。利用电子健康记录（EHR）监测门诊临床接触可能会导致识别新出现的疫情。目的：本研究的目的是调查2019年12月至2020年2月期间，与前5年相比，电子健康记录中出现“咳嗽”一词的过度就诊以及急性呼吸衰竭住院是否更频繁。方法：一项回顾性观察性队列研究来自美国一个大型卫生系统，该系统包括3家医院、180多家诊所，每年有250万例患者就诊。纳入了2014年7月1日至2020年2月29日的患者接触数据。季节性自回归综合移动平均（SARIMA）时间序列模型用于评估2019/2020年冬季观测到的速率是否高于预测的95%预测区间。计算了2019/2020年冬季与前几个季节相比的估计额外就诊和住院人数。在2019年12月22日的一周内，以EHR原因就诊的患者百分比超过了95%的预测区间，并且在截至2020年2月底的所有10周内一直高于95%的预测区间。从2019年12月22日开始，急诊科就诊和住院也出现了类似的趋势，其中观察到的数据分别在10周中的6周和7周超过了95%的预测区间。2019/2020年冬季3个月的估计超额，通过减去当前季节的最大值或减去前五个季节的平均值获得，每1000次门诊就诊的咳嗽次数为1.6或2.0次，每1000次急诊科就诊的咳嗽次数为11.0或19.2次，每1000例急性呼吸衰竭住院患者分别有21.4或39.1次额外就诊。超过95%预测区间的超额病例总数为门诊168例，急诊56例，急性呼吸衰竭住院18例。从2019年12月下旬开始并持续到2020年2月，有呼吸道疾病和疾病的患者人数明显增加，这表明SARS-CoV在社区传播。2.在建立临床意识和检测能力之前。这提供了一个案例，说明卫生系统分析与EHR数据相结合如何提供强大而灵活的工具，用于识别患者人群的未来趋势何时超出预期范围。
Background: Accurately assessing the regional activity of diseases such as COVID-19 is important in guiding public health interventions. Leveraging electronic health records (EHRs) to monitor outpatient clinical encounters may lead to the identification of emerging outbreaks.Objective: The aim of this study is to investigate whether excess visits where the word "cough" was present in the EHR reason for visit, and hospitalizations with acute respiratory failure were more frequent from December 2019 to February 2020 compared with the preceding 5 years.Methods: A retrospective observational cohort was identified from a large US health system with 3 hospitals, over 180 clinics, and 2.5 million patient encounters annually. Data from patient encounters from July 1, 2014, to February 29, 2020, were included. Seasonal autoregressive integrated moving average (SARIMA) time-series models were used to evaluate if the observed winter 2019/2020 rates were higher than the forecast 95% prediction intervals. The estimated excess number of visits and hospitalizations in winter 2019/2020 were calculated compared to previous seasons.Results: The percentage of patients presenting with an EHR reason for visit containing the word "cough" to clinics exceeded the 95% prediction interval the week of December 22, 2019, and was consistently above the 95% prediction interval all 10 weeks through the end of February 2020. Similar trends were noted for emergency department visits and hospitalizations starting December 22, 2019, where observed data exceeded the 95% prediction interval in 6 and 7 of the 10 weeks, respectively. The estimated excess over the 3-month 2019/2020 winter season, obtained by either subtracting the maximum or subtracting the average of the five previous seasons from the current season, was 1.6 or 2.0 excess visits for cough per 1000 outpatient visits, 11.0 or 19.2 excess visits for cough per 1000 emergency department visits, and 21.4 or 39.1 excess visits per 1000 hospitalizations with acute respiratory failure, respectively. The total numbers of excess cases above the 95% predicted forecast interval were 168 cases in the outpatient clinics, 56 cases for the emergency department, and 18 hospitalized with acute respiratory failure.Conclusions: A significantly higher number of patients with respiratory complaints and diseases starting in late December 2019 and continuing through February 2020 suggests community spread of SARS-CoV-2 prior to established clinical awareness and testing capabilities. This provides a case example of how health system analytics combined with EHR data can provide powerful and agile tools for identifying when future trends in patient populations are outside of the expected ranges.