Complexity and Challenges of the Clinical Diagnosis and Management of Long COVID.
Complexity and Challenges of the Clinical Diagnosis and Management of Long COVID.
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DOI：
10.1001/jamanetworkopen.2022.40332
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发表时间：
2022-11-01
影响因子：
13.8
通讯作者：
Ioannou, George N.
中科院分区：
文献类型：
--
作者：
O'Hare, Ann M.;Vig, Elizabeth K.;Iwashyna, Theodore J.;Fox, Alexandra;Taylor, Janelle S.;Viglianti, Elizabeth M.;Butler, Catherine R.;Vranas, Kelly C.;Helfand, Mark;Tuepker, Anais;Nugent, Shannon M.;Winchell, Kara A.;Laundry, Ryan J.;Bowling, C. Barrett;Hynes, Denise M.;Maciejewski, Matthew L.;Bohnert, Amy S. B.;Locke, Emily R.;Boyko, Edward J.;Ioannou, George N.
在对退伍军人事务部保健系统的健康记录进行定性分析时，可以确定哪些与长期COVID有关的主题？这项定性研究包括随机抽样的200名退伍军人的健康记录，确定了两个主要主题：(1)临床不确定性：考虑到许多患者的医疗复杂性和功能限制，以及缺乏针对这种疾病的特定标记物，通常不清楚特定症状是否是由于长期的冠状病毒感染所致；(2)护理分散：新冠肺炎后的护理流程往往与其他护理分开，可能给患者带来负担。这些发现突显了在临床环境中诊断和管理长COVID的复杂性。这项定性研究描述了退伍军人电子健康记录中与长期COVID的临床诊断和管理有关的主要主题，并为这种情况提供了诊断代码。人们越来越多地认识到SARS-CoV-2感染(有时称为长冠状病毒病)对健康的长期影响。然而，对卫生系统中长期COVID的临床诊断和管理知之甚少。在具有诊断代码(国际疾病和相关健康问题统计分类，第十版[ICD-10]代码U09.9)的患者的电子健康记录(EHR)中描述与长期COVID的临床诊断和管理有关的主要主题。这项定性分析使用了退伍军人事务部(VA)200名接受护理的全国随机抽样患者的电子病历数据，这些患者在2020年2月27日至2021年12月31日期间对SARS-CoV-2进行了聚合酶链式反应(PCR)检测呈阳性结果，并在2021年10月1日至2022年3月1日期间对LONG COVID使用了ICD-10诊断代码。对2022年2月5日至5月31日的数据进行了分析。对患者的VA范围的EHR进行文本单词搜索和定性分析，以确定与长期COVID的临床诊断和处理有关的主导主题。在对退伍军人病史文献的定性分析中，200名样本患者在退伍军人病历中首次SARS-CoV-2聚合酶链式反应阳性时的平均年龄(SD)为60岁(14.5岁)。样本包括173名男性(86.5%)；45名(22.5%)被确认为黑人，136名(68.0%)被确认为白人。在对与患者EHR中长期COVID相关的文献进行定性分析时，确定了2个主要主题：(1)临床不确定性，考虑到许多患者的医疗复杂性和功能限制，以及缺乏这种情况的特定标记物，通常不清楚特定症状是否可归因于长期COVID，这可能导致持续的监测、诊断测试和专家转诊；(2)护理碎片化，描述新冠肺炎后的护理流程往往与其他护理方面割裂开来，协调不力，可能给患者带来负担。这项对VA EHR文献的定性研究突出了在临床环境中诊断长期COVID的复杂性，以及护理患有或怀疑患有这种疾病的患者的挑战。
What themes pertaining to long COVID can be identified in qualitative analysis of health records from the Department of Veterans Affairs health system? This qualitative study including health records from 200 randomly sampled veterans identified 2 dominant themes: (1) clinical uncertainty: it was often unclear whether particular symptoms were due to long COVID, given the medical complexity and functional limitations of many patients and absence of specific markers for this condition, which led to ongoing monitoring, diagnostic testing, and referral; and (2) care fragmentation: post–COVID-19 care processes were often siloed from other care and could be burdensome to patients. These findings highlight the complexity of diagnosing and managing long COVID in clinical settings. This qualitative study describes dominant themes pertaining to the clinical diagnosis and management of long COVID in the electronic health records of veterans with a diagnostic code for this condition. There is increasing recognition of the long-term health effects of SARS-CoV-2 infection (sometimes called long COVID). However, little is yet known about the clinical diagnosis and management of long COVID within health systems. To describe dominant themes pertaining to the clinical diagnosis and management of long COVID in the electronic health records (EHRs) of patients with a diagnostic code for this condition (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code U09.9). This qualitative analysis used data from EHRs of a national random sample of 200 patients receiving care in the Department of Veterans Affairs (VA) with documentation of a positive result on a polymerase chain reaction (PCR) test for SARS-CoV-2 between February 27, 2020, and December 31, 2021, and an ICD-10 diagnostic code for long COVID between October 1, 2021, when the code was implemented, and March 1, 2022. Data were analyzed from February 5 to May 31, 2022. A text word search and qualitative analysis of patients’ VA-wide EHRs was performed to identify dominant themes pertaining to the clinical diagnosis and management of long COVID. In this qualitative analysis of documentation in the VA-wide EHR, the mean (SD) age of the 200 sampled patients at the time of their first positive PCR test result for SARS-CoV-2 in VA records was 60 (14.5) years. The sample included 173 (86.5%) men; 45 individuals (22.5%) were identified as Black and 136 individuals (68.0%) were identified as White. In qualitative analysis of documentation pertaining to long COVID in patients’ EHRs 2 dominant themes were identified: (1) clinical uncertainty, in that it was often unclear whether particular symptoms could be attributed to long COVID, given the medical complexity and functional limitations of many patients and absence of specific markers for this condition, which could lead to ongoing monitoring, diagnostic testing, and specialist referral; and (2) care fragmentation, describing how post–COVID-19 care processes were often siloed from and poorly coordinated with other aspects of care and could be burdensome to patients. This qualitative study of documentation in the VA EHR highlights the complexity of diagnosing long COVID in clinical settings and the challenges of caring for patients who have or are suspected of having this condition.
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成人共卷199岁和≥65岁的成人共同条件 - 2020年3月至2021年11月，美国
DOI：
10.15585/mmwr.mm7121e1
发表时间：
2022-05-27
期刊：
Morbidity and Mortality Weekly Report
影响因子：
--
作者：
通讯作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
3.8
作者：
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通讯作者：
Kyngaes, Helvi
影响因子：
5.4
作者：
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通讯作者：
McAndrew, Lisa M.
影响因子：
39.2
作者：
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通讯作者：
Guessous, Idris