Application of the Sight Outcomes Research Collaborative Ophthalmology Data Repository for Triaging Patients With Glaucoma and Clinic Appointments During Pandemics Such as COVID-19
Application of the Sight Outcomes Research Collaborative Ophthalmology Data Repository for Triaging Patients With Glaucoma and Clinic Appointments During Pandemics Such as COVID-19
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DOI：
10.1001/jamaophthalmol.2020.2974
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发表时间：
2020-09-01
影响因子：
8.1
通讯作者：
Stein, Joshua D.
中科院分区：
文献类型：
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作者：
Bommakanti, Nikhil K.;Zhou, Yunshu;Stein, Joshua D.
这项横断面研究使用了一种针对青光眼患者的算法，该算法考虑了青光眼的严重程度和进展风险与COVID-19发病率的高风险特征，以评估哪些患者可以在COVID-19大流行期间安全地推迟预约。研究人员是否可以使用大型数据集来帮助眼科诊所识别即将到来的青光眼预约，以安全地推迟和优先安排预约，重新开放（ramp-up）时期？在这项横断面研究中，开发了一种算法，该算法考虑了青光眼的严重程度和进展风险，以及2019年潜在冠状病毒病暴露对1034名即将到来的青光眼患者的发病风险。它确定了可以安全地推迟预约的患者，并促进了预约的优先级重新安排。这些发现表明，研究人员可以利用大数据对眼科诊所预约进行分流，在眼科护理期间平衡青光眼进展风险与2019年冠状病毒病暴露的发病风险。重要性（COVID-19）大流行，眼科护理专业人员护理患有青光眼等威胁视力疾病的患者，必须确定一些患者的预约是否可以安全地推迟，权衡患者青光眼在过渡期间可能恶化的风险与在寻求眼科护理时获得COVID-19的发病风险。他们还需要在加速阶段（当与流行病相关的服务减少得到缓解时）优先考虑预约重新安排。目的描述一种灵活且可扩展的青光眼患者评分算法，该算法使用来自大型数据库的信息，考虑青光眼严重程度和进展风险与COVID-19发病率的高风险特征的存在。设计、设置和参与者在这项横断面研究中，确定了2020年3月16日至2020年4月16日期间在视力结果研究协作（SOURCE）眼科电子健康记录数据存储库中注册的学术机构即将进行青光眼门诊预约的患者。开发了一种风险分层工具，用于计算青光眼严重程度和进展风险评分以及COVID-19发病风险评分。将这些评分相加以确定每例患者的总评分。主要结果和措施总评分和建议重新安排诊所预约的百分比。结果1034例青光眼患者的平均年龄为66.7（14.6）岁。有575名妇女（55.6%）、733名白色人（71%）和160名黑人（15.5%）。平均（SD）青光眼严重程度和进展风险评分为4.0（14.4）分，平均（SD）COVID-19发病风险评分为27.2（16.1）分，平均（SD）总分为31.2（21.4）分。在与流行病相关的服务减少期间，使用0分、25分和50分的总分阈值将分别确定970个预约（93.8%）、668个预约（64.6%）和275个预约（26.6%）需要推迟和重新安排。算法生成的总分还有助于在提升阶段优先安排预约时间。结论和相关性我们开发并实施了一种工具，该工具考虑了延迟接受护理导致的基础眼科疾病进展风险和COVID-19暴露导致的发病风险，有助于对即将到来的眼科预约进行分诊。在COVID-19大流行和类似危机期间，可以使用这种方法创建其他眼科和非眼科护理的可比方法。
This cross-sectional study used an algorithm for patients with glaucoma that considered glaucoma severity and progression risk vs high-risk features for COVID-19 morbidity to assess which patients can safely postpone appointments during the COVID-19 pandemic.Question During a pandemic, can researchers use large data sets to help ophthalmology clinics identify upcoming glaucoma appointments to safely postpone and prioritize appointments for rescheduling during ramp-up (reopening) periods? Findings In this cross-sectional study, an algorithm was developed that considered glaucoma severity and progression risk plus the morbidity risk from potential coronavirus disease 2019 exposure for 1034 upcoming glaucoma patient appointments. It identified patients whose appointments could safely get postponed and facilitated prioritization of appointments for rescheduling. Meaning These findings suggest that researchers can leverage big data to triage ophthalmic clinic appointments, balancing the glaucoma progression risk against the morbidity risk from coronavirus disease 2019 exposure during ophthalmic care.Importance During the coronavirus disease 2019 (COVID-19) pandemic, eye care professionals caring for patients with sight-threatening diseases, such as glaucoma, have had to determine whether some patient appointments could safely get postponed, weighing the risk that the patient's glaucoma could worsen during the interim vs the morbidity risk of acquiring COVID-19 while seeking ophthalmic care. They also need to prioritize appointment rescheduling during the ramp-up phase (when pandemic-associated service reductions are eased). Objective To describe a flexible and scalable scoring algorithm for patients with glaucoma that considers glaucoma severity and progression risk vs the presence of high-risk features for morbidity from COVID-19, using information from a large data repository. Design, Setting, and Participants In this cross-sectional study, patients with upcoming clinic appointments for glaucoma from March 16, 2020, to April 16, 2020, at an academic institution enrolled in the Sight Outcomes Research Collaborative (SOURCE) Ophthalmology Electronic Health Record Data Repository were identified. A risk stratification tool was developed that calculated a glaucoma severity and progression risk score and a COVID-19 morbidity risk score. These scores were summed to determine a total score for each patient. Main Outcomes and Measures Total scores and percentages of clinic appointments recommended for rescheduling. Results Among the 1034 patients with upcoming clinic appointments for glaucoma, the mean (SD) age was 66.7 (14.6) years. There were 575 women (55.6%), 733 White individuals (71%), and 160 Black individuals (15.5%). The mean (SD) glaucoma severity and progression risk score was 4.0 (14.4) points, the mean (SD) COVID-19 morbidity risk score was 27.2 (16.1) points, and the mean (SD) total score was 31.2 (21.4) points. During pandemic-associated reductions in services, using total score thresholds of 0, 25, and 50 points would identify 970 appointments (93.8%), 668 appointments (64.6%), and 275 appointments (26.6%), respectively, for postponement and rescheduling. The algorithm-generated total scores also helped prioritize appointment rescheduling during the ramp-up phase. Conclusions and Relevance A tool that considers the risk of underlying ophthalmic disease progression from delayed care receipt and the morbidity risk from COVID-19 exposure was developed and implemented, facilitating the triage of upcoming ophthalmic appointments. Comparable approaches for other ophthalmic and nonophthalmic care during the COVID-19 pandemic and similar crises may be created using this methodology.