Endnote for mac emory4/3/2023 ![]() During the study period, outpatient testing was performed by nasopharyngeal sampling for real-time reverse transcription–polymerase chain reaction (RT-PCR) detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The study is a retrospective cohort investigation of outpatients with confirmed COVID-19 at Emory Healthcare, the largest academic health system in Georgia (serving the greater Atlanta metropolitan area). ![]() Below, we outline our findings and our initial experience using this risk assessment tool. We hypothesized that the multifactorial tool would predict hospitalization rates. In this retrospective study, we analyzed patient data gathered systematically at VOMC intake visits, including patient characteristics and assigned risk tier, and used an outcome of hospitalization related to COVID-19. The clinical care pathway for outpatients with COVID-19 in our clinic, the Virtual Outpatient Monitoring Clinic (VOMC), is outlined in eAppendix 2. Patients were followed with regular phone calls (frequency and duration varied by risk tier) until clinical improvement or hospitalization. We prospectively applied this risk assessment tool during the telemedicine assessment of outpatients diagnosed with COVID-19 in a large quaternary academic health system in Atlanta, GA. Exceptions to the criteria included: (1) provider discretion to override the risk assessment tool (2) patients who appeared to be improving after the second week of illness could be assigned to a low tier even if older age or comorbidities were present. For patients seen during acute illness, low-risk patients (Tier 1) must meet all of the following criteria: age 6 days), or uncertain ability to self-isolate. 4 Based on these factors, patients are assigned to a “risk tier 1-3” (indicating low, moderate, or high risk for hospitalization). This tool incorporates age, comorbidities, symptom severity and course, and the ability to isolate – criteria highlighted in initial Centers for Disease Control (CDC) guidance for home monitoring of patients with COVID-19. In order to better target care for outpatients with COVID-19, we created a risk assessment tool based on published data available in March 2020 (eAppendix 1). vital signs, labs, imaging) not available by telemedicine. 13 The tools in existence often require in-person criteria (e.g. older adults, patients with diabetes) 9- 12 have higher rates of hospitalization, there are no validated risk assessment tools that stratify risk for outpatients undergoing home monitoring. While it is recognized that certain groups (e.g. 6- 8 Monitoring programs require investment and staffing 7 it may be appropriate to focus these resources on those at highest risk of hospitalization for severe COVID-19. medical centers have employed telemedicine and remote monitoring programs to provide this care. 3 For these patients, the recommendation is to isolate at home and monitor symptoms under the care of a medical provider. ![]() 1, 2 At the time of diagnosis, most patients have mild illness and do not require hospitalization. ![]() The severity of coronavirus disease 2019 (COVID-19) varies from asymptomatic to life-threatening.
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