Effectiveness of a telephone-based nursing intervention to reduce hospital utilization by COVID-19 patients.

OBJECTIVE: Determine the effectiveness of a COVID-19 remote monitoring and management program in reducing preventable hospital utilization. DESIGN: A retrospective cohort study utilizing data from electronic health records. SAMPLE: Two hundred ninety-three patients who tested positive for COVID-19 at a drive-through testing site in Michigan. [Correction added on 11 April 2022, after first online publication: In the preceding sentence, "Two hundred and ninety-third" has been corrected to "Two hundred ninety-three" in this version.] The intervention group, consisting of 139 patients, was compared to a control group of 154 patients. MEASUREMENTS: The primary outcome was the 30-day probability of hospital utilization. The covariates included in the analysis were age, gender, tobacco use, body mass index (BMI), race, and ethnicity. INTERVENTION: A nurse-led, telephone-based active management protocol for COVID-19 patients who were isolating at home. RESULTS: The intervention group had a non-statistically significant 42% reduction in risk of hospital utilization within 30 days of a positive COVID-19 test when compared to the control group (HR = 0.578, p-value .111, HR 95% CI [0.29, 1.13]). CONCLUSIONS: A nurse-led remote monitoring and management program for COVID-19 reduced the probability of 30-day hospital utilization. Although the findings were not statistically significant, the program yielded practical significance by reducing hospital utilization, in-person interaction, and the risk of infection for healthcare workers.

The impact of industry and body part injured on repeat workers' compensation claims.

BACKGROUND: Few studies investigate the influence of body part injured and industry on future workers' compensation claims. METHODS: Using claims incurred from 1 January 2005 to 31 July 2015 (n = 77 494) from the largest workers' compensation insurer in Colorado, we assessed associations between worker characteristics, second claims involving any body part and the same body part. We utilized Cox proportional hazards models to approximate the probability of a second claim. RESULTS: First claims represented 74.9% (n = 58 007) and second claims 25.2% (n = 19 487) of total claims. Sex, age, industry, and body part of the first claim were associated with the probability of second claims and the body part affected. The 5-year probabilities of second claims and same body part second claims were 27.0% (95% confidence interval [CI]: 26.6%-27.5%) and 6.2% (95% CI: 5.9%-6.5%) in males and 26.5% (95% CI: 26.0%-27.0%) and 6.7% (95% CI: 6.5%-7.0%) in females. Most second claims occurred within 3 years. CONCLUSIONS: Most second claims occur within 3 years. Body part and industry-specific injury patterns suggest missed opportunities for prevention.

Inverse Relationship of Maximal Exercise Capacity to Hospitalization Secondary to Coronavirus Disease 2019.

OBJECTIVE: To investigate the relationship between maximal exercise capacity measured before severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalization due to coronavirus disease 2019 (COVID-19). METHODS: We identified patients (≥18 years) who completed a clinically indicated exercise stress test between January 1, 2016, and February 29, 2020, and had a test for SARS-CoV-2 (ie, real-time reverse transcriptase polymerase chain reaction test) between February 29, 2020, and May 30, 2020. Maximal exercise capacity was quantified in metabolic equivalents of task (METs). Logistic regression was used to evaluate the likelihood that hospitalization secondary to COVID-19 is related to peak METs, with adjustment for 13 covariates previously identified as associated with higher risk for severe illness from COVID-19. RESULTS: We identified 246 patients (age, 59±12 years; 42% male; 75% black race) who had an exercise test and tested positive for SARS-CoV-2. Among these, 89 (36%) were hospitalized. Peak METs were significantly lower (P<.001) among patients who were hospitalized (6.7±2.8) compared with those not hospitalized (8.0±2.4). Peak METs were inversely associated with the likelihood of hospitalization in unadjusted (odds ratio, 0.83; 95% CI, 0.74-0.92) and adjusted models (odds ratio, 0.87; 95% CI, 0.76-0.99). CONCLUSION: Maximal exercise capacity is independently and inversely associated with the likelihood of hospitalization due to COVID-19. These data further support the important relationship between cardiorespiratory fitness and health outcomes. Future studies are needed to determine whether improving maximal exercise capacity is associated with lower risk of complications due to viral infections, such as COVID-19.

The hospital tech laboratory: quality innovation in a new era of value-conscious care.

For decades, the healthcare industry has been incentivized to develop new diagnostic technologies, but this limitless progress fueled rapidly growing expenditures. With an emphasis on value, the future will favor information synthesis and processing over pure data generation, and hospitals will play a critical role in developing these systems. A Michigan Medicine, IBM, and AirStrip partnership created a robust streaming analytics platform tasked with creating predictive algorithms for critical care with the potential to support clinical decisions and deliver significant value.