TY - JOUR
T1 - Application of the Sight Outcomes Research Collaborative Ophthalmology Data Repository for Triaging Patients with Glaucoma and Clinic Appointments during Pandemics Such as COVID-19
AU - Bommakanti, Nikhil K.
AU - Zhou, Yunshu
AU - Ehrlich, Joshua R.
AU - Elam, Angela R.
AU - John, Denise
AU - Kamat, Shivani S.
AU - Kelstrom, Jared
AU - Newman-Casey, Paula Anne
AU - Shah, Manjool M.
AU - Weizer, Jennifer S.
AU - Wood, Sarah D.
AU - Zhang, Amy D.
AU - Zhang, Jason
AU - Lee, Paul P.
AU - Stein, Joshua D.
N1 - Funding Information:
Funding/Support: This study was supported by Lighthouse Guild, National Eye Institute (grant R01 EY026641), and the Beverley and Gerson Geltner Fund.
Funding Information:
grants from National Institutes of Health during the conduct of the study. Dr Newman-Casey reported grants from National Eye Institute, Research to Prevent Blindness, and the Centers for Disease Control and Prevention during the conduct of the study. Dr Shah reported personal fees from Glaukos, Allergan, and Katena outside the submitted work. Dr Lee reported receiving grants from Research to Prevent Blindness; having received consulting fees from the Centers for Disease Control and Prevention; holding stocks in Pfizer, GSK, Merck, and Medco Health Solutions; and having received an honorarium from Alcon Research Institute outside the submitted work. Dr Stein reported grants from National Eye Institute during the conduct of the study. No other disclosures were reported.
Publisher Copyright:
© 2020 American Medical Association. All rights reserved.
PY - 2020/9
Y1 - 2020/9
N2 - 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..
AB - 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..
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U2 - 10.1001/jamaophthalmol.2020.2974
DO - 10.1001/jamaophthalmol.2020.2974
M3 - Article
C2 - 32678424
AN - SCOPUS:85088430088
SN - 2168-6165
VL - 138
SP - 974
EP - 980
JO - JAMA Ophthalmology
JF - JAMA Ophthalmology
IS - 9
ER -