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Analysis of hospitalized COVID-19 patients in the CarePort network

CarePort Health, a wholly owned subsidiary of Allscripts, recently released COVID-19 insights that analyze how certain characteristics of COVID-19 patients may correlate with specific outcomes.

Given the rapidly evolving nature of the COVID-19 pandemic, CarePort has shared these early observations to help healthcare providers manage this crisis as effectively as possible – from both a clinical and operational perspective – and to empower clinicians, researchers and government agencies to more proactively address anticipated care needs.

CarePort’s analysis demonstrates the value of the clinical data stored in EHRs, and how this aggregated information can provide critical insights into the acute and post-acute course of care for COVID-19 patients. Learn more about how hospitals are using this data during the current public health emergency in these articles from The Washington Post and Becker’s Health IT.

Below is further background about CarePort’s preliminary observations, and a summary of the new report: CarePort COVID-19 Insights. Learn how CarePort can support your organization during COVID-19 on CarePort’s website.

CarePort Health is a transitions of care platform used by 1,000 hospitals and 180,000 post-acute providers. Real-time patient data from Allscripts, Epic, Cerner and Meditech, as well as many skilled nursing and home health EHRs, feed into the CarePort platform.

CarePort has a broad, national view of COVID-19 patients across hospitals of all sizes and distributed across urban, suburban and rural locations in 43 states.

CarePort manages thousands of COVID-19 hospitalizations every day and tracks patients through their acute and post-acute course of care. Given CarePort’s national footprint and visibility from the minute the patient presents at the emergency department through their care journey post-discharge, CarePort has a comprehensive view of COVID-19 hospitalizations and post-discharge needs. We believe our observations can augment and complement the depth of data that each hospital has in its own EHR.

Presented below are preliminary observations from 6,479 hospital stays of patients admitted after March 1, 2020.

Male patients are 1.3 times more likely to die during a hospital stay even after controlling for age and the most common underlying conditions

Several reports in China, Italy and the US have identified that the gender breakdown of patients with severe outcomes skews towards male. However, it is not well understood whether male patients have worse outcomes because they are disproportionately older or have more underlying comorbidities.

CarePort data, for the first time, shows that men are 1.3 times more likely to die during a hospitalization, even after controlling for age and common underlying conditions. These results may be potentially confounded, as CarePort did not control for all underlying conditions. However, CarePort did take into account the most prevalent chronic conditions in the US, including chronic kidney disease, cerebrovascular disease, congestive heart failure, obesity, diabetes, COPD and hypertension.

Interestingly, the predilection of males for severe disease is also seen in the pediatric data that the CDC recently reported on April 10, 2020. One would not expect the pediatric population to have differences in chronic conditions between male and female patients. If male patients do indeed fare worse than female patients, this may have implications for clinical triage, treatment and potentially vaccine efficacy.

Hospitalized COVID-19 patients with multiple underlying medical conditions are at high risk for mortality

A 75-year-old with no underlying conditions has a mortality rate of 16-19% when hospitalized with COVID-19. Though a decade younger, a 65-year-old with hypertension, diabetes, chronic kidney disease and/or obesity has a similar mortality rate as the 75-year-old with no underlying conditions. This example illustrates the differential impact of underlying health conditions on the risk of severe disease.

Consistent with prior reports, CarePort observed that trends in mortality varied based on the number of underlying health conditions. Specifically, CarePort examined the impact of common chronic conditions such as heart failure, diabetes, cerebrovascular disease, COPD, hypertension, chronic kidney disease and obesity.

CarePort’s observations give an early indication of risk after adjusting for age. It is important to adjust for age as older patients may be more likely to have chronic conditions. Without controlling for age, it is unclear whether age or the underlying condition drives a higher risk of mortality – but when adjusting for age, it is possible to more clearly isolate the impact of an underlying condition. For example, patients with chronic kidney disease are 2.5 times more likely to die during a COVID-19 hospitalization after controlling for age.

Acute kidney injury in COVID-19 patients is associated with poor outcomes across all age groups

In the context of COVID-19, these data signal that acute kidney injury increases the risk of mortality. For example, a hospitalized 85-year-old with no underlying conditions has a mortality rate of 22-27%. If that same 85-year-old is hospitalized with acute kidney injury, his mortality rate nearly doubles to 39-49%.

When the kidney is injured over a few hours or days, the medical term is “acute kidney injury.” The kidney is often an early casualty of other disease processes occurring in the body. Clinicians routinely measure kidney function with a blood test upon admission to the hospital, and the presence or absence of acute kidney injury is a prognostic indicator commonly used in multiple models of mortality.

1 in 10 middle-aged COVID-19 patients do not survive their hospital stay

Across CarePort hospitals, 1,123 COVID-19 patients have died during hospitalization. The mortality rate was highest among those aged 85 and older, with more than 40% of hospitalized patients dying during their hospital stay. However, even among the middle-aged population (ages 45-64), the risk of mortality during a hospital stay is significant, with a 9% mortality rate in the 45-54 population and a 13% mortality rate in the 55-64 patient population.

Notably, these observations are from a patient population that is already hospitalized and at baseline, these patients are already likely showing severe disease requiring hospitalization. Therefore, these data cannot be generalized to all middle-aged patients who develop COVID-19 as many do not require hospitalization.

Patients under 65 comprise 57% of hospitalizations for COVID-19

CarePort data shows that a significant portion of COVID-19 hospitalizations (57%) are for patients under the age of 65, which aligns with CDC data (55%). The average age of a patient hospitalized with COVID-19 is 59.6 years old. The experience of these hospitals further confirms that COVID-19 is a medical condition that impacts a broad swath of the population, not just seniors.

Looking ahead

The observations represent a uniquely broad and deep view of hospitalized COVID-19 patients across the US. Given the richness of CarePort data, many subsequent analyses are possible and are actively being pursued.

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