Abstract Background We previously developed and validated a predictive model to help clinicians identify hospitalized adults with coronavirus disease 2019 (COVID-19) who may be ready for discharge given their low risk of adverse events. Whether this algorithm can prompt more timely discharge for stable patients in practice is unknown. Objectives The aim of the study is to estimate the effect of displaying risk scores on length of stay (LOS). Methods We integrated model output into the electronic health record (EHR) at four hospitals in one health system by displaying a green/orange/red score indicating low/moderate/high-risk in a patient list column and a larger COVID-19 summary report visible for each patient. Display of the score was pseudo-randomized 1:1 into intervention and control arms using a patient identifier passed to the model execution code. Intervention effect was assessed by comparing LOS between intervention and control groups. Adverse safety outcomes of death, hospice, and re-presentation were tested separately and as a composite indicator. We tracked adoption and sustained use through daily counts of score displays. Results Enrolling 1,010 patients from May 15, 2020 to December 7, 2020, the trial found no detectable difference in LOS. The intervention had no impact on safety indicators of death, hospice or re-presentation after discharge. The scores were displayed consistently throughout the study period but the study lacks a causally linked process measure of provider actions based on the score. Secondary analysis revealed complex dynamics in LOS temporally, by primary symptom, and hospital location. Conclusion An AI-based COVID-19 risk score displayed passively to clinicians during routine care of hospitalized adults with COVID-19 was safe but had no detectable impact on LOS. Health technology challenges such as insufficient adoption, nonuniform use, and provider trust compounded with temporal factors of the COVID-19 pandemic may have contributed to the null result. Trial registration ClinicalTrials.gov identifier: NCT04570488.
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Toward Accurate Spatiotemporal COVID-19 Risk Scores Using High-Resolution Real-World Mobility Data
As countries look toward re-opening of economic activities amidst the ongoing COVID-19 pandemic, ensuring public health has been challenging. While contact tracing only aims to track past activities of infected users, one path to safe reopening is to develop reliable spatiotemporal risk scores to indicate the propensity of the disease. Existing works which aim at developing risk scores either rely on compartmental model-based reproduction numbers (which assume uniform population mixing) or develop coarse-grain spatial scores based on reproduction number (R0) and macro-level density-based mobility statistics. Instead, in this article, we develop a Hawkes process-based technique to assign relatively fine-grain spatial and temporal risk scores by leveraging high-resolution mobility data based on cell-phone originated location signals. While COVID-19 risk scores also depend on a number of factors specific to an individual, including demography and existing medical conditions, the primary mode of disease transmission is via physical proximity and contact. Therefore, we focus on developing risk scores based on location density and mobility behaviour. We demonstrate the efficacy of the developed risk scores via simulation based on real-world mobility data. Our results show that fine-grain spatiotemporal risk scores based on high-resolution mobility data can provide useful insights and facilitate safe re-opening.
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- NSF-PAR ID:
- 10332819
- Date Published:
- Journal Name:
- ACM Transactions on Spatial Algorithms and Systems
- Volume:
- 8
- Issue:
- 2
- ISSN:
- 2374-0353
- Page Range / eLocation ID:
- 1 to 30
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1145/3481044
