J Am Board Fam Med
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Meta Analysis
Primary Care Relevant Risk Factors for Adverse Outcomes in Patients With COVID-19 Infection: A Systematic Review.
The aim of this systematic review is to summarize the best available evidence regarding individual risk factors, simple risk scores, and multivariate models that use patient characteristics, vital signs, comorbidities, and laboratory tests relevant to outpatient and primary care settings. ⋯ Our systematic review identifies several risk factors for adverse outcomes in COVID-19-infected inpatients that are often available in the outpatient and primary care settings: increasing age, increased CRP or procalcitonin, decreased lymphocyte count, decreased oxygen saturation, dyspnea on presentation, and the presence of comorbidities. Future research to develop clinical prediction models and rules should include these predictors as part of their core data set to develop and validate pragmatic outpatient risk scores.
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Review Case Reports
A Review of Clinical and Laboratory Predictors of Severe COVID-19 Disease.
In late December 2019, the coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China. It quickly spread and emerged as a global pandemic with far-reaching impacts on society. As clinical research on this novel virus emerges, there is a limited amount of data that review clinical and laboratory predictors of severe disease. We present a case of a patient with severely elevated inflammatory markers who remained clinically stable during his hospital course. ⋯ COVID-19 has proven to be a viral disease with a high transmission rate, that has caused over 100,000 deaths in the United States, thus far. The decision to admit a patient must balance the risks of transmission with the benefit of being readily available to provide urgent supportive care should the patient develop complications. Thus, there is a significant benefit to being able to predict poor outcomes. We performed a targeted review of the literature, focusing on clinical and laboratory predictors of poor outcomes in COVID-19. Our case report and narrative review outline these findings within the context of our case.
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Multicenter Study
Prevalence of Pre-existing Conditions Among Community Health Center Patients With COVID-19: Implications for the Patient Protection and Affordable Care Act.
Short- and long-term effects of COVID-19 will likely be designated pre-existing conditions. We describe the prevalence of pre-existing conditions among community health center patients overall and those with COVID-19 by race/ethnicity. ⋯ The future of the Patient Protection and Affordable Care Act is uncertain, and the long-term health effects of COVID-19 are largely unknown; therefore, ensuring people with pre-existing conditions can acquire health insurance is essential to achieving health equity.
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Our university hospital-based primary care practices transitioned a budding interest in telehealth to a largely telehealth-based approach in the face of the COVID-19 pandemic. ⋯ Several key lessons are important for future efforts regarding clinical implementation: (1) prepare for innovation, (2) cultivate an innovation mindset, (3) standardize (but not too much), (4) technological innovation is necessary but not sufficient, and (5) communicate widely and often.
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Multicenter Study
Development and Validation of the COVID-NoLab and COVID-SimpleLab Risk Scores for Prognosis in 6 US Health Systems.
Develop and validate simple risk scores based on initial clinical data and no or minimal laboratory testing to predict mortality in hospitalized adults with COVID-19. ⋯ Because they use simple, readily available predictors, developed risk scores have potential applicability in the outpatient setting but require prospective validation before use.