Claims surveillance, patient surveys 'critical' to track COVID-19 in rheumatology patients
Combining broad-based surveillance strategies with frequent patient surveys can help rheumatologists keep tabs on their patients in the setting of COVID-19, according to findings presented during a webinar hosted by United Rheumatology.
“We still do not understand the relationship between our patients, COVID-19, the medications they are using and the risks,” Andrew L. Concoff, MD, FACR, CAQSM, executive vice president and chief value medical officer at United Rheumatology, said during the “On Survival and Resilience: Managing A Rheumatology Practice Through the COVID-19 Pandemic” webinar.
Because so little is understood, the two-pronged approach of surveillance and survey will be critical to gathering information about incidence of and associations with COVID-19 among patients with rheumatic diseases.
“In terms of the surveillance program, we can use patient claims data to monitor our patients for signs of COVID-19 crossover,” he said. “We can learn whether they have seen primary care or urgent care, whether they are hospital visits, emergency department visits or intensive care admissions,” Concoff said.
Clinicians may also use these data to track prescriptions and other health care interventions that are used for either their rheumatic condition or COVID-19. Whenever a patient acquires a COVID-related problem, the surveillance system will allow experts to do what Concoff called a “deep clinical dive” to monitor outcomes. “We can see if they are diagnosed more,” he said, and added that the information will also allow for further understanding of disease severity in these patients.
That said, Concoff raised one potential concern with this approach. “Using medical claims data can lead to selection bias,” he said. The issue is that some patients will be asymptomatic, others will not be able to gain access to services due to an overwhelmed health care system and still others may simply choose not to visit a doctor or hospital.”
“The second program is a survey program, which will be a complement to the surveillance program,” Concoff said. “We have set up a call center to reach out to our patients.”
Zip codes have been used to identify COVID-19 hotspots. “We will reach out proactively to patients in those populations to see how they are doing,” Concoff said.
Patients will be asked about medication adherence and symptoms of COVID-19, among others. “This will allow a clinical deep dive to do clinical phenotyping of patients who have been diagnosed,” Concoff said. He added that some of this information can also be gathered “in reverse,” meaning that patients who have had symptoms or survived COVID-19 can report on the disease course.
“As we reduce social distancing, we need to re-think how we get patients back into society,” Concoff said. This may involve risk stratifying patients, or prioritizing those who have the “most to lose” by not being seen and not being cared for. “We can identify patients at greatest risk and reach out to them sequentially.” – by Rob Volansky
Concoff AL. Surveillance and Survey: Two Data-Sharing Approaches to Evaluate the Risks of COVID-19 Infection Among Patients with Rheumatic Disease. Presented at United Rheumatology webinar “On Survival and Resilience: Managing A Rheumatology Practice Through the COVID-19 Pandemic”; April 17, 2020 (virtual meeting).
Disclosures: Concoff reports consultant and/or speaker to Flexion Pharmaceuticals, Exagen Inc. and UCB.