Background: Little is known about electronic consultation (e-consult) utilization during the COVID-19 pandemic when health systems rapidly implemented and scaled telehealth alternatives to in-person care. It is also unknown if e-consult utilization during the pandemic replaced or merely deferred the need for a specialty appointment. We evaluated if primary care providers' (PCPs) e-consult utilization and specialists' recommendations for specialty appointments changed after the transition to telemedicine during the COVID-19 pandemic. Methods: This cohort study used an interrupted time series analysis of e-consult utilization in a large, urban academic health care system between December 1, 2019, and June 27, 2020; the post-telemedicine time period began March 15, 2020. The primary outcome measure was the odds of an e-consult ordered during a PCP appointment; the secondary outcome measure was the odds of a specialist recommending a specialty appointment in an e-consult. Results: During 193,263 PCP appointments, 1,318 e-consults were placed to internal medicine subspecialties. Compared to the pre-telemedicine time period, the odds of a PCP ordering an e-consult increased (OR 1.04, 95% CI [1.02-1.07]) and the odds of specialists recommending specialty appointments increased (OR 1.11, 95% CI [1.06-1.15]).Conclusions: E-consult use increased following the transition to telemedicine in the context of the COVID-19 pandemic, suggesting that PCPs consider the e-consult a valuable tool for patient care when there is limited availability of specialty appointments. However, recommendations for specialty appointments following an e-consult also increased, suggesting that the e-consult may not replace the need for a specialty appointment.
Aims: The association between cardiovascular diseases, such as coronary artery disease and hypertension, and worse outcomes in COVID-19 patients has been previously demonstrated. However, the effect of a prior diagnosis of heart failure (HF) with reduced or preserved left ventricular ejection fraction on COVID-19 outcomes has not yet been established. Methods and Results: We retrospectively studied all adult patients with COVID-19 admitted to our institution from March 1st to 2nd May 2020. Patients were grouped based on the presence or absence of HF. We used competing events survival models to examine the association between HF and death, need for intubation, or need for dialysis during hospitalization. Of 4043 patients admitted with COVID-19, 335 patients (8.3%) had a prior diagnosis of HF. Patients with HF were older, had lower body mass index, and a significantly higher burden of co-morbidities compared to patients without HF, yet the two groups presented to the hospital with similar clinical severity and similar markers of systemic inflammation. Patients with HF had a higher cumulative in-hospital mortality compared to patients without HF (49.0% vs. 27.2%, p < 0.001) that remained statistically significant (HR = 1.383, p = 0.001) after adjustment for age, body mass index, and comorbidities, as well as after propensity score matching (HR = 1.528, p = 0.001). Notably, no differences in mortality, need for mechanical ventilation, or renal replacement therapy were observed among HF patients with preserved or reduced ejection fraction. Conclusions: The presence of HF is a risk factor of death, substantially increasing in-hospital mortality in patients admitted with COVID-19.
Special Patient Populations 2.0 MEDICAL OVERSIGHT OF EMS 2.1 Medical Oversight 2.1.1 Medical Oversight of EMS Systems 2.1.2 Legal Issues 2.2 EMS Systems 2.2.1 Public Safety Answering Points 2.2.2 Design of System Components 2.2.3 Delivery Systems with Special Considerations Thomas 2014 2.3 EMS Personnel 2.3.1 Scope of Practice Models 2.3.2 Education Bhanji 2015 Miller 2004 Powers 2018 2.3.3 EMS Provider Health and Wellness Patterson 2018 2.4 System Management 2.4.1 System Finance 2.4.2 Legislation and Government 2.4.3 Public Health 2.4.4 System Status Management 3.0 QUALITY MANGEMENT AND RESEARCH 3.1 Quality Improvement Principles and Programs 3.1.1 Data Collection, Management, and Analysis 3.1.2 Quality Improvement Programs Kronick 2015 3.1.3 Evidence-based Practice 3.2 Research 3.2.1 Data Collection, Management, and Analysis 3.2.2 Fundamental Knowledge of Biostatistics and Epidemiology 3.2.3 EMS Research Design 4.0 SPECIAL OPERATIONS 4.1 Mass Casualty Management 4.1.1 Incident Command System (ICS) 4.1.2 Triage 4.1.3 Patient Care in Mass Casualty Events / Scene Management 4.2 Chemical / Biological / Radiological / Nuclear / Explosive (CBRNE) 4.2.1 Toxic Exposure / Poisoning / Hazardous Materials (HAZMAT) 4.2.2 Explosive Incidents 4.2.3 Weapons of Mass Destruction and Related Injury 4.3 Mass Gathering 4.3.1 Planning and Operations 4.3.2 Personnel Needs 4.3.3 Training and Drills 4.3.4 Design of Temporary Treatment Facilities 4.3.5 Equipment 4.3.6 Communications 4.4 Disaster Management 4.4.1 National Incident Management System (NIMS) & National Response Framework 4.4.2 Catastrophic Events 4.4.3 Health and Medical Resources 4.4.4 Special Response Considerations 4.5 EMS Operations 4.5.1 Tactical 4.5.2 Technical Rescue 4.5.
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