Key Points Question Is continuing use of dexamethasone, 6 mg/d, at discharge for patients with COVID-19 who received less than 10 days of dexamethasone treatment during hospitalization associated with readmission or mortality after discharge? Findings In a cohort of 1164 patients with COVID-19 who received less than 10 days of dexamethasone, 6 mg/d, during hospitalization, the rate of readmission or mortality within 14 days of discharge was 9.1% among patients who continued dexamethasone treatment compared with 11.4% among patients who did not. The difference was not statistically significant. Meaning The findings of this study suggest that prescribing dexamethasone at discharge for patients hospitalized with COVID-19 who received less than 10 days of dexamethasone is not associated with a reduction in readmission or mortality.

Background Understanding the implications of disease-specific factors beyond baseline patient characteristics for coronavirus disease 2019 (COVID-19) may allow for identification of indicators for safe hospital discharge. Objective Assess whether disease-specific factors are associated with adverse events post-discharge using a data-driven approach. Design Retrospective cohort study. Setting Fifteen medical centers within Kaiser Permanente Southern California. Participants Adult patients ( n =3508) discharged alive following hospitalization for COVID-19 between 05/01/2020 and 09/30/2020. Interventions None. Main Measures Adverse events defined as all-cause readmission or mortality within 14 days of discharge. Least absolute shrinkage and selection operator (LASSO) was used for variable selection and logistic regression was performed to estimate odds ratio (OR) and 95% confidence interval (CI). Key Results Four variables including age, Elixhauser index, treatment with remdesivir, and symptom duration at discharge were selected by LASSO. Treatment with remdesivir was inversely associated with adverse events (OR: 0.46 [95%CI: 0.36–0.61]), while symptom duration ≤ 10 days was associated with adverse events (OR: 2.27 [95%CI: 1.79–2.87]) in addition to age (OR: 1.02 [95%CI: 1.01–1.03]) and Elixhauser index (OR: 1.15 [95%CI: 1.11–1.20]). A significant interaction between remdesivir and symptom duration was further observed ( p =0.01). The association of remdesivir was stronger among those with symptom duration ≤10 days vs >10 days at discharge (OR: 0.30 [95%CI: 0.19–0.47] vs 0.62 [95%CI: 0.44–0.87]), while the association of symptom duration ≤ 10 days at discharge was weaker among those treated with remdesivir vs those not treated (OR: 1.31 [95%CI: 0.79–2.17] vs 2.71 [95%CI 2.05–3.59]). Conclusions Disease-specific factors including treatment with remdesivir, symptom duration, and their interplay may help guide clinical decision making at time of discharge. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07610-5.

BACKGROUND Non-invasive tests, such as Fibrosis-4 index and transient elastography (commonly FibroScan), are utilized in clinical pathways to risk stratify and diagnose non-alcoholic fatty liver disease (NAFLD). In 2018, a clinical decision support tool (CDST) was implemented to guide primary care providers (PCPs) on use of FibroScan for NAFLD. AIM To analyze how this CDST impacted health care utilization and patient outcomes. METHODS We performed a retrospective review of adults who had FibroScan for NAFLD indication from January 2015 to December 2017 (pre-CDST) or January 2018 to December 2020 (post-CDST). Outcomes included FibroScan result, laboratory tests, imaging studies, specialty referral, patient morbidity and mortality. RESULTS We identified 958 patients who had FibroScan, 115 before and 843 after the CDST was implemented. The percentage of FibroScans ordered by PCPs increased from 33% to 67.1%. The percentage of patients diagnosed with early F1 fibrosis, on a scale from F0 to F4, increased from 7.8% to 14.2%. Those diagnosed with advanced F4 fibrosis decreased from 28.7% to 16.5%. There were fewer laboratory tests, imaging studies and biopsy after the CDST was implemented. Though there were more specialty referrals placed after the CDST was implemented, multivariate analysis revealed that healthcare utilization aligned with fibrosis score, whereby patients with more advanced disease had more referrals. Very few patients were hospitalized or died. CONCLUSION This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.