Outcomes of COVID-19 With the Mayo Clinic Model of Care and Research

O’Horo, John C.; Cerhan, James R.; Cahn, Elliot J; Bauer, Philippe R.; Temesgen, Zelalem; Ebbert, Jon O.; Abril, Andy; Saleh, Omar M. Abu; Assi, Mariam; Berbari, Elie F.; Bierle, Dennis M.; Bosch, Wendelyn; Burger, Charles D.; Cano, Edison J; Clements, Casey M.; Porquera, Eva M. Carmona; Almeida, Natalia E. Castillo; Challener, Douglas W.; Chesdachai, Supavit; Comba, Isin Yagmur; Campioli, Cristina G Corsini; Crane, Sarah J.; Dababneh, Ala S.; Enzler, Mark J.; Fadel, Hind J.; Ganesh, Ravindra; Moraes, Alice Gallo De; Go, John Raymond; Gordon, Joel E; Gurram, Pooja; Guru, Pramod; Halverson, Erika L.; Harrison, Michael F.; Heaton, Heather A.; Hurt, Ryan T.; Kasten, Mary J.; Lee, Augustine S.; Levy, Emily R.; Libertin, Claudia R.; Mallea, Jorge M.; Marshall, W F; Matcha, Gautam; Meehan, Anne M.; Franco, Pablo Moreno; Morice, William G.; OʼBrien, Jennifer; Oeckler, Richard A.; Ommen, Steve R.; C, Oravec; Orenstein, Robert; Ough, Natalie J; Palraj, Raj; Patel, B. M.; Pureza, Vincent; Pickering, Brian; Phelan, David; Razonable, Raymund R.; Rizza, Stacey A.; Sampathkumar, Priya; Sanghavi, Devang; Sen, Ayan; Siegel, Jason; Singbartl, Kai; Shah, Aditya; Shweta, Fnu; Speicher, Leigh; Suh, Gina A.; Tabaja, Hussam; Tande, Aaron J.; Ting, Henry H.; Tontz, Russell C; Vaillant, James J.; Vergidis, Paschalis; Warsame, Mohamed Y; Yetmar, Zachary A.; Zomok, Catherine Cate D; Williams, Amy W.; Badley, Andrew D.

doi:10.1016/j.mayocp.2020.12.006

Cited by 22 publications

(18 citation statements)

References 31 publications

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“…10 However, lower mortality rates have been observed with the Mayo Clinic model of care and research, as reported in a study that compared Mayo Clinic outcomes in COVID-19 patients with the rates reported nationally. 11 Further, the observed mortality in our study was noted in patients that were older and had comorbidities.…”

Section: Discussionmentioning

confidence: 57%

Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile Coinfection

Sehgal¹,

Fadel

Tande

et al. 2021

IDR

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Background Coronavirus infectious disease 2019 (COVID-19) is primarily a respiratory disease. However, it may manifest with gastrointestinal symptoms that may overlap with Clostridioides difficile infection (CDI). COVID-19 appears to have higher mortality in those with comorbidities. We aimed to assess the outcomes of coinfection in these patients. Methods A retrospective chart review was conducted to identify patients with CDI and COVID-19 from January 1st, 2020 to November 17th, 2020. Both infections were diagnosed via PCR. Clinical features, treatment for COVID-19 and CDI and outcomes including intensive care unit admission, colectomy, 30 day-mortality and long-term complications were analyzed. Results Overall, 21 patients (20 hospitalized) with median age 70.9 years (range 51.8–90.7 years) had CDI and COVID-19 within 4 weeks of each other. Of these, 4 patients (19%) with CDI were diagnosed with COVID-19 at the time of admission, 12 (57%) had CDI diagnosed after COVID-19, and 5 (23.9%) developed COVID-19 within 4 weeks after CDI. Fourteen patients (66.7%) were treated with medications directed against COVID-19 including remdesivir and dexamethasone (n=7), remdesivir with convalescent plasma (n= 1), remdesivir (n= 5) and dexamethasone (n=1). The most common treatment for CDI was oral vancomycin in 20 patients (95.2%), and 1 patient received intravenous metronidazole. No patient required colectomy for CDI but 2 (9.5%) required ICU admission. Four patients (19%) died likely due to COVID-19 with median age 80 years (range 61–90 years). Conclusion The relationship between COVID-19 and CDI is poorly understood, and studies are required to further investigate this association. Whether coinfection results in a worsening of outcomes, including mortality and clinical course, are questions that should be answered in future research studies. Diagnosing both infections for appropriate management is vital in light of overlapping symptoms.

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Section: Discussionmentioning

confidence: 57%

Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile Coinfection

Sehgal¹,

Fadel

Tande

et al. 2021

IDR

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“…The absolute difference in the all-cause hospitalization rate is relatively small but this likely reflects an overall low hospitalization rate at baseline in our clinical practice, and given the continued prevalence of COVID-19, even small absolute differences add up to represent significant public health benefit. 22 This study highlights the potential impact on clinical outcomes that can come from addressing social and cultural factors influencing medical decisions. Interestingly, the difference in hospitalization was magnified in non-White and non-English speaking populations.…”

Section: Discussionmentioning

confidence: 99%

Influence of Social and Cultural Factors on the Decision to Consent for Monoclonal Antibody Treatment among High-Risk Patients with Mild-Moderate COVID-19

Bierle

Ganesh

Wilker

et al. 2021

J Prim Care Community Health

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Background The clinical outcomes of patients who decline anti-spike monoclonal antibody therapies for coronavirus disease-2019 (COVID-19) is not known. Factors associated with the decision to accept or decline the offer for anti-spike monoclonal antibody therapies are not established. This study aimed to identify factors impacting the decision to consent for monoclonal antibody therapies and assess the differences in clinical outcomes of patients who accepted compared to those who declined these therapies. Methods This retrospective cohort study enrolled 2820 adult patients who were offered monoclonal antibody therapies, bamlanivimab and casirivimab-imdevimab, for COVID-19 at Mayo Clinic in the Midwest between 11/19/2020 and 12/31/2020. The primary endpoint is the decision to accept or decline monoclonal antibody treatment. Secondary endpoints were patient-level factors that could have impacted the decision to accept treatment (age, gender, race, ethnicity, primary language spoken, and medical comorbidities). The main clinical endpoint was hospitalization within 28 days of COVID-19 diagnosis. Results 59.1% (n = 1669) chose to accept monoclonal antibody therapy, and 40.9% (n = 1151) chose to decline the offer for treatment. Patients were more likely to accept treatment if they were non-Hispanic White, English speaking, identified a spouse or life partner, had a religious affiliation, and possessed more medical comorbidities. Overall, 28-day hospitalization rate was 2.6% (n = 72/2820) and was higher among those who declined (3.3%) than those who accepted monoclonal antibody therapy (2.0%; Rate Ratio = 0.62, 95% Confidence Interval, 0.39-0.98). Conclusions Despite having more comorbidities, patients who accepted monoclonal antibody treatments had a lower rate of hospitalization compared to patients who declined treatment. Several social and cultural factors were associated with the decision to decline therapy, including race, language, ethnicity, and lack of social support. These findings can inform public health efforts to reduce social disparities in the treatment of COVID-19 and increase utilization of monoclonal antibody therapies in high risk populations.

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“…The mortality rates for patients managed by this model of care were one-third of those observed in national data. 5 Telehealth and Medicine Today ® ISSN 2471-6960 https://doi.org/10.30953/tmt.v6.280…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Telehealth Impact Study

Campion

Ommen

Shah

et al. 2021

TMT

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Importance: This three-part study characterizes the widespread implementation of telehealth during the first year of the COVID-19 pandemic, giving us insight into the role of telehealth as we enter a stage of “new normal” healthcare delivery in the U.S. Objective: The COVID-19 Telehealth Impact Study was designed to describe the natural experiment of telehealth adoption during the pandemic. Using a large claims data stream and surveys of providers and patients, we studied telehealth in all 50 states to inform healthcare leaders. Design, Setting, Participants: In March 2020, the MITRE Corporation and Mayo Clinic founded the COVID-19 Healthcare Coalition (C19HCC), to respond to the pandemic. We report trends using a dataset of over 2 billion healthcare claims covering over 50% of private insurance activity in the U.S. (January 2019-December 2020), along with key elements from our provider survey (July-August 2020) and patient survey (November 2020 - February 2021). Main Outcomes and Measures: There was rapid and widespread adoption of telehealth in Spring 2020 with over 12 million telehealth claims in April 2020, accounting for 49.4% of total health care claims. Providers and patients expressed high levels of satisfaction with telehealth. 75% of providers indicated that telehealth enabled them to provide quality care. 84% of patients agreed that quality of their telehealth visit was good. Results: Peak levels of telehealth use varied widely among states ranging from 74.9% in Massachusetts to 25.4% in Mississippi. Every clinical discipline saw a steep rise with the largest claims volume in behavioral health. Provision of care by out-of-state provider was common at 6.5% (October-December 2020). Providers reported multiple modalities of telehealth care delivery. 74% of patients indicated they will use telehealth services in the future. Conclusions and Relevance: Innovation shown by providers and patients during this period of rapid telehealth expansion constitutes a great natural experiment in care delivery with evidence supporting widespread clinical adoption and satisfaction on the part of both patients and clinicians. The authors encourage continued broad access to telehealth over the next 12 months to allow telehealth best practices to emerge, creating a more effective and resilient system of care delivery.

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Outcomes of COVID-19 With the Mayo Clinic Model of Care and Research

Cited by 22 publications

References 31 publications

Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile Coinfection

Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile Coinfection

Influence of Social and Cultural Factors on the Decision to Consent for Monoclonal Antibody Treatment among High-Risk Patients with Mild-Moderate COVID-19

COVID-19 Telehealth Impact Study

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