Abstract 16681: Ability of the Intermountain Risk Score Measured in 2019 (pre-COVID) to Predict Major Adverse Health Events in Patients Positive for SARS-CoV-2 in 2020

Background: The Intermountain Risk Sore (IMRS) is a general health clinical decision tool based on the complete blood count (CBC) and basic metabolic profile (BMP). IMRS was developed to predict all-cause mortality. IMRS was validated previously in patients from the US and elsewhere, including in general medical and surgical patients and in diagnosis-specific populations. IMRS has been implemented at Intermountain Healthcare to guide clinical care in hospital settings. IMRS has not been tested as a predictor of major adverse health events after diagnosis of novel coronavirus disease (COVID)-19. Methods: Intermountain patients (ages ≥18 years) with a CBC and BMP measured in 2019 and with a COVID-positive test in 2020 (N=1,025) were evaluated to determine if the pre-2020 IMRS predicted a composite of hospitalization or mortality. All study subjects tested positive for COVID between March 3 and June 8, 2020. IMRS was calculated using original sex-specific variable weightings (see Horne BD et al, Am J Med 2009). Results: Overall, 55 females and 54 males had a composite endpoint, respectively (5 and 10 deaths; 52 and 46 hospitalizations), with c-statistics of c=0.748 for females and c=0.669 for males using IMRS calculations from 2019 (see Table). For n=170 patients, IMRS was also calculated from 2020 CBC/BMP panels obtained at the time of COVID diagnosis, and it also predicted the composite endpoint at that timepoint (for females and males combined, odds ratios= 4.05, 2.46, and 1.53 for high-, moderate-, and mild-risk categories vs. low-risk; see Table for category thresholds). Conclusion: IMRS measured using 2019 CBC and BMP lab results predicted major adverse health events for patients diagnosed with COVID in 2020. Use of IMRS may empower population health with anticipation of COVID outcomes; for higher risk patients, the IMRS result may lead to enhanced preventive measures if the patient is free of COVID and, if COVID is diagnosed, it may lead to earlier, more aggressive care.

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BORROWING TO COPE WITH ADVERSE HEALTH EVENTS: LIQUIDITY CONSTRAINTS, INSURANCE COVERAGE, AND UNSECURED DEBT

Health Economics ◽

10.1002/hec.2877 ◽

2012 ◽

Vol 22 (10) ◽

pp. 1177-1198 ◽

Cited By ~ 22

Author(s):

Patryk Babiarz ◽

Richard Widdows ◽

Tansel Yilmazer

Keyword(s):

Insurance Coverage ◽

Liquidity Constraints ◽

Health Events ◽

Adverse Health ◽

Unsecured Debt ◽

Adverse Health Events

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Acetazolamide to Prevent Adverse Altitude Effects in COPD and Healthy Adults

NEJM Evidence ◽

10.1056/evidoa2100006 ◽

2021 ◽

Author(s):

Michael Furian ◽

Maamed Mademilov ◽

Aline Buergin ◽

Philipp M. Scheiwiller ◽

Laura Mayer ◽

...

Keyword(s):

Adverse Effects ◽

Adverse Events ◽

Randomized Controlled Trials ◽

Older Persons ◽

Healthy Adults ◽

Controlled Trials ◽

Health Events ◽

Randomized Controlled ◽

Adverse Health ◽

Adverse Health Events

Furian and colleagues report on the results of two randomized controlled trials testing the use of acetazolamide to prevent the adverse effects of altitude on healthy older persons and in people with COPD. They find that acetazolamide decreased the incidence of altitude related adverse health events (primarily hypoxemia) in both populations with no evidence of adverse events.

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Reuse of single use medical devices in Canada: Clinical and economic outcomes, legal and ethical issues, and current hospital practice

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462308080562 ◽

2008 ◽

Vol 24 (04) ◽

pp. 430-436 ◽

Cited By ~ 19

Author(s):

David Hailey ◽

Philip D. Jacobs ◽

Nola M. Ries ◽

Julie Polisena

Keyword(s):

Laparoscopic Cholecystectomy ◽

Medical Devices ◽

Coronary Angioplasty ◽

Ethical Issues ◽

Economic Outcomes ◽

Health Events ◽

Adverse Health ◽

Single Use ◽

Adverse Health Events ◽

Legal And Ethical Issues

Objectives:The aim of this study was to assess the evidence that reuse of medical devices marketed for single use only (SUDs) is safe, effective and cost-effective, and to consider the use and health services impact of this practice in Canada.Methods:A systematic review was performed of studies that reported clinical or economic outcomes following reuse of SUDs in humans. Direct costs of adverse health events associated with SUD reuse and indications of budget impact were obtained using data for devices for laparoscopic cholecystectomy and coronary angioplasty. Legal and ethical issues were reviewed, drawing on material relevant to Canada. Data on current reuse of SUDs were obtained through a survey of Canadian acute care hospitals.Results:Studies of variable quality suggested that SUD reuse could be safe and effective, and would give cost savings, if there were no adverse events. Eliminating reuse of SUDs for laparoscopic cholecystectomy and coronary angioplasty would add less than 0.1 percent to costs of the procedures over 1 year. Adverse health events associated with device reuse create liability risks; patients should be informed of any known or foreseeable risks of reuse. Most of the 28 percent (111/398) of acute hospitals that reprocess SUDs do so in-house. Some do not have a written policy or an incident reporting mechanism.Conclusions:There is insufficient evidence to establish the safety, efficacy and cost-effectiveness of reusing SUDs. Legal and ethical issues require attention to minimize liability and maintain patient safety and trust. Some hospitals that reprocess SUDs do not have adequate documentation. These findings do not support the reuse of SUDs in Canadian hospitals.

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