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Comparing Single-Hospital and National Models to Predict 30-Day Inpatient Mortality

JOURNAL OF GENERAL INTERNAL MEDICINE 2025年第4期40卷 803-810页

作者： Cogill, Steven Heberer, Kent Kaushal, Amit Fang, Daniel Lee, Jennifer VA Palo Alto Cooperat Studies Program Coordinating Palo Alto CA USA VA Palo Alto Hlth Care Syst Big Data Scientist Training Enhancement Program Palo Alto CA USA VA Palo Alto Hlth Care Syst Hosp Med Palo Alto CA 94304 USA Stanford Dept Med Div Hosp Med Stanford CA USA Stanford Univ Dept Med Div Endocrinol Gerontol & Metab & Courtesy Epidemi Sch Med Stanford CA USA

BackgroundAdvances in artificial intelligence and machine learning have facilitated the creation of mortality prediction models which are increasingly used to assess quality of care and inform clinical practice. One open question is whether a hospital should utilize a mortality model trained from a diverse nationwide dataset or use a model developed primarily from their local hospital data. ObjectiveTo compare performance of a single-hospital, 30-day all-cause mortality model against an established national benchmark on the task of mortality prediction. Design/ParticipantsWe developed a single-hospital mortality prediction model using 9975 consecutive inpatient admissions at the Department of Veterans Affairs Palo Alto Healthcare System from July 26, 2018, to September 30, 2021, and compared performance against an established national model with similar features. Main MeasuresBoth the single-hospital model and the national model placed each patient in one of five prediction bins: < 2.5%, 2.5-5%, 5-10%, 10-30%, and >= 30% risks of 30-day mortality. Evaluation metrics included receiver operator characteristic area under the curve (ROC AUC), sensitivity, specificity, and balanced accuracy. Final comparisons were made between the single-hospital model trained on the full training set and the national model for both metrics and prediction overlap. Key ResultsWith sufficiently large training sets of 2720 or greater inpatient admissions, there was no statistically significant difference between the performances of the national model (ROC AUC 0.89, 95%CI [0.858, 0.919]) and single-hospital model (ROC AUC 0.878, 95%CI [0.84, 0.912]). For the 89 mortality events in the test set, the single-hospital model agreed with the national model risk assessment or an adjacent risk assessment in 92.1% of the encounters. ConclusionsA single-hospital inpatient mortality prediction model can achieve performance comparable to a national model when evaluated on a single-hospital population, g

关键词： predictive modeling inpatient mortality single hospital interpretability precision medicine hospital care

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A Multi-Institutional Natural Language Processing Pipeline to Extract Performance Status From Electronic Health Records

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CANCER CONTROL 2024年 31卷

作者： Maghsoudi, Arash Sada, Yvonne H. Nowakowski, Sara Guffey, Danielle Zhu, Huili Yarlagadda, Sudha R. Li, Ang Razjouyan, Javad Michael E Bakey VA Med Ctr Ctr Innovat Qual Effectiveness & Safety Holcombe Blvd Suite 01Y Houston TX 77021 USA Baylor Coll Med Dept Med Houston TX USA Baylor Coll Med Sect Hematol Oncol Houston TX USA VA Off Res & Dev Big Data Scientist Training Enhancement Program BD Washington DC USA

PurposePerformance status (PS), an essential indicator of patients' functional abilities, is often documented in clinical notes of patients with cancer. The use of natural language processing (NLP) in extracting PS from electronic medical records (EMRs) has shown promise in enhancing clinical decision-making, patient monitoring, and research studies. We designed and validated a multi-institute NLP pipeline to automatically extract performance status from free-text patient *** and MethodsWe collected data from 19,481 patients in Harris Health System (HHS) and 333,862 patients from veteran affair's corporate data warehouse (VA-CDW) and randomly selected 400 patients from each data source to train and validate (50%) and test (50%) the proposed pipeline. We designed an NLP pipeline using an expert-derived rule-based approach in conjunction with extensive post-processing to solidify its proficiency. To demonstrate the pipeline's application, we tested the compliance of PS documentation suggested by the American Society of Clinical Oncology (ASCO) Quality Metric and investigated the potential disparity in PS reporting for stage IV non-small cell lung cancer (NSCLC). We used a logistic regression test, considering patients in terms of race/ethnicity, conversing language, marital status, and *** test results on the HHS cohort showed 92% accuracy, and on VA data demonstrated 98.5% accuracy. For stage IV NSCLC patients, the proposed pipeline achieved an accuracy of 98.5%. Furthermore, our analysis revealed a documentation rate of over 85% for PS among NSCLC patients, surpassing the ASCO Quality Metrics. No disparities were observed in the documentation of *** proposed NLP pipeline shows promising results in extracting PS from free-text notes from various health institutions. It may be used in longitudinal cancer data registries.

关键词： Non small cell lung cancer natural language processing performance status American Society of Clinical Oncology quality metric Eastern cooperative oncology group

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Guillotine Transmetatarsal Amputations With Staged Closure Promote Early Ambulation and Limb Salvage in Patients With Advanced Chronic Limb-Threatening Ischemia

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JOURNAL OF ENDOVASCULAR THERAPY 2024年第4期31卷 687-696页

作者： Lepow, Brian D. D. Zulbaran-Rojas, Alejandro Park, Catherine Chowdhary, Saakshi Najafi, Bijan Chung, Jayer Ross, Jeffrey A. A. Mills, Joseph L. L. Montero-Baker, Miguel Baylor Coll Med Michael E DeBakey Dept Surg Div Vasc Surg & Endovasc Therapy Houston TX 77030 USA VA Hlth Serv Res & Dev Michael E DeBakey VA Med Ctr Ctr Innovat Qual Effectiveness & Safety Houston TX USA VA Off Res & Dev Big Data Scientist Training Enhancement Program Washington DC USA Houston Methodist Cardiovasc Surg Associates Vasc Surg Houston TX USA

Purpose: Transmetatarsal amputation (TMA) with primary closure has long been an option for limb salvage in patients with advanced chronic limb-threatening ischemia (CLTI) with extensive tissue loss of the forefoot. However, TMA healing and closure techniques are challenging, specifically in high-risk patients. Guillotine transmetatarsal amputations (gTMA) with staged closure may provide an alternative treatment in this population. We report long-term outcomes of such technique. Materials and Methods: A single-center retrospective cohort study of CLTI patients undergoing gTMA between 2017 and 2020 was performed. Limb salvage, wound healing, and survival rates were quantified using Kaplan-Meier (KM) analysis. Multivariate regression was used to identify the effect of patient characteristics on the outcomes. Results: Forty-four gTMA procedures were reviewed. Median follow-up was 381 (interquartile range [IQR], 212-539.75) days. After gTMA, 87.8% (n=36) of the patients were able to ambulate after a median interval of 2 (IQR, 1-3) days. Eventual coverage was achieved in a personalized and staged approach by using a combination of skin substitutes (88.6%, n=39) +/- split thickness skin grafts (STSG, 61.4%, n=27). KM estimates for limb salvage, wound healing, and survival were 84.1%, 54.5%, and 88.6% at 1 year and 81.8%, 63.8%, and 84.1% at 2 years. Wound healing was significantly associated with STSG application (p=0.002, OR=16.5, 95% CI 2.87-94.81). Conclusion: gTMA resulted in high limb salvage rates during long-term follow-up in CLTI patients. Adjunctive STSG placement may enhance wound healing at the gTMA site, thus leading to expedited wound closure. Surgeons may consider gTMA as an alternative to reduce limb loss in CLTI patients at high risk of major amputation. Clinical Impact Currently, the clinical presentation of CLTI is becoming more complex to deal with due to the increasing comorbidities as the society becomes older. The data shown in this article means for

关键词： CLTI guillotine transmetatarsal amputation wound healing limb salvage early ambulation revascularization

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Differences in COVID-19-Related Testing and Healthcare Utilization by Race and Ethnicity in the Veterans Health Administration

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JOURNAL OF RACIAL AND ETHNIC HEALTH DISPARITIES 2022年第2期9卷 519-526页

作者： Razjouyan, Javad Helmer, Drew A. Li, Ang Naik, Aanand D. Amos, Christopher, I Bandi, Venkata Sharafkhaneh, Amir Michael E DeBakey VA Med Ctr VA HSR&D Ctr Innovat Qnnl Effectiveness & Safety Houston TX 77030 USA Michael E DeBakey VA Med Ctr Baylor Coll Med Dept Med Houston TX 77030 USA VA Off Res & Dev Big Data Scientist Training Enhancement Program B Washington DC USA

Importance Recent reports indicate differences in COVID-19-related care and outcomes between Black and White Americans. Objective We examine the COVID-19-related healthcare utilization and mortality by race and ethnicity of patients tested for SARS-CoV-2 in the Veterans Health Administration (VHA). Design A retrospective cohort study. Setting We used the VHA COVID-19 shared data resources between February 1 and June 30, 2020. Participants Veterans tested for SARS-CoV-2 virus by VHA. Exposure(s) Three racial-ethnicity groups of Black, Hispanic, and White (as reference) veterans. Main Outcome(s) and Measure(s) Main outcomes are testing rate, positivity rate, hospitalization rate, ICU admission rate, and in-hospital mortality. Controlling for sex, age, and Elixhauser comorbidity index, we report adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) from logistic regression models. Results Of the 8,667,996 active veteran enrollees, 252,702 were tested by VHA from February to June, 2020, with 20,500 positive results and 4,790 hospitalizations. The testing rate was 4.4% among Black and 4.7% among Hispanic veterans compared to White veterans, 2.8%. The testing positivity rate was similarly elevated among Black (12.2%) and Hispanic (11.6%) veterans compared to White veterans (6.0%). The aORs of hospitalization in Black veterans (1.88;95% CI 1.74, 2.03) and Hispanic veterans (1.41;95% CI 1.25, 1.60) were higher compared to White veterans. No significant differences by race and ethnicity were observed in OR or aOR of ICU admission and in-hospital death among hospitalized patients. Conclusions and Relevance On a national level, the VHA was more likely to test and hospitalize Black and Hispanic veterans compared to White veterans, but there were no significant differences in ICU admission or in-hospital mortality among those hospitalized. This pattern of differences may relate to social determinants of health, factors affecting access to non-VHA care, or preferences

关键词： COVID19 Disparity Prevalence Veteran

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Identification of Frailty Clusters Using Cross-Sectional Frailty and Frailty Trajectory: Cohort of Heart Failure Veterans

JACC: Advances

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JACC: Advances 2025年第5期4卷 101751页

作者： Razjouyan, Javad Tofighi, Saeed Orkaby, Ariela R. Bozkurt, Biykem Sharafkhaneh, Amir Horstman, Molly J. Goyal, Parag Amos, Christopher I. Intrator, Orna Naik, Aanand D. VA HSR&D Center for Innovations in Quality Effectiveness and Safety Michael E. DeBakey VA Medical Center Houston TX United States Department of Medicine Baylor College of Medicine Houston TX United States Big Data Scientist Training Enhancement Program VA Office of Research and Development Washington DC United States Tehran Heart Center Cardiovascular Diseases Research Institute Tehran University of Medical Sciences Tehran Iran New England Geriatrics Research Education and Clinical Center VA Boston Health Care System Boston MA United States Brigham & Women's Hospital Harvard Medical School Boston MA United States Division of General Internal Medicine Department of Medicine Weill Medical College of Cornell University New York NY United States Division of Cardiology Department of Medicine Weill Medical College of Cornell University New York NY United States Department of Internal Medicine UNM Comprehensive Cancer Center University of New Mexico Albuquerque NM United States Brookdale Department of Geriatrics & Palliative Medicine Icahn School of Medicine at Mount Sinai New York NY United States Geriatrics & Extended Care Data Analysis Center James J. Peters VA Medical Center Bronx NY United States Department of Management Policy and Community Health The University of Texas Health Science Center at Houston (UTHealth) Houston TX United States UTHealth Institute on Aging University of Texas Health Science Center Houston TX United States

Background: Frailty is a syndrome associated with increased vulnerability and diminished physiological reserves. Three-quarters (78%) of heart failure (HF) patients are frail. Traditional frailty indices (FIs) assess cross-sectional deficits, while frailty trajectories (FTs) measure changes over time. Objectives: This study aims to examine the interaction between FI and FT to enhance risk stratification in hospitalized adults with HF. Methods: This retrospective cohort study utilized data from the Veterans Health Administration, including 143,687 veterans aged >50 admitted for HF from 2005 to 2019. FT measurements were derived from FI calculations for each of the 3 years before index hospitalization. Unsupervised clustering identified 4 clusters based on FI and FT interactions: low-low, low-high, high-low, and high-high. Associations between these clusters and clinical outcomes (ie, 1-year mortality, prolonged hospital stays, emergency department visits, and readmissions) were analyzed. Results: The study cohort was mostly older (mean age 74 ± 10 years), male (98%), and diverse (55% non-Hispanic White). Survival analysis showed distinct mortality risks across clusters;while the 2 clusters with low FI had the longest survival, the high-high group had the lowest survival probability. Adjusted logistic regression indicated that the high-high cluster had over twice the odds of 1-year mortality compared to the low-low cluster (OR: 2.29;95% CI: 2.15-2.44). The high-high cluster also had significantly higher rates of prolonged hospital stays, emergency department visits, and readmissions at 30 and 90 days postdischarge. Conclusions: Integrating cross-sectional FI and longitudinal FT offers a comprehensive assessment of frailty in HF patients, improving risk stratification and disease management. © 2025

关键词： cluster analysis frailty heart failure patient outcome risk assessment

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Age modifies the association between severe sleep apnea and all-cause mortality

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SLEEP MEDICINE 2024年 121卷 18-24页

作者： Ramezani, Amin Azarian, Mehrnaz Sharafkhaneh, Amir Maghsoudi, Arash Jones, Melissa B. Penzel, Thomas Razjouyan, Javad Michael E DeBakey VA Med Ctr Ctr Innovat Qual Effectiveness & Safety Houston TX USA Baylor Coll Med Dept Med Houston TX USA Michael E DeBakey VA Med Ctr Pulm Crit Care & Sleep Med Sect Med Care Line Houston TX USA Michael E DeBakey VA Med Ctr Mental Hlth & Res Care Lines Houston TX USA Baylor Coll Med Menninger Dept Psychiat & Behav Sci Houston TX USA Charite Sleep Med Ctr Berlin Germany VA Off Res & Dev Big Data Scientist Training Enhancement Program BD Washington DC USA

Purpose: While sleep apnea (SA) gets more prevalent with advancing age, the impact of age on the association between SA and health outcomes is not well known. We assessed the association between the severity of SA and all-cause mortality in different age groups using large longitudinal data. Method: We applied a Natural Language Processing pipeline to extract the apnea-hypopnea index (AHI) from the physicians' interpretation of sleep studies performed at the Veteran Health Administration (FY 1999-2022). We categorized the participants as no SA (n-SA, AHI< 5) and severe SA (s-SA, AHI >= 30). We grouped the cohort based on age: Young <= 40;Middle-aged:40-65;and Older adults >= 65;and calculated the odds ratio (aOR) of mortality adjusted for age, sex, race, ethnicity, BMI, and Charlson-Comorbidity Index (CCI) using n-SA as the reference. Results: We identified 146,148 participants (age 52.23 +/- 15.02;BMI 32.11 +/- 6.05;male 86.7 %;White 66 %). Prevalence of s-SA increased with age. All-cause mortality was lower in s-SA compared to n-SA in the entire cohort (aOR,0.56;95%CI: 0.54,0.58). Comparing s-SA to n-SA, the all-cause mortality rates (Young 1.86 % vs 1.49 %;Middle-aged 12.07 % vs 13.34 %;and Older adults 26.35 % vs 40.18 %) and the aOR diminished as the age increased (Young: 1.11, 95%CI: 0.93-1.32;Middle-aged: 0.64, 95%CI: 0.61-0.67;and Older adults: 0.44, 95%CI: 0.41-0.46). Conclusion: The prevalence of severe SA increased while the odds of all-cause mortality compared to n-SA diminished with age. SA may exert less harmful effects on the aged population. A causality analysis is warranted to assess the relationship between SA, aging, and all-cause mortality.

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Patient Priorities Care Increases Long-Term Service and Support Use: Propensity Match Cohort Study

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JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION 2024年第5期25卷 751-756页

作者： Samper-Ternent, Rafael Razjouyan, Javad Dindo, Lilian Halaszynski, Jaime Silva, Jennifer Fried, Terri Naik, Aanand D. UTHlth Houston Dept Management Policy & Community Hlth 1200 Pressler StRoom E905 Houston TX 77030 USA UTHlth Houston Inst Aging Houston TX USA Michael E DeBakey VA Med Ctr VA Hlth Serv Res & Dev Serv Ctr Innovat Qual Effectiveness & Safety Houston TX USA Baylor Coll Med Dept Med Houston TX USA VA Off Res & Dev Big Data Scientist Training Enhancement Program BD Washington DC USA Butler VA Hlth Care Syst Social Work Serv Butler PA USA Dept Vet Affairs VA Natl Social Work Program Care Management & Social Work Serv Off Patient Care Serv Washington DC USA Yale Univ Sch Med Dept Med New Haven CT USA Connecticut Vet Adm Hlth Syst West Haven CT USA

Objectives: Patient priorities care (PPC) is an evidence-based approach designed to help patients achieve what matters most to them by identifying their health priorities and working with clinicians to align the care they provide to the patient's priorities. This study examined the impact of the PPC approach on longterm service and support (LTSS) use among veterans. Design: Quasi-experimental study examining differences in LTSS use between veterans exposed to PPC and propensity-matched controls not exposed to PPC adjusting for covariates. Setting and Participants: Fifty-six social workers in 5 Veterans Health Administration (VHA) sites trained in PPC in 2018,143 veterans who used the PPC approach, and 286 matched veterans who did not use the PPC approach. Methods: Veterans with health priorities identified through the PPC approach were the intervention group (n = 143). The usual care group included propensity-matched veterans evaluated by the same social workers in the same period who did not participate in PPC (n = 286). The visit with the social worker was the index date. We examined LTSS use, emergency department (ED), and urgent care visits, 12 months before and after this date for both groups. Electronic medical record notes were extracted with a validated natural language processing algorithm (84% sensitivity, 95% specificity, and 92% accuracy). Results: Most participants were white men, mean age was 76, and 30% were frail. LTSS use was 48% higher in the PPC group compared with the usual care group [odds ratio (OR), 1.48;95% CI, 1.00-2.18;P = .05]. Among those who lived >2 years after the index date, new LTSS use was higher (OR, 1.69;95% CI, 1.04-2.76;P = .036). Among nonfrail individuals, LTSS use was also higher in the PPC group (OR, 1.70;95% CI, 1.06-2.74;P = .028). PPC was not associated with higher ED or urgent care use. Conclusions and Implications: PPC results in higher LTSS use but not ED or urgent care in these veterans. LTSS use was higher for nonfra

关键词： Long-term services and supports patient priorities veterans older adults

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Obesity paradox or hypoxia preconditioning: How obstructive sleep apnea modifies the Obesity-MI relationship

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SLEEP MEDICINE 2023年第1期110卷 132-136页

作者： Sharafkhaneh, Amir Agrawal, Ritwick Nambi, Vijay Bahammam, Ahmed Razjouyan, Javad Baylor Coll Med Dept Med Houston TX USA Michael E DeBakey VA Med Ctr Ctr Innovat Qual Effectiveness & Safety Houston TX USA South Cent Mental Illness Res Educ & Clin Ctr Houston TX USA Michael E DeBakey VA Med Ctr Pulm Crit Care & Sleep Med Sect Med Care Line Houston TX USA King Saud Univ Dept Med Univ Sleep Disorders Ctr & Pulm Serv Riyadh Saudi Arabia Natl Plan Sci & Technol & Innovat Kingdom Saudi Ar Strateg Technol Program Riyadh Saudi Arabia VA Off Res & Dev Big Data Scientist Training Enhancement Program BD Washington DC USA Michael E DeBakey VA Med Ctr Cardiol Sect Med Care Line Houston TX USA Michael E DeBakey VA Med Ctr Sleep Disorders & Res Ctr Houston TX 77030 USA

Objectives: The objective of this study was to evaluate the interaction between obesity and obstructive sleep apnea on acute MI in hospital ***: This retrospective cohort study utilized Veterans Health Administration data from years 1999-2020. Participants were categorized according to their body mass index (BMI) to non-obese (BMI <30) and obese (BMI & GE;30) groups. Clinical obstructive sleep apnea (SA) diagnosis was confirmed using ICD9/10 codes and the study subgroups included non-obese with no obstructive sleep apnea (nOB-nSA), non-Obese with obstructive sleep apnea (nOB-SA), obese with no obstructive sleep apnea (OB-nSA), and obese with obstructive sleep apnea (OBSA). The primary outcome was odds ratio of in-hospital mortality during the hospitalization with acute MI as the principal diagnosis adjusted for age, gender, race, ethnicity, and Charlson comorbidity index (CCI) with the nOBnSA group as the comparison ***: Among 72,036 veterans with acute-MI hospitalization, individuals with obesity and obstructive sleep apnea (OB-SA) had the lowest in-hospital mortality rate (1.0%) compared to those without obesity and obstructive sleep apnea (nOB-nSA, 2.8%), with obesity but without obstructive sleep apnea (OB-nSA, 2.4%), and with obesity and obstructive sleep apnea (nOB-SA, 1.4%). The adjusted odds ratio for mortality, compared to nOB-nSA, was 9% higher but not significant in OB-nSA (aOR, 1.09, 95%CI: 0.95, 1.25), 46% lower in OB-nSA (aOR, 0.54, 95%CI: 0.45, 0.66), and 52% lower in OB-SA (aOR, 0.48: 95%CI: 0.41, 0.57).Conclusion: Our data suggest that the association between obesity and improved survival in acute MI is largely driven by the presence of sleep apnea.

关键词： Intermitted hypoxia Hypoxic preconditioning Obesity paradox Survival

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Smoking Status and Factors associated with COVID-19 In-Hospital Mortality among US Veterans

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NICOTINE & TOBACCO RESEARCH 2022年第5期24卷 785-793页

作者： Razjouyan, Javad Helmer, Drew A. Lynch, Kristine E. Hanania, Nicola A. Klotman, Paul E. Sharafkhaneh, Amir Amos, Christopher, I Michael E DeBakey VA Med Ctr VA HSR&D Ctr Innovat Qual Effectiveness & Safety Houston TX 77030 USA Baylor Coll Med Dept Med Houston TX 77021 USA Michael E DeBakey VA Med Ctr VA Qual Scholars Coordinating Ctr IQuESt Houston TX USA VA Off Res & Dev Big Data Scientist Training Enhancement Program B Washington DC USA VA Salt Lake City Hlth Care Syst Salt Lake City UT USA Univ Utah Div Epidemiol Salt Lake City UT USA Univ Utah Sch Med Dept Internal Med Salt Lake City UT USA Baylor Coll Med Integrat Mol & Biomed Sci Program Houston TX 77021 USA Baylor Coll Med Margaret M & Albert B Alkek Dept Med Nephrol Houston TX 77021 USA Michael E DeBakey VA Med Ctr Med Care Line Sect Pulm Crit Care & Sleep Med Houston TX USA

Introduction The role of smoking in risk of death among patients with COVID-19 remains unclear. We examined the association between in-hospital mortality from COVID-19 and smoking status and other factors in the United States Veterans Health Administration (VHA). Methods This is an observational, retrospective cohort study using the VHA COVID-19 shared data resources for February 1 to September 11, 2020. Veterans admitted to the hospital who tested positive for SARS-CoV-2 and hospitalized by VHA were grouped into Never (as reference, NS), Former (FS), and Current smokers (CS). The main outcome was in-hospital mortality. Control factors were the most important variables (among all available) determined through a cascade of machine learning. We reported adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) from logistic regression models, imputing missing smoking status in our primary analysis. Results Out of 8 667 996 VHA enrollees, 505 143 were tested for SARS-CoV-2 (NS = 191 143;FS = 240 336;CS = 117 706;Unknown = 45 533). The aOR of in-hospital mortality was 1.16 (95%CI 1.01, 1.32) for FS vs. NS and 0.97 (95%CI 0.78, 1.22;p > .05) for CS vs. NS with imputed smoking status. Among other factors, famotidine and nonsteroidal anti-inflammatory drugs (NSAID) use before hospitalization were associated with lower risk while diabetes with complications, kidney disease, obesity, and advanced age were associated with higher risk of in-hospital mortality. Conclusions In patients admitted to the hospital with SARS-CoV-2 infection, our data demonstrate that FS are at higher risk of in-hospital mortality than NS. However, this pattern was not seen among CS highlighting the need for more granular analysis with high-quality smoking status data to further clarify our understanding of smoking risk and COVID-19-related mortality. Presence of comorbidities and advanced age were also associated with increased risk of in-hospital mortality. Implications Veterans who were forme

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Effects of COVID-19 on Sleep Services Use and Its Recovery

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NATURE AND SCIENCE OF SLEEP 2024年 16卷 761-768页

作者： Ramezani, Amin Sharafkhaneh, Amir BaHammam, Ahmed S. Kuna, Samuel Razjouyan, Javad Michael E DeBakey VA Med Ctr Ctr Innovat Qual Effectiveness & Safety VAs Hlth Serv Res & Dev Serv HSR&D Houston TX 77030 USA VA Off Res & Dev Big Data Scientist Training Enhancement Program Washington DC 20420 USA Michael E DeBakey VA Med Ctr VA Qual Scholars Coordinating Ctr Iquest Houston TX 77030 USA Baylor Coll Med Dept Med Houston TX 77030 USA King Saud Univ Coll Med Univ Sleep Disorders Ctr Dept Med Riyadh Saudi Arabia Natl Plan Sci & Technol & Innovat Kingdom Saudi Ar Strateg Technol Program Riyadh Saudi Arabia Corporal Michael J Crescenz Vet Affairs Med Ctr Dept Med Philadelphia PA USA Michael E DeBakey VA Med Ctr Ctr Innovat Qual Effectiveness & Safety VAs Hlth Serv Res & Dev Serv HSR&D Houston TX 77030 USA

Purpose: The COVID-19 pandemic affected the utilization of various healthcare services differentially. Sleep testing services utilization (STU), including Home Sleep Apnea Testing (HSAT) and Polysomnography (PSG), were uniquely affected. We assessed the effects of the pandemic on STU and its recovery using the Veterans Health Administration (VHA) data. Patients and Methods: A retrospective cohort study from the VHA between 01/2019 and 10/2023 of veterans with age >= 50. We extracted STU data using Current Procedural Terminology codes for five periods based on STU and vaccination status: pre -pandemic (Pre -Pan), pandemic sleep test moratorium (Pan-Mor), and pandemic pre -vaccination (Pan-Pre-Vax), vaccination (Pan-Vax), and postvaccination (Pan-Post-Vax). We compared STU between intervals (Pre -Pan as the reference). Results: Among 261,371 veterans (63.7 +/- 9.6 years, BMI 31.9 +/- 6.0 kg/m 2 , 80% male), PSG utilization decreased significantly during Pan-Mor (-56%), Pan-Pre-Vax (-61%), Pan-Vax (-42%), and Pan-Post-Vax (-36%) periods all compared to Pre -Pan. HSAT utilization decreased significantly during the Pan-Mor (-59%) and Pan-Pre-Vax (-9%) phases compared to the Pre -Pan and subsequently increased during Pan-Vax (+6%) and Pan-Post-Vax (-1%) periods. Over 70% of STU transitioned to HSAT, and its usage surged five months after the vaccine Introduction. Conclusion: Sleep testing services utilization recovered differentially during the pandemic (PSG vs HSAT), including a surge in HSAT utilization post -vaccination.

关键词： home sleep apnea testing polysomnography COVID-19 pandemic current procedural terminology

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