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Maaß L, Zeeb H, Rothgang H. International perspectives on measuring national digital public health system maturity through a multidisciplinary Delphi study. NPJ Digit Med 2024; 7:92. [PMID: 38609458 PMCID: PMC11014962 DOI: 10.1038/s41746-024-01078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
Unlocking the full potential of digital public health (DiPH) systems requires a comprehensive tool to assess their maturity. While the World Health Organization and the International Telecommunication Union released a toolkit in 2012 covering various aspects of digitalizing national healthcare systems, a holistic maturity assessment tool has been lacking ever since. To bridge this gap, we conducted a pioneering Delphi study, to which 54 experts from diverse continents and academic fields actively contributed to at least one of three rounds. 54 experts participated in developing and rating multidisciplinary quality indicators to measure the maturity of national digital public health systems. Participants established consensus on these indicators with a threshold of 70% agreement on indicator importance. Eventually, 96 indicators were identified and agreed upon by experts. Notably, 48% of these indicators were found to align with existing validated tools, highlighting their relevance and reliability. However, further investigation is required to assess the suitability and applicability of all the suggestions put forward by our participants. Nevertheless, this Delphi study is an essential initial stride toward a comprehensive measurement tool for DiPH system maturity. By working towards a standardized assessment of DiPH system maturity, we aim to empower decision-makers to make informed choices, optimize resource allocation, and drive innovation in healthcare delivery. The results of this study mark a significant milestone in advancing DiPH on a global scale.
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Affiliation(s)
- Laura Maaß
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Department Health, Long-Term Care and Pensions, Bremen, Germany.
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany.
| | - Hajo Zeeb
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Department Prevention and Evaluation, Bremen, Germany
| | - Heinz Rothgang
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Department Health, Long-Term Care and Pensions, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
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Douillet D, Riou J, Morin F, Mahieu R, Chauvin A, Gennai S, Ferrant L, Lopez R, Sebbane M, Plantefeve G, Brice C, Cayeux C, Savary D, Moumneh T, Penaloza A, Roy PM. Derivation and validation of a risk-stratification model for patients with probable or proven COVID-19 in EDs: the revised HOME-CoV score. Emerg Med J 2024; 41:218-225. [PMID: 38365436 DOI: 10.1136/emermed-2022-212631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The HOME-CoV (Hospitalisation or Outpatient ManagEment of patients with SARS-CoV-2 infection) score is a validated list of uniquely clinical criteria indicating which patients with probable or proven COVID-19 can be treated at home. The aim of this study was to optimise the score to improve its ability to discriminate between patients who do and do not need admission. METHODS A revised HOME-CoV score was derived using data from a previous prospective multicentre study which evaluated the original Home-CoV score. Patients with proven or probable COVID-19 attending 34 EDs in France, Monaco and Belgium between April and May 2020 were included. The population was split into a derivation and validation sample corresponding to the observational and interventional phases of the original study. The main outcome was non-invasive or invasive ventilation or all-cause death within 7 days following inclusion. Two threshold values were defined using a sensitivity of >0.9 and a specificity of >0.9 to identify low-risk and high-risk patients, respectively. The revised HOME-CoV score was then validated by retrospectively applying it to patients in the same EDs with proven or probable COVID-19 during the interventional phase. The revised HOME-CoV score was also tested against original HOME-CoV, qCSI, qSOFA, CRB65 and SMART-COP in this validation cohort. RESULTS There were 1696 patients in the derivation cohort, of whom 65 (3.8%) required non-invasive ventilation or mechanical ventilation or died within 7 days and 1304 patients in the validation cohort, of whom 22 (1.7%) had a progression of illness. The revised score included seven clinical criteria. The area under the curve (AUC) was 87.6 (95% CI 84.7 to 90.6). The cut-offs to define low-risk and high-risk patients were <2 and >3, respectively. In the validation cohort, the AUC was 85.8 (95% CI 80.6 to 91.0). A score of <2 qualified 73% of patients as low risk with a sensitivity of 0.77 (0.55-0.92) and a negative predictive value of 0.99 (0.99-1.00). CONCLUSION The revised HOME-CoV score, which does not require laboratory testing, may allow accurate risk stratification and safely qualify a significant proportion of patients with probable or proven COVID-19 for home treatment.
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Affiliation(s)
- Delphine Douillet
- Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, France
- UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, University of Angers; FCRIN, INNOVTE, Universite Angers Faculte des sciences, Angers, France
| | - Jérémie Riou
- Micro et Nano médecines Translationnelles, MINT, UNIV Angers, UMR INSERM 1066, UMR CNRS 6021, CHU Angers, Angers, France
- Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, Université Angers Faculté des Sciences, Angers, France
| | - François Morin
- Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, France
| | - Rafaël Mahieu
- Department of Infectious Disease, Angers University Hospital; University of Angers, CHU Angers, Angers, France
- CRCINA, Inserm U1232, University of Nantes-Angers, Universite Angers Faculte Des Sciences, Angers, France
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Stéphane Gennai
- Emergency Department, Reims University Hospital, University Hospital Centre Reims, Reims, France
- UFR Médecine, Université de Reims Champagne-Ardenne, Reims, France
| | - Lionel Ferrant
- Emergency Department, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Raphaëlle Lopez
- Emergency Department, Sart Tilman University Hospital, Centre hospitalier universitaire de Liège, Liege, Belgium
| | - Mustapha Sebbane
- Emergency Department, Montpellier University Hospital, Montpellier, France
| | | | - Christian Brice
- Emergency Department, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Coralie Cayeux
- Emergency Department, Centre Hospitalier de Remiremont, Remiremont, France
| | - Dominique Savary
- Department of Emergency Medicine, University of Angers, ANGERS, France
- Inserm IRSET UMR_S1085, I, EHESP, Angers, France
| | | | - Andrea Penaloza
- Emergency, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Pierre Marie Roy
- Emergency Department, CHU Angers, University of Angers, CHU Angers, Angers, France
- UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, University of Angers; FCRIN, INNOVTE, Universite Angers Faculte des sciences, Angers, France
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ADAPTE with modified Delphi supported developing a National Clinical Guideline: Stratification of Clinical Risk in Pregnancy. J Clin Epidemiol 2022; 147:21-31. [DOI: 10.1016/j.jclinepi.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/14/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022]
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Douillet D, Riou J, Penaloza A, Moumneh T, Soulie C, Savary D, Morin F, Mahieu R, Roy PM. Risk of symptomatic venous thromboembolism in mild and moderate COVID-19: A comparison of two prospective European cohorts. Thromb Res 2021; 208:4-10. [PMID: 34653718 PMCID: PMC8498792 DOI: 10.1016/j.thromres.2021.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Severely ill patients with SARS-CoV-2 have an increased risk of venous thromboembolism (VTE) i.e., deep vein thrombosis and pulmonary embolism. However, the VTE risk in patients with mild and moderate COVID-19, hospitalized or managed at home, remain uncertain. The aims of this study were to assess the rate and the risk factors symptomatic VTE, in patients with mild and moderate COVID-19 and to compare them to a cohort of similar patients without COVID-19. METHODS Patients presenting to the emergency department (ED) of participating centers for confirmed or probable mild or moderate COVID-19 and not having acute VTE were included. This COVID-19 cohort was retrospectively compared to a prospective cohort of similar ED patients using propensity score matching. The main outcome was the rate of symptomatic VTE within the 28 days after ED presentation. RESULTS A total of 2292 patients were included in the COVID-19 cohort. The 28-day incidence of symptomatic VTE was 1.3% (n = 29/2292, 95%CI: 0.9 to 1.8), 2.3% (n = 20/866, 95%CI: 1.5 to 3.5) in moderate COVID-19 patients and 0.6% (n = 9/1426; 95%CI: 0.3 to 1.2) in mild COVID-19 patients managed as outpatients. An age over 65 years and hospitalization were independent risk factors of VTE. After adjustment, patients in the COVID-19 cohort had an absolute increase in over symptomatic VTE risk of +1.69% (95%CI, 0.88 to 2.51) versus patients in the comparison cohort (n = 1539). CONCLUSIONS Patients with moderate COVID-19 presenting to the ED had a high risk of subsequent VTE. TRIAL REGISTRATION Ethics committee of the CHU of Angers (N°2020/87).
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Affiliation(s)
- Delphine Douillet
- Emergency Department, Angers University Hospital, Angers, France,UNIV Angers, UMR MitoVasc CNRS 6015 - INSERM 1083, Angers, France,FCRIN, INNOVTE, Saint Etienne, France,Corresponding author at: Département de Médecine d'Urgence, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49100 Angers, France
| | - Jérémie Riou
- UNIV Angers, UMR MINT, INSERM 1066 - CNRS 6021, Angers, France,Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, Angers, France
| | - Andrea Penaloza
- FCRIN, INNOVTE, Saint Etienne, France,Emergency Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Thomas Moumneh
- Emergency Department, Angers University Hospital, Angers, France,UNIV Angers, UMR MitoVasc CNRS 6015 - INSERM 1083, Angers, France,FCRIN, INNOVTE, Saint Etienne, France
| | | | - Dominique Savary
- Emergency Department, Angers University Hospital, Angers, France,EHESP, Irset, UMR INSERM S1085, CAPTV CDC, University of Rennes, Rennes, France
| | - Francois Morin
- Emergency Department, Angers University Hospital, Angers, France
| | - Rafaël Mahieu
- Department of Infectious Diseases, Angers University Hospital, Angers, France,UNIV Angers, UMR CRCINA, INSERM 1232, SFR ICAT, Angers, France
| | - Pierre-Marie Roy
- Emergency Department, Angers University Hospital, Angers, France,UNIV Angers, UMR MitoVasc CNRS 6015 - INSERM 1083, Angers, France,FCRIN, INNOVTE, Saint Etienne, France
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Hospital or Home?: A Pandemic Decision Tool in Context. Chest 2021; 160:1155-1156. [PMID: 34625158 PMCID: PMC8490856 DOI: 10.1016/j.chest.2021.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/22/2022] Open
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Suppressa P, Pagella F, Lenato GM, Gaetani E, Serio I, Masala MS, Spinozzi G, Lizzio R, Matti E, De Silvestri A, Passali GC, Aguglia M, Crocione C, Sabbà C. Characterization of epidemiological distribution and outcome of COVID-19 in patients with hereditary hemorrhagic telangiectasia: a nationwide retrospective multi-centre study during first wave in Italy. Orphanet J Rare Dis 2021; 16:378. [PMID: 34496900 PMCID: PMC8424156 DOI: 10.1186/s13023-021-02000-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus Disease 2019 (COVID-19) continues to have a devastating impact across the world. A number of pre-existing common clinical conditions were reported to represent risk factors for more severe COVID-19 outcomes. Hereditary Hemorrhagic Telangiectasia (HHT) is a rare vascular heritable disorders, characterized by complications secondary to visceral Arterio-Venous Malformations. The impact of HHT, as well as for many Rare Diseases (RDs) on infection susceptibility profile and clinical adverse outcome risk is an unresolved issue. Objectives The main objectives were: to assess the clinical features and outcomes of HHT patients infected with COVID-19; to compare the relative infection risk in these patients with the Italian general population throughout the first pandemic wave; to investigate the factors potentially associated with severe COVID-19 outcome in HHT patients, and the possible impact of COVID-19 infection on HHT-related symptoms/complications. Finally, we aimed to estimate how the lockdown-associated wearing of personal protective equipment/individual protection devices could affect HHT-related telangiectasia bleeding frequency. Methods The study is a nation-wide questionnaire-based survey, with a multi-Center retrospective cross-sectional design, addressed to the whole Italian HHT population. COVID-19 cases, occurring throughout the first pandemic wave, were collected by a questionnaire-based semi-structured interview. Only the cases ascertained by laboratory confirmation (molecular/serological) were included for epidemiological estimates. Information concerning eventual SarS-Cov-2 infection, as well as regarding HHT-related manifestations and HHT-unrelated co-morbidities were collected by the questionnaire. Prevalence data were compared to Italian general population in the same period. Results The survey disclosed 9/296 (3.04%) COVID-19 cases, 8/9 of them being resident in Lombardy, the main epidemic epicenter. Pneumonia was reported by 4/9 patients, which prompted hospital admission and intensive care management in 2 cases. No fatal outcome was recorded. After careful refinement of epidemiological analysis, the survey evidenced overlapping infection risk in HHT compared to general population. Conclusions COVID-19 infection profile parallels geographical distribution of epidemic foci. COVID-19 in HHT patients can lead to highly variable clinical profile, likely overlapping with that of general population. The HHT disease does not seem to involve a different approach in terms of hospital admission and access to intensive care with respect to general population.
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Affiliation(s)
- Patrizia Suppressa
- DIM-Interdisciplinary Department of Medicine, "Frugoni" Internal Medicine and Geriatrics Unit, HHT Interdepartmental Center, VascERN HHT Reference Center, Policlinico Hospital, University of Bari, P.zza Giulio Cesare, 70124, Bari, Italy
| | - Fabio Pagella
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Pavia, Italy
| | - Gennaro Mariano Lenato
- DIM-Interdisciplinary Department of Medicine, "Frugoni" Internal Medicine and Geriatrics Unit, HHT Interdepartmental Center, VascERN HHT Reference Center, Policlinico Hospital, University of Bari, P.zza Giulio Cesare, 70124, Bari, Italy
| | - Eleonora Gaetani
- Department of Medical and Surgical Sciences, Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Ilaria Serio
- Division of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | | | - Giuseppe Spinozzi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Lizzio
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elina Matti
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulio Cesare Passali
- Division of Otorhinolaryngology, Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Maria Aguglia
- Clinical Pathology Unit, Vito Fazzi Hospital, Lecce, Italy.,HHT Onlus Patient Association, Rome, Italy
| | | | - Carlo Sabbà
- DIM-Interdisciplinary Department of Medicine, "Frugoni" Internal Medicine and Geriatrics Unit, HHT Interdepartmental Center, VascERN HHT Reference Center, Policlinico Hospital, University of Bari, P.zza Giulio Cesare, 70124, Bari, Italy.
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Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol 2021. [PMID: 34322364 DOI: 10.5662/wjm.v11.i4.116.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The Delphi technique is a systematic process of forecasting using the collective opinion of panel members. The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine. The Delphi methods assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited, ethically/logistically difficult or evidence is conflicting. However, the attempts to assess the quality standard of Delphi studies have reported significant variance, and details of the process followed are usually unclear. We recommend systematic quality tools for evaluation of Delphi methodology; identification of problem area of research, selection of panel, anonymity of panelists, controlled feedback, iterative Delphi rounds, consensus criteria, analysis of consensus, closing criteria, and stability of the results. Based on these nine qualitative evaluation points, we assessed the quality of Delphi studies in the medical field related to coronavirus disease 2019. There was inconsistency in reporting vital elements of Delphi methods such as identification of panel members, defining consensus, closing criteria for rounds, and presenting the results. We propose our evaluation points for researchers, medical journal editorial boards, and reviewers to evaluate the quality of the Delphi methods in healthcare research.
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Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol 2021; 11:116-129. [PMID: 34322364 PMCID: PMC8299905 DOI: 10.5662/wjm.v11.i4.116] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/26/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023] Open
Abstract
The Delphi technique is a systematic process of forecasting using the collective opinion of panel members. The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine. The Delphi methods assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited, ethically/logistically difficult or evidence is conflicting. However, the attempts to assess the quality standard of Delphi studies have reported significant variance, and details of the process followed are usually unclear. We recommend systematic quality tools for evaluation of Delphi methodology; identification of problem area of research, selection of panel, anonymity of panelists, controlled feedback, iterative Delphi rounds, consensus criteria, analysis of consensus, closing criteria, and stability of the results. Based on these nine qualitative evaluation points, we assessed the quality of Delphi studies in the medical field related to coronavirus disease 2019. There was inconsistency in reporting vital elements of Delphi methods such as identification of panel members, defining consensus, closing criteria for rounds, and presenting the results. We propose our evaluation points for researchers, medical journal editorial boards, and reviewers to evaluate the quality of the Delphi methods in healthcare research.
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Affiliation(s)
- Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 00000, United Arab Emirates
| | - Ravi Jain
- Critical Care Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur 302001, Rajasthan, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
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Outpatient Management of Patients With COVID-19: Multicenter Prospective Validation of the Hospitalization or Outpatient Management of Patients With SARS-CoV-2 Infection Rule to Discharge Patients Safely. Chest 2021; 160:1222-1231. [PMID: 34004154 PMCID: PMC8123410 DOI: 10.1016/j.chest.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/13/2021] [Accepted: 05/04/2021] [Indexed: 01/08/2023] Open
Abstract
Background The Hospitalization or Outpatient Management of Patients With SARS-CoV-2 Infection (HOME-CoV) rule is a checklist of eligibility criteria for home treatment of patients with COVID-19, defined using a Delphi method. Research Question Is the HOME-CoV rule reliable for identifying a subgroup of COVID-19 patients with a low risk of adverse outcomes who can be treated at home safely? Study Design and Methods We aimed to validate the HOME-CoV rule in a prospective, multicenter study before and after trial of patients with probable or confirmed COVID-19 who sought treatment at the ED of 34 hospitals. The main outcome was an adverse evolution, that is, invasive ventilation or death, occurring within the 7 days after patient admission. The performance of the rule was assessed by the false-negative rate. The impact of the rule implementation was assessed by the absolute differences in the rate of patients who required invasive ventilation or who died and in the rate of patients treated at home, between an observational and an interventional period after implementation of the HOME-CoV rule, with propensity score adjustment. Results Among 3,000 prospectively enrolled patients, 1,239 (41.3%) demonstrated a negative HOME-CoV rule finding. The false-negative rate of the HOME-CoV rule was 4 in 1,239 (0.32%; 95% CI, 0.13%-0.84%), and its area under the receiver operating characteristic curve was 80.9 (95% CI, 76.5-85.2). On the adjusted populations, 25 of 1,274 patients (1.95%) experienced an adverse evolution during the observational period vs 12 of 1,274 patients (0.95%) during the interventional period: –1.00 (95% CI, –1.86 to –0.15). During the observational period, 858 patients (67.35%) were treated at home vs 871 patients (68.37%) during the interventional period: –1.02 (95% CI, –4.46 to 2.26). Interpretation A large proportion of patients treated in the ED with probable or confirmed COVID-19 have a negative HOME-CoV rule finding and can be treated safely at home with a very low risk of complications. Trial Registry ClinicalTrials.gov; No.: NCT04338841; URL: www.clinicaltrials.gov;
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