Triaging Glaucoma Appointments Amid the Pandemic
JAMA Ophthalmology, September 2020
During the pandemic, professionals caring for patients with sight-threatening diseases must decide whether some patients’ appointments can be safely postponed. Another challenge is prioritization of rescheduled appointments. Bommakanti et al. developed a flexible and scalable scoring system for patients with glaucoma that accounts for disease severity and progression risk, as well as risk factors for COVID-related morbidity. This “big data” tool proved useful for determining which appointments could be delayed and for establishing an appropriate rescheduling scheme.
For this cross-sectional study, the authors identified patients with clinic appointments that had been scheduled from mid-March to mid-April 2020 at an academic center enrolled in the Sight Outcomes Research Collaborative Ophthalmology Electronic Health Record Data Repository. This information was used to create a system that involved scoring glaucoma severity and progression risk as well as COVID morbidity risk. High-risk factors for COVID-related morbidity or mortality included being older than age 65, chronic comorbid medical illness, and pregnancy. The two scores were summed for each patient. The total value helped determine whether to keep or postpone the visit, and it guided the prioritization of rescheduled appointments.
Overall, 1,034 adults with appointments scheduled for that month were eligible for inclusion. Their glaucoma severity and progression risk scores ranged from –50 to 20 (mean, 4.0). COVID morbidity risk scores ranged from 0 to 55 (mean, 27.2). Total scores ranged from –50 to 75 (mean, 31.2). To translate these data into actionable items for clinicians, the authors determined the percentage of visits that could safely be postponed based on score thresholds of 0, 25, and 50 points. This strategy identified 970 (93.8%), 668 (64.6%), and 275 appointments (26.6%), respectively, that could be rescheduled.
The original article can be found here.