Since the COVID-19 pandemic swept across the world, U.S. government agencies – including the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH) and the U.S. Food and Drug Administration (FDA) – have leveraged real-world evidence to characterize the disease, find cures and assess the impact of the pandemic on healthcare service delivery, clinical outcomes and quality.
Which database has emerged as the ideal source of data for studying COVID-19? The Premier Healthcare Database (PHD), the largest hospital discharge database in the nation that not only captures all clinical aspects of the disease but is also comprehensive and timely, has become a frontrunner in COVID-19 research. The PHD has been utilized in research studies conducted by the Premier Applied Sciences® (PAS) research team, the CDC, the NIH and leading academic institutions.
As of February 2021, the PHD has captured more than 1 million confirmed COVID-19 patients who were treated in inpatient and outpatient settings across 896 U.S. hospitals and health systems. All patient-related data is de-identified and HIPAA-compliant from both the inpatient and hospital-based outpatient settings. Information on demographic and disease state, billed services (e.g., medications, laboratory tests performed, diagnostics and therapeutic services) as well as information on hospital characteristics such as geographic location, bed size and teaching status is included.
Here are some examples of COVID-19 research projects informed by PHD data that have been published in top-tier peer-reviewed journals.
- Uptake and Accuracy of the Diagnosis Code for COVID-19 Among U.S. Hospitalizations
This research letter published by The Journal of the American Medical Association (JAMA) highlights a collaboration between the PAS research team and counterparts from the Critical Care Medicine Department at the NIH. The study demonstrates the accuracy of the COVID-19-specific ICD-10 diagnosis code (U07.1) and finds that hospitals provide accurate COVID-19 diagnosis in administrative data. Furthermore, it shows that coding serves as an important and reliable means to track inpatient discharges and costs associated with COVID-19.
- Risk Factors Associated with In-Hospital Mortality in a U.S. National Sample of Patients with COVID-19
This paper published by JAMA Network Open identifies a number of clinically relevant factors associated with COVID-19 mortality, which may help improve clinical practice. The study finds that the use of statins, angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers were associated with decreased odds of death in patients with COVID-19, while having sepsis, acute kidney injury, hyperkalemia, acidosis, acute liver damage and neurological disorders were independently associated with increased odds of mortality. These findings imply that use of statins, ACE inhibitors and calcium channel blockers during a patient’s inpatient stay may reduce their risk of mortality and that early implementation of effective measures to prevent severe acute complications may help reduce risk of mortality.
- Characteristics of Hospitalized COVID-19 Patients Discharged and Experiencing Same-Hospital Readmission
In its Morbidity and Mortality Weekly Report (MMWR), the CDC published an analysis that assesses patterns of hospital discharge, readmission, and demographic and clinical characteristics associated with hospital readmission after a patient’s initial COVID-19 hospitalization (index hospitalization). It finds that one in 11 patients hospitalized with COVID-19 was readmitted to the same hospital within two months. Understanding readmission factors can inform clinical practice, discharge disposition decisions and healthcare planning to ensure availability of resources needed for acute and follow-up care of COVID-19 patients.
- Risk of Clinical Severity by Age and Race/Ethnicity Among Adults Hospitalized for COVID-19
This study published on Open Forum Infectious Diseases applies multivariable log-binomial regression to assess the associations between age and race/ethnicity and COVID-19 clinical severity (ICU admission, invasive mechanical ventilation and death) to determine whether the impact of age on clinical severity differs by race/ethnicity. Results indicate age is a driver of poor outcomes among those hospitalized with COVID-19, and clinical severity may be elevated among patients of some racial and ethnic minority groups.
- Real-World Inpatient Use of Medications Repurposed for COVID-19 in U.S. Hospitals
This study, also published on Open Forum Infectious Diseases, offers important population-level insights into how, when and possibly why inpatient clinicians used medications repurposed for COVID-19 and how prescribing practices changed over the first three months of the pandemic in the U.S. The findings tell a cautionary tale and provide key lessons for the various stakeholders in the current and future pandemics.
- Clinical Outcomes in Young U.S. Adults Hospitalized With COVID-19
This research letter published in JAMA Internal Medicine provides insights on the severity of COVID-19 among young adults 18-34 years of age. The study findings show that young adult COVID-19 patients experienced substantial adverse outcomes and their risk of in-hospital mortality approximately doubled that of young adults with acute myocardial infarction. Meanwhile, morbid obesity, hypertension and diabetes were associated with greater risk of adverse outcomes in these young adult patients.
- Clinical Characteristics and Outcomes of Hospitalized Women Giving Birth With and Without COVID-19
This research letter, also published in JAMA Internal Medicine, reports on the risk of in-hospital mortality and other adverse pregnancy and birth-related outcomes among women who tested positive for COVID-19 while giving birth in U.S. hospitals. The findings show that compared to women without COVID-19, those with COVID-19 had substantially higher risk of in-hospital mortality, preeclampsia, pre-term birth and thrombotic events, which emphasizes the importance of including pregnant women in clinical trials of treatments and vaccines for COVID-19.
- Clinical Outcomes in Patients with Heart Failure Hospitalized With COVID-19
This study published in Journals of the American College of Cardiology (JACC): Heart Failure compares the clinical outcomes between hospitalized patients with COVID-19 and those with acute heart failure among patients with heart failure history. The findings show that patients with heart failure hospitalized with COVID-19 had higher odds of death (one in four) than those hospitalized for acute heart failure.
The Power of Data
Understanding how treatments perform in the real world is critical to achieving successful clinical outcomes. The PHD will continue to provide academia, government agencies, healthcare providers and manufacturers the inimitable opportunity to use real-world data to conduct evidence-based and population-based analyses of drugs, devices, disease states, epidemiology, resource utilization, healthcare economics and clinical outcomes – in our current COVID-19 landscape and beyond.