In recent weeks the Biden administration announced it is trying to make better sense of COVID hospitalization numbers. The issue, which is not new, is that medical records and reporting make it very hard to distinguish between patients who come to the hospital because of a severe case of COVID, those who come because COVID has exacerbated another condition like heart disease, and those who come for a condition unrelated to COVID and happen to test positive while there. This problem stems partly from structural characteristics of the US healthcare system: complex, independent EHRs, disjointed data collection, and ever-more burdensome documentation requirements of physicians and care teams. This data is clearly valuable; hospitalization numbers are an important tool in developing guidance and setting policies and will likely become a more important metric than case counts as the pandemic continues. While we may all agree that having this information is crucial, we must also acknowledge the limitations and challenges associated with obtaining and interpreting it.
Naturally as I read the article referenced above, I started thinking about Azara’s database and how our customers sometimes struggle to make sense of their own numbers. DRVS contains millions of patient records, displayed in so many ways that it can be hard to know where to look for the right report. Even if you do find it, the data is complex, so how do you make sense of what you see?
I always like to start by defining the question I am trying to answer. Are you looking for the number of patients who have had a COVID booster, or the number of boosters you have administered? Do you want to know how many positive COVID cases there were among your patient population in the last week? Last month? The more specific you can get with your question, the easier it will be to tell if the report you are using is the right one. Let’s look an example of COVID reporting in DRVS to help illustrate this process:
If I want to know how many of my practice’s patients have been vaccinated, where do I go? First, we must define some parameters around this question.
Now that we have defined our parameters, where might you go in DRVS to find this information? I would start with the COVID-19 (SARS-COV-2) Immunization Status Active Patients scorecard shown below:
Here, we can see a breakdown of all the patients meeting the parameters of the question – “my practice’s patients.” If you read the info snippet of any of these measures, you can see they are counting patients, not vaccines, and are requiring a qualifying visit in the last 12 months:
But the Immunization Completed After Initiation is showing me among the population who initiated a first dose, who went on to complete the series. The denominators are different. As we can see from the data in this screenshot, fully immunized patients make up a much smaller percentage than those who completed the series after initiation. This is not surprising – patients who choose to initiate the series are more likely to complete it. The Completed After Initiation measure helps you know who needs a follow up vaccine through the gap list, while the Full Immunization Status gap could be patients who may still need a first dose.
This is just one example of how many ways there are to parse data around a seemingly simple question; imagine the complexity of defining this type of data need at a national level. Some key takeaways for DRVS users (and really anyone trying to make sense of any data):
Throughout this pandemic, most Americans have been exposed to data that they are wholly unprepared to interpret. This is not because Americans cannot understand complex data; it is because even experts cannot agree on how to define what to measure. Even if they can, the data is often lacking crucial context that would make it actionable.
I write this post not to discourage data review, but quite the opposite; the more time spend questioning and probing data, the greater its value for decision making. So as always, thank you to our wonderful clients who ask the right questions to make their data, and our product, ever better. And thank you to the amazing team at Azara who has been updating our COVID reporting suite non-stop for the past 2 years and will continue to do so as long as it takes.
For more information on Azara’s COVID tools, please see our COVID-19 Tools in DRVS page in the Help section.