Early in the pandemic, researchers at the ChristianaCare Value Institute, an embedded research institute within the healthcare system with a mission to improve health outcomes for all, pivoted its focus toward understanding the impact of COVID-19 in its community and healthcare system. The Cerner COVID-19 data set, fueled in part by the Cerner Learning Health Network, provided the opportunity to investigate the impact of COVID-19 on rare, but critically important, clinical subgroups. Led by Stephanie Guarino, MD, a hematology oncologist with the ChristianaCare Center for Special Healthcare Needs, and Michael Vest, MD, a critical care medicine specialist, two investigations were launched in collaboration with Value Institute data managers, biostatisticians and epidemiologists. The studies included patients living with sickle cell disease (SCD) and those needing mechanical ventilation. SCD affects more than 100,000 Americans, primarily racial and ethnic minority groups who experience health disparities likely exacerbated by COVID-19. The unique constellation of SCD manifestations complicate both the diagnosis and management of COVID-19, particularly related to anticoagulation and transfusion practices. Understanding the impact of early exchange and anticoagulation can help guide development of appropriate treatment guidelines and future understanding of pathophysiology. Once hospitalized, the timing of intubation is an important clinical decision for COVID-19 patients with respiratory failure. Clinically, there has been substantial debate around the timing of intubation: too early may needlessly subject patients to complication of invasive mechanical ventilation; too late may further the inflammatory cytokine release and result in additional injury to lungs and kidneys. The Cerner COVID-19 data set provided the patient population size necessary for these two investigations otherwise not possible with the patient size coming from a single healthcare system in Delaware with a population of just under 1 million residents. The insights gleaned from these two studies will have significant impact on clinical practice ultimately resulting in improved health outcomes for patients with COVID-19 who also suffer from SCD, as well as those needing mechanical ventilation.
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