Assessing Provider Utilization of COVID-19 Inflammatory Marker Trends in Hospitalized Patients and Implications in Optimizing Value-Based Care During a Pandemic

Abstract

Introduction. Numerous inflammatory markers may serve a role in prognostication of patients hospitalized with COVID-19.  Our health system created an admission order set which included daily d-dimer, c-reactive protein (CRP), lactate dehydrogenase (LDH), and ferritin.  Limiting ordering of studies that do not affect daily management could result in significant cost savings to the health system without adverse patient outcomes.  We aim to determine ordering and utilization patterns of inflammatory markers by physicians caring for patients hospitalized with COVID-19 infections.

Methods. An anonymous 10-question survey was distributed to 125 physicians (Infectious Diseases, Hospitalist, and Intensivists).  Response values greater than 50% were assumed to be an accurate representation of the entire group.

Results. In total, 77 (62%) physicians responded.  57.1% (44/77) of physicians reported ordering daily inflammatory markers for 3-10 days.  Another 31.2% (24/77) ordered markers until clinical improvement or hospital discharge.  D-dimer was used by 83.1% (64/77) of respondents, with 93.8% (60/64) of those reporting utilizing it in determining anticoagulation dose.  CRP was used by 61% (47/77) of physicians to identify a secondary infection or help determine steroid dose or duration.  LDH and ferritin were not used for management decisions by the majority of physicians.  Inflammatory markers were not routinely used after isolation precautions had been discontinued.

Conclusions. Of the markers studied, both d-dimer and CRP were considered useful by the majority of respondents.  LDH and ferritin were not considered as useful in guiding medical decision making.  Discontinuation of daily LDH and ferritin would result in significant savings to the health care system.