Since March 2020, the City and County of Denver has had more than 46,000 cases of COVID-19. The race and ethnicity of these cases consisted of 52% Hispanic, 35% White, 7% Black, 2% Asian, and 4% other or multiple races. The largest age group with COVID-19, 26% of all cases, was for ages 20-29. The second largest age group, 30-39, made up 21% of the cases.

One of the goals for case investigation was to contact all new cases within the first 24 hours of being identified. In the earlier months of the pandemic, there were occasions where Denver averaged more than 100 cases per day. In the months of November and December, the average number of new cases exceeded 700 per day. With that many cases needing investigation, it became very important to provide the case information as quickly as possible to those performing case investigations. Extracting the data from the State data downloads and converting it into the case investigation spreadsheets in a timely fashion was a critical step in the process.

The informatics components that were developed were resourceful and innovative in their approach. The initial process that was set up required copying and pasting data elements one-by-one from the State CEDRS download file into the case investigation spreadsheet. It was a slow, tedious process that required concentrated effort to make sure that the correct data were copied and pasted into the designated cells of the spreadsheet. There was opportunity for errors, skipping cases, or duplicating cases.

One of the first changes to the initial process was to convert and format the downloaded data so that they could be imported directly into the case investigation spreadsheet. This eliminated a lot of the manual effort of copying each individual data element and pasting it into a cell of the spreadsheet. It also eliminated the possibility of duplicating or omitting cases during that process.

The next innovative step was combining current hospital data with the COVID case data. Denver Public Health is a department within a larger Denver Health organization. Denver Health, the parent organization, provides an integrated safety-net health care system that serves about one-third of all residents within the City and County of Denver. The program extracted the current inpatient population of the hospital and then was matched with name, birth date, and gender information from the COVID case file to identify the new cases who were currently hospitalized. This enhancement eliminated the need for someone to manually search the electronic health record system for each person on the new COVID cases list. It also provided additional information to the case investigator of the hospitalized status of the individual, along with more specific contact information and primary language spoken.

Another innovative time-saving step was linking the addresses of the new cases to various types of housing. Lists were developed and updated to identify the addresses of long-term care facilities, group or foster homes, jails, public housing units subsidized by HUD, homeless shelters, and university dorms. This information provided the case investigator with key information on steps which may need to be taken in order to contact the individual newly diagnosed with COVID-19.

The addresses from the State CEDRS database frequently had misspelled street names or missing apartment numbers. By electronically standardizing and formatting the different elements of the addresses, the program more accurately matched the addresses of other patients and flagged them as same households or matched them to reference files that contained the addresses of Long term Care Facilities, Jails, Homeless Shelters and Denver Housing Authority housing. Technology called SPEDIS (Spelling Distance) was incorporated to determine possible address matches for incomplete addresses or similar addresses that were entered slightly differently. Depending on the ‘spelling distance’ value, it would then flag them as a possible ‘Same household’ for the case investigators to follow up on. This enabled addresses to be corrected, which also facilitated the matching to the various housing types mentioned earlier.

Other automatic flags were also established to help case investigators better understand the individuals to whom they were to contact. The program flagged healthcare workers, first responders, minors, Denver City and County workers, individuals who had passed away, Denver Public school students, and professional athletes. It also matched cases with the same phone number or the same address. Each of these flags improved the case investigation process.

The final innovative step was to automatically send an email out to the case investigators when the completed file had been finalized and posted in the folder for them to being reviewing.

As these processes and functions were implemented, the case investigators provided valuable feedback to the program developer so that further enhancements and improvements could be made.

Innovative data integration techniques to streamline COVID Case Management

Category

Description