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In Journal of the American Medical Informatics Association : JAMIA

OBJECTIVE : The spread of COVID-19 has led to severe strain on hospital capacity in many countries. We aim to develop a model helping planners assess expected COVID-19 hospital resource utilization based on individual patient characteristics.

MATERIALS AND METHODS : We develop a model of patient clinical course based on an advanced multistate survival model. The model predicts the patient's disease course in terms of clinical states-critical, severe, or moderate. The model also predicts hospital utilization on the level of entire hospitals or healthcare systems. We cross-validated the model using a nationwide registry following the day-by-day clinical status of all hospitalized COVID-19 patients in Israel from March 1st to May 2nd, 2020 (n = 2,703).

RESULTS : Per-day mean absolute errors for predicted total and critical-care hospital-bed utilization were 4.72 ± 1.07 and 1.68 ± 0.40 respectively, over cohorts of 330 hospitalized patients; AUCs for prediction of critical illness and in-hospital mortality were 0.88 ± 0.04 and 0.96 ± 0.04, respectively. We further present the impact of patient influx scenarios on day-by-day healthcare system utilization. We provide an accompanying R software package.

DISCUSSION : The proposed model accurately predicts total and critical-care hospital utilization. The model enables evaluating impacts of patient influx scenarios on utilization, accounting for the state of currently hospitalized patients and characteristics of incoming patients. We show that accurate hospital-load predictions were possible using only a patient's age, sex, and day-by-day clinical state (critical, severe or moderate).

CONCLUSION : The multistate model we develop is a powerful tool for predicting individual-level patient outcomes and hospital-level utilization.

Roimi Michael, Gutman Rom, Somer Jonathan, Ben Arie Asaf, Calman Ido, Bar-Lavie Yaron, Gelbshtein Udi, Liverant-Taub Sigal, Ziv Arnona, Eytan Danny, Gorfine Malka, Shalit Uri


COVID-19, healthcare facilities, hospital utilization, multistate model, survival analysis