Online COVID-19 Self-Assessment Eases Burden on Southern California’s Safety Net

USC triage tool, piloted with AltaMed Health Services, has helped 500,000 people decide whether to seek testing or in-person medical help

Michael Hochman, MD.
Michael Hochman, MD, a former FQHC internal medicine physician in Los Angeles who spearheaded development of the triage tool. Photo: Nick Agro

A sore throat or cough is always annoying. During the COVID-19 pandemic, it can be an especially worrisome development. Yet many hesitate to call a doctor or line up at a testing site.

A simple and free online questionnaire to help patients assess their own conditions has helped half a million people worldwide make informed individual decisions about whether to seek care for COVID-19. The test, developed by physicians at the University of Southern California’s Keck School of Medicine, has also helped reduce the burden of care for Los Angeles–based safety-net provider AltaMed Health Services, which is the nation’s largest independent Federally Qualified Health Center, with 27 clinics.

There are several such tools, but this one has gained significant traction, especially in underserved communities. Developed according to US Centers for Disease Control and Prevention guidelines, it’s easy to use and quick yet thorough. Its developers have been encouraged by the success it has had since March.

“When the pandemic was beginning, my colleagues and I realized we needed a way to deal with the patients rushing to our hospitals, and we needed a way to triage them,” said Michael Hochman, MD, an internal medicine physician and director of the USC Gehr Family Center for Health Systems Science and Innovation. He previously worked at AltaMed and is familiar with the demands placed on safety-net systems. When he and his colleagues put the assessment tool together, they sought feedback from AltaMed, which has a disproportionately large share of Latinx patients. The clinic system subsequently began using it to screen patients.

Thousands of Users a Day

“I thought once patients got their questions answered in the first couple months, [interest] would go down, but with the surge of cases in LA County, we are getting a couple thousand users daily,” Hochman said.

Eighty percent of the self-assessment tool users had mild symptoms requiring home self-care and quarantine, while 20% required medical attention, according to a USC study published in June in the Journal of General Internal Medicine. “This tool really reduced the burden on the hospital system and allowed clinicians to prioritize the care of people who really needed it,” said the study’s lead author, second-year USC medical student William Mehring.

This pandemic is making us look at how we deliver care because the demand is greater than our ability to keep up with it.

—Efrain Talamantes, COO of AltaMed

Much of the traffic for the tool comes from referral links on AltaMed’s website, which directs patients to take the self-assessment before deciding whether to access in-person care. A STAT op-ed authored by Hochman and colleagues also drove early traffic to the tool. About 40,000 Angelenos have used it so far, along with people in more than 100 countries who have found it through online searches or word of mouth. Most do the assessment on smartphones.

Available in English and Spanish, it walks users through these key questions:

  • Do you have severe symptoms requiring immediate care?
  • Are you over 65 years old?
  • Do you have underlying conditions such as diabetes or sickle cell disease, or are you immune-compromised because of HIV or cancer treatment?
  • Does your job require you to work in close proximity to others?
  • Have you been in contact with anyone diagnosed recently with COVID-19?
  • Are you experiencing any of a long list of symptoms associated with the coronavirus?

Based on the answers, the tool recommends next steps and directs users to resources.

Previous wellness assessment tools barely gained traction because preventive care is not a top priority for most people. But the scale of the COVID-19 pandemic — with more than 6.8 million positive cases in the US and 200,000 deaths so far — changed that.

“Hopefully, we learn lessons from here and use it to improve tools in the future,” Hochman said. “People are worried about COVID-19 and really hungry for high-quality information to apply to their own situation. We will need to debrief after the pandemic to really apply what we learn from this use of digital tools.”

Better Triage with Limited Resources

Hochman worked with Ilan Shapiro, MD, medical director of health education and wellness at AltaMed, to develop content for the assessment and to translate it into Spanish. The tool directs users on next steps and tracks geographic trends in cases when users share their zip codes.

“We can create a hot map zone, which is very helpful,” Shapiro said. “We have 300,000 patients. When you have a surge, and patients have a lot of questions and want to see their own provider and get access to testing, these types of screening tools are so helpful and make huge sense when we have limited resources for testing.”

Patients with severe symptoms are connected with AltaMed’s telehealth services, which direct them to testing centers. In the early months of the pandemic, AltaMed had nine testing centers authorized by LA County.

When the pandemic began, the volume of daily calls coming in to AltaMed call centers with patients seeking testing and medical consultations spiked to more than 15,000, up from the prepandemic daily average of 6,000.

“We were inundated with thousands of cases we were testing, and this tool really helped us when we needed it,” said Efrain Talamantes, MD, chief operating officer of AltaMed. “Patients needed a more personalized way to ascertain if they had mild or severe symptoms and if they needed to get tested. . . . This tool is the future for us, and it shows such tools can be very effective for our patient population and their needs.”

The success has sparked discussion at AltaMed about using other digital tools to screen patients and oversee chronic disease management.

“This pandemic is making us look at how we deliver care,” Talamantes said, “because the demand is greater than our ability to keep up with it.”