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. 2024 Mar 18;11(4):ofae151.
doi: 10.1093/ofid/ofae151. eCollection 2024 Apr.

Health Care Utilization and Clinical Management of All-Cause and Norovirus-Associated Acute Gastroenteritis Within a US Integrated Health Care System

Jordan Cates  1 , Claire P Mattison  1   2 , Holly Groom  3 , Judy Donald  3 , Rebecca P Hall  4 , Mark A Schmidt  3 , Aron J Hall  1 , Allison L Naleway  3 , Sara A Mirza  1
Affiliations

Health Care Utilization and Clinical Management of All-Cause and Norovirus-Associated Acute Gastroenteritis Within a US Integrated Health Care System

Jordan Cates et al. Open Forum Infect Dis. .

Abstract

Background: Norovirus-associated acute gastroenteritis (AGE) exacts a substantial disease burden, yet the health care utilization for and clinical management of norovirus-associated AGE are not well characterized.

Methods: We describe the health care encounters and therapeutics used for patients with all-cause and norovirus-associated AGE in the Kaiser Permanente Northwest health system from 1 April 2014 through 30 September 2016. Medical encounters for patients with AGE were extracted from electronic health records, and encounters within 30 days of one another were grouped into single episodes. An age-stratified random sample of patients completed surveys and provided stool samples for norovirus testing.

Results: In total, 40 348 individuals had 52 509 AGE episodes; 460 (14%) of 3310 participants in the substudy tested positive for norovirus. An overall 35% of all-cause AGE episodes and 29% of norovirus-associated AGE episodes had ≥2 encounters. While 80% of norovirus-associated AGE episodes had at least 1 encounter in the outpatient setting, all levels of the health care system were affected: 10%, 22%, 10%, and 2% of norovirus-associated AGE episodes had at least 1 encounter in virtual, urgent care, emergency department, and inpatient settings, respectively. Corresponding proportions of therapeutic use between norovirus-positive and norovirus-negative episodes were 13% and 10% for intravenous hydration (P = .07), 65% and 50% for oral rehydration (P < .001), 7% and 14% for empiric antibiotic therapy (P < .001), and 33% and 18% for antiemetics (P < .001).

Conclusions: Increased health care utilization and therapeutics are likely needed for norovirus-associated AGE episodes during peak norovirus winter seasons, and these data illustrate that effective norovirus vaccines will likely result in less health care utilization.

Keywords: acute gastroenteritis; clinical management; diarrhea; health care utilization; norovirus.

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Conflict of interest statement

Potential conflicts of interest. A. L. N. has received research funding from Pfizer, Merck, and MedImmune (now AstraZeneca) for unrelated studies. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Index encounter setting, stratified by age group: A, all-cause AGE episodes; B, norovirus-associated episodes. Proportions <1% are not illustrated. *Norovirus-associated episodes were detected by active surveillance testing in the substudy. There were no substantive differences when norovirus-associated AGE episodes detected through clinician-ordered diagnostic testing were included (data not shown). AGE, acute gastroenteritis.
Figure 2.
Figure 2.
Modified Vesikari score (A), diarrhea ≥4 days (B), vomiting ≥3 days (C), fever (D), and intravenous (IV) fluids or hospitalization (E) among norovirus-associated acute gastroenteritis episodes detected by active surveillance, stratified by age group (n = 439).
Figure 3.
Figure 3.
Therapies used in norovirus-positive vs norovirus-negative medically attended acute gastroenteritis episodes tested in active surveillance, Kaiser Permanent Northwest, 1 April 2014–30 September 2016. IV, intravenous.
See this image and copyright information in PMC

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