TY - JOUR T1 - Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1307 US academic medical centre inpatients and 427 224 US Medicare patients JF - Journal of Epidemiology and Community Health JO - J Epidemiol Community Health SP - 254 LP - 260 DO - 10.1136/jech-2021-216697 VL - 76 IS - 3 AU - Joseph T King, Jr. AU - James S Yoon AU - Zachary M Bredl AU - Joseph P Habboushe AU - Graham A Walker AU - Christopher T Rentsch AU - Janet P Tate AU - Nitu M Kashyap AU - Richard C Hintz AU - Aneesh P Chopra AU - Amy C Justice Y1 - 2022/03/01 UR - http://jech.bmj.com/content/76/3/254.abstract N2 - Background The Veterans Health Administration COVID-19 (VACO) Index predicts 30-day all-cause mortality in patients with COVID-19 using age, sex and pre-existing comorbidity diagnoses. The VACO Index was initially developed and validated in a nationwide cohort of US veterans—we now assess its accuracy in an academic medical centre and a nationwide US Medicare cohort.Methods With measures and weights previously derived and validated in US national Veterans Health Administration (VA) inpatients and outpatients (n=13 323), we evaluated the accuracy of the VACO Index for estimating 30-day all-cause mortality using area under the receiver operating characteristic curve (AUC) and calibration plots of predicted versus observed mortality in inpatients at a single US academic medical centre (n=1307) and in Medicare inpatients and outpatients aged 65+ (n=427 224).Results 30-day mortality varied by data source: VA 8.5%, academic medical centre 17.5%, Medicare 16.0%. The VACO Index demonstrated similar discrimination in VA (AUC=0.82) and academic medical centre inpatient population (AUC=0.80), and when restricted to patients aged 65+ in VA (AUC=0.69) and Medicare inpatient and outpatient data (AUC=0.67). The Index modestly overestimated risk in VA and Medicare data and underestimated risk in Yale New Haven Hospital data.Conclusions The VACO Index estimates risk of short-term mortality across a wide variety of patients with COVID-19 using data available prior to or at the time of diagnosis. The VACO Index could help inform primary and booster vaccination prioritisation, and indicate who among outpatients testing positive for SARS-CoV-2 should receive greater clinical attention or scarce treatments.Data may be obtained from a third party and are not publicly available. The United States Department of Veterans Affairs (VA) places legal restrictions on access to veteran’s health care data, which includes both identifying data and sensitive patient information. The analytic data sets used for this study are not permitted to leave the VA firewall without a Data Use Agreement. This limitation is consistent with other studies based on VA data. However, VA data are made freely available to researchers behind the VA firewall with an approved VA study protocol. For more information, please visit https://www.virec.research.va.gov or contact the VA Information Resource Center (VIReC) at VIReC{at}va.gov. CareJourney has an existing Data Use Agreement with CMS that prohibits disclosure of patient health care data. The datasets used for this study are not permitted to be accessed unless users have an existing Data Use Agreement with CMS for the necessary datasets. This limitation is consistent with studies done by entities with access to Medicare Claims through the CMS Innovators' License. ER -