Characterization of the Post-Acute Care Disposition of COVID-19 Patients in an Academic Healthcare Setting in Atlanta, Georgia, USA Restricted; Files & ToC

Kiiza, Peter (Spring 2022)

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Background: There is a dearth of information regarding post-acute care (PAC) dispositions among hospital discharged COVID-19 patients. Providing post-acute care to COVID-19 patients, demands specific patient needs be well-characterized to guide holistic care and equitable resource allocation.

Methods. We conducted an 18-month retrospective cohort study for COVID-19 patients discharged from four acute care hospitals within Emory HealthCare Network, Atlanta, GA. We reviewed electronic medical records (EMRs) at 3 time points (i.e., April 22, 2020, May 07, 2020, and October 21, 2021). EMRs of patients discharged from the same hospitals in 2018 and 2019 were extracted for comparison. Both clinical and sociodemographic variables were abstracted. Primary and secondary outcomes of interest were post-acute care dispositions and death. Means (standard deviations), and frequencies and percentages were computed for continuous and categorical variables respectively. Polytomous logistic regression was used to assess associations between the exposures (COVID-19, gender, study year) and PAC disposition (either as a 7-or 3-level) outcome. Logistic regression assessed death as an outcome. Statistical analyses were conducted in R. 

Results:  There were 680, 994 and 7646 patients at the 1st, 2nd and 3rd EMR encounters respectively. Overall, mean (standard deviation) age was 58.5 (1.8) years, 50.8% female and 54.1% Black. 7.0% died, 70.0% and 84.7% of the participants had home self-care and outpatient services respectively, as their PAC disposition outcomes at end of study. During the early phase of the pandemic, hospital discharged COVID-19 survivors were less likely to die (odds ratio [OR] 0.48, confidence interval [CI] 0.25-0.95) as compared to non-COVID-19 patients. Additionally, COVID-19 diagnosis did not influence whether patients received facility-based or outpatient services (OR: 0.82, CI [0.48-1.40]). Female survivors were less likely to die (OR: 0.55, CI [0.41-0.73]) or receive facility-based services (OR: 0.76, CI [0.63-0.91]). COVID-19 diagnosis or year of study did not significantly impact odds of death when historical controls (patients discharged in 2018-19) were compared to COVID-19 survivors (OR: 0.97, CI [0.84-1.12]).

Conclusion:  Home self-care services constituted the major PAC disposition, death and facility-based services were common among male COVID-19 survivors, and a COVID-19 diagnosis or year of study had no substantiative impact on mortality.

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