Characterization of the Post-Acute Care Disposition of COVID-19 Patients in an Academic Healthcare Setting in Atlanta, Georgia, USA Public

Kiiza, Peter (Spring 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/sq87bv78t?locale=fr
Published

Abstract

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.

Table of Contents

INTRODUCTION(9)

Chapter 1(11)

Global Burden of COVID-19 cases and related Post-Acute Care Challenges(11)

Post-acute care and COVID-19 globally (12)

COVID-19 in the USA.(12)

COVID-19 cases in Atlanta, Fulton County and Georgia(14)

Epidemiology and current therapeutics for SARS-CoV-2(15)

Risk factors for the need of post-acute care disposition facilities (16)

Post-acute health services in the USA and Georgia (18)

Rationale (18)

Chapter 2: Methods (21)

Study sites (21)

Study design (21)

Study population (21)

Inclusion criteria (22)

Exclusion criteria (22)

Data collection and management (22)

Data cleaning and coding process.(23)

Outcomes (23)

Study Research Questions (23)

Questions assessing the primary outcome (post-acute care disposition) of the study: (23)

Questions assessing the secondary outcome (odds of death) of the study:(24)

Statistical Analysis (24)

Results(26)

Figure 1: Diagram showing the post-acute disposition of patients at 3 different encounters. (26)

Table 1: Showing the demographics of participants at each of the 3 encounters(29)

Table 2: Characteristics of patients on the 3rd encounter (18-month point) by the post-acute care disposition (32)

Figure 2: Post-Acute Care Disposition by study years 2018, 2019 and 2020-21 (35)

Figure 3: Post-Acute Care Disposition of services by study years 2018, 2019 and 2020-21 (36)

Table 3: Comparisons of Post-Acute Care Dispositions, Health Insurance Consumptions and Acute Care Hospitals Utilized between the Years 2018/2019 and 2020/2021 (37)

Primary Outcome (38)

Question 1a: Did the odds of post-acute care (PAC) disposition differ by the patient’s principal diagnosis (COVID-19) at acute-care hospital discharge during the early phase of the pandemic?(38)

Question 1b: Does the post-acute care disposition differ by the patient’s principal diagnosis (COVID-19) at the time of acute-care hospital discharge during the early phase of the pandemic? (39)

Question 2: Does the post-acute care disposition at the 18-month study follow up time differ by the patient’s gender among COVID-19 survivors?(40)

Question 3a: Do the odds of PAC disposition among COVID-19 discharged patients during the 18-month follow up period of 2020-2021 differ from the odds of PAC disposition among discharged patients in the financial years of 2018-2019?(40)

Question 3b: Do the odds of PAC disposition among COVID-19 discharged patients during the 18-month follow up period of 2020-2021 differ from the odds of PAC disposition among discharged patients in the financial years of 2018-2019? Using a 3-level categorization for the PAC disposition outcome.(41)

Secondary Outcome(42)

Question 4: Do the odds of death among COVID-19 survivors discharged from acute-care hospitals differ by gender at the end of the 18-month study follow up period?(42)

Question 5: Do the odds of death among COVID-19 survivors discharged from acute-hospital during the 18-month follow up period of 2020-2021 differ from the odds of death among acute-care hospital discharged patients in the financial years of 2018 and 2019?(43)

Discussion(44)

Principal findings(44)

Limitations(44)

Strengths and weaknesses(44)

Possible implications for clinicians and policy makers of these study findings.(46)

Unanswered questions and future research.(47)

References (48)

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