AI Article Synopsis
- The study analyzes the discharge outcomes of 6,248 hospitalized SARS-CoV-2 positive patients from a Midwest health system between March 2020 and May 2022, focusing on factors influencing whether patients were sent home, to post-acute care (PAC), or died in the hospital.
- Results indicate that older patients and those with a higher comorbidity index were more likely to be discharged to PAC or die in the hospital, with younger patients being discharged home.
- Racial disparities were noted, as Black, Asian, and Hispanic patients were less likely to be assigned to PAC, and specific COVID-19 variants were linked to a lower likelihood of discharge to PAC.
Article Abstract
Importance: The SARS-CoV-2 pandemic has overwhelmed hospital capacity, prioritizing the need to understand factors associated with type of discharge disposition.
Objective: Characterization of disposition associated factors following SARS-CoV-2.
Design: Retrospective study of SARS-CoV-2 positive patients from March 7th, 2020, to May 4th, 2022, requiring hospitalization.
Setting: Midwest academic health-system.
Participants: Patients above the age 18 years admitted with PCR + SARS-CoV-2.
Intervention: None.
Main Outcomes: Discharge to home versus PAC (inpatient rehabilitation facility (IRF), skilled-nursing facility (SNF), long-term acute care (LTACH)), or died/hospice while hospitalized (DH).
Results: We identified 62,279 SARS-CoV-2 PCR+ patients; 6,248 required hospitalizations, of whom 4611(73.8%) were discharged home, 985 (15.8%) to PAC and 652 (10.4%) died in hospital (DH). Patients discharged to PAC had a higher median age (75.7 years, IQR: 65.6-85.1) compared to those discharged home (57.0 years, IQR: 38.2-69.9), and had longer mean length of stay (LOS) 14.7 days, SD: 14.0) compared to discharge home (5.8 days, SD: 5.9). Older age (RRR:1.04, 95% CI:1.041-1.055), and higher Elixhauser comorbidity index [EI] (RRR:1.19, 95% CI:1.168-1.218) were associated with higher rate of discharge to PAC versus home. Older age (RRR:1.069, 95% CI:1.060-1.077) and higher EI (RRR:1.09, 95% CI:1.071-1.126) were associated with more frequent DH versus home. Blacks, Asians, and Hispanics were less likely to be discharged to PAC (RRR, 0.64 CI 0.47-0.88), (RRR 0.48 CI 0.34-0.67) and (RRR 0.586 CI 0.352-0.975). Having alpha variant was associated with less frequent PAC discharge versus home (RRR 0.589 CI 0.444-780). The relative risks for DH were lower with a higher platelet count 0.998 (CI 0.99-0.99) and albumin levels 0.342 (CI 0.26-0.45), and higher with increased CRP (RRR 1.006 CI 1.004-1.007) and D-Dimer (RRR 1.070 CI 1.039-1.101). Increased albumin had lower risk to PAC discharge (RRR 0.630 CI 0.497-0.798. An increase in D-Dimer (RRR1.033 CI 1.002-1.064) and CRP (RRR1.002 CI1.001-1.004) was associated with higher risk of PAC discharge. A breakthrough (BT) infection was associated with lower likelihood of DH and PAC.
Conclusion: Older age, higher EI, CRP and D-Dimer are associated with PAC and DH discharges following hospitalization with COVID-19 infection. BT infection reduces the likelihood of being discharged to PAC and DH.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10101512 | PMC |
| http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0283326 | PLOS |
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