Clinical characteristics and social determinants of health associated with 30-day hospital readmissions of patients with COVID-19.

COVID-19 readmissions are associated with increased patient mortality and healthcare system strain. This retrospective cohort study of PCR-confirmed COVID-19 positive adults (>18 years) hospitalized and readmitted within 30 days of discharge from index admission was performed at eight Atlanta hospitals from March to December 2020. The objective was to describe COVID-19 patient-level demographics and clinical characteristics, and community-level social determinants of health (SDoH) that contribute to 30-day readmissions. Demographics, comorbidities, COVID-19 treatment, and discharge disposition data were extracted from the index admission. ZIP codes were linked to a demographic/lifestyle database interpolating to community-level SDoH. Of 7155 patients with COVID-19, 463 (6.5%) had 30-day, unplanned, all-cause hospital readmissions. Statistically significant differences were not found in readmissions stratified by age, sex, race, or ethnicity. Patients with a high-risk Charlson Comorbidity Index had higher odds of readmission (OR 4.8 (95% CI: 2.1 to 11.0)). Remdesivir treatment and intensive care unit (ICU) care were associated with lower odds of readmission (OR 0.5 (95% CI: 0.4 to 0.8) and OR 0.5 (95% CI: 0.4 to 0.7), respectively). Patients residing in communities with larger average household size were less likely to be readmitted (OR 0.7 (95% CI: 0.5 to 0.9). In this cohort, patients who received remdesivir, were cared for in an ICU, and resided in ZIP codes with higher proportions of residents with increased social support had lower odds of readmission. These patient-level factors and community-level SDoH may be used to identify patients with COVID-19 who are at increased risk of readmission.

Assessment of Patient and Provider Satisfaction With the Change to Telehealth From In-Person Visits at an Academic Safety Net Institution During the COVID-19 Pandemic.

INTRODUCTION: The 2019 novel coronavirus (COVID-19) caused a global pandemic that forced medical providers to rapidly alter methods of health care delivery. One month into this pandemic, we surveyed providers and patients to assess satisfaction or concerns with the change from in-person visits. METHODS: We surveyed internal medicine (IM) and family medicine (FM) faculty and residents to ascertain satisfaction or concerns with the change to telehealth from in-person visits. RESULTS: Of patients surveyed (129 IM, 94 FM), 84.4% of IM patients and 94% of FM patients agreed or strongly agreed that they enjoyed the televisits, and 82.9% of IM providers (47 surveyed) and 64% of FM providers (25 surveyed) felt the same. For continued televisits, 76.74% of IM patients and 84.1% of FM patients agreed or strongly agreed that they would not mind having virtual visits after the pandemic, compared with 89.44% of IM providers and 88% of FM providers, and 91% of IM providers and 88% of FM providers felt comfortable managing visits virtually. CONCLUSION: Patients are open to the expanded use of telemedicine, and providers and hospital systems should be prepared to embrace it for the benefit of patient care.