ABSTRACT
Background. Understanding comorbidities that drive all-cause readmission in patients hospitalized with Coronavirus disease 2019 (COVID-19) can inform healthcare system capacity planning and improve post-discharge care. Methods. This was a retrospective cohort study of patients hospitalized for COVID-19 between April 2020-December 2020 (index cohort) across 760 hospitals in the Premier Healthcare Database. Patients who died or left against medical advice were excluded from the index cohort. Surviving patients in the index cohort were followed until May 2021. First readmission to the same hospital as the COVID-19 index admission was considered all-cause readmission. The all-cause 14-month risk (95% confidence interval) of readmission was calculated using the Kaplan-Meier approach. A multivariable Cox proportional hazards model adjusted for demographic variables, hospital characteristics, co-existing comorbidities, and COVID-19 severity was built to study the association between Elixhauser comorbidities and readmission. Results. Among 232155 unique patients in the index cohort, 36680 were readmitted to the same hospital at least once, followed through May 2021. The 14-month risk of readmission was 16.2% (95% CI:16.1% - 16.4%). The most frequent primary diagnosis on readmission was infectious disease (14240, 38.8%), of which 8754 (24%) were for COVID-19. With each additional comorbidity, the readmission hazard increased by 19% (HR, 1.19;95% CI:1.18 - 1.19). In the multivariable Cox proportional hazards model, many comorbidity categories were associated with an increased risk of readmission. Metastatic cancer (HR, 1.74;95% CI:1.60 -1.89), lymphoma (HR, 1.61;95% CI:1.47 - 1.77), drug abuse (HR, 1.51;95% CI:1.41 - 1.62), congestive heart failure (HR, 1.47;95% CI:1.44- 1.51), and alcohol abuse (HR, 1.46;95% CI:1.36- 1.56) were associated with the highest hazard for readmission. Conclusion. COVID-19 patients have a high risk of all-cause readmission and are frequently readmitted for COVID-19. With the continued emergence of COVID-19 variants, this study provides valuable insights into developing more informed discharge plans and improving post-discharge care for COVID-19 patients with existing comorbidities to prevent readmission.
ABSTRACT
Background: AML is a haematologic cancer primarily affecting older people (median age 68 at diagnosis). Prognosis is poor, with median survival ranging from 2 to 10 months from diagnosis, depending on patient health, age, and treatment path. Some patients described struggling with uncertainty about the future, but it is unclear how this differs across patients and treatment paths. Aims: This study explored the experiences of AML patients (≥65 years old, not receiving intensive chemotherapy), their close relatives, and independent clinicians. Specifically, patient expectations for the future and how these varied by treatment path and by time since diagnosis were investigated. Methods: A total of 28 AML patients (aged 65-83;median 74), 25 relatives, and 10 clinicians from the US, UK, and Canada each took part in a 60-minute, semi-structured telephone interview. Open-ended questions were used to elicit spontaneous content, followed by focused questions when needed. Results: Patients had diverse treatment histories: 13 no treatment, 14 with experience of non-intensive chemotherapy (NIC) including 3 who discontinued treatment, and 1 on best supportive care (BSC). At time of interview the mean time since diagnosis was 5 (range 2 to 9) months for patients with no treatment experience, and 8 (range 2 to 19) months for those with treatment experience. The BSC patient was diagnosed 9 months prior to interview. Patients discussed positive and negative expectations for the future related to: physical functioning;treatment;life expectancy;ability to do hobbies, spend time with family, and go on vacation. In the no treatment group, there was evidence that expectations about the future became more negative over time. Few patients (n=4/13) recalled having negative expectations about the future at diagnosis, while most (n=10/13) did at time of interview. In contrast, patients with treatment experience appeared to have increasingly positive expectations. Most of these patients (n=11/14) recalled negative expectations when diagnosed, whereas at interview most (n=9/14) felt hopeful about future events. Further, of patients with treatment experience, almost all those diagnosed ≥6 months prior to interview had positive expectations about their future (n=6/7), while under half of those diagnosed <6 months prior (n=3/7) did. Clinicians (n=7/10) further highlighted that patient expectations changed over time depending on treatment success. Additionally, patients (n=15/28) and relatives (n=15/25) discussed feeling uncertain throughout the AML journey, reporting unknowns around life expectancy, what they would be able to accomplish, and future plans. Uncertainty was a consistent experience regardless of treatment history, with similar proportions of patients not on treatment (n=7/13) and those with NIC experience (n=7/14) reporting the sentiment. Additionally, recently interviewed patients (n=7/13) and relatives (n=7/10) noted that the ongoing COVID-19 pandemic contributed to experiences of uncertainty and difficulties planning for the future. Summary/Conclusion: There were key differences between patients not on treatment and those with experience of NIC, as patients with treatment experience demonstrated more hope for the future. Regardless, uncertainty is a key element of the AML journey. For some patients, this was exacerbated by the COVID-19 pandemic. These findings highlight the importance of ensuring all patients are provided with emotional and spiritual support to help them process their diagnosis and plan for the future, both during this pandemic and beyond.