Early versus late COVID-19 Home Health Care patient population: Shifting sociodemographics and comparable outcomes.

Early in the pandemic when hospitals reached capacity, Home Health Care (HHC) became a critical source of care for COVID-19 patients and continues to be an important source of care for recovering COVID-19 patients. Little is known about the COVID-19 patient population treated in HHC. This retrospective observational cohort follows 1614 HHC patients with a COVID-19 diagnosis and compares an "Early Cohort" between March 31 and May 31, 2020 to a "Late Cohort" between June 1 and December 31, 2020 for differences in: (1) sociodemographic and clinical characteristics (2) health care utilization, and (3) outcomes. Early patients were younger, more likely to be a minority, referred from hospitals or directly from emergency departments, started their care with greater independence in functional abilities, and had fewer comorbidities. Early patients were more likely to have COVID-19 as their primary diagnosis (88.5% vs. 79.4%, p < 0.001), and were assessed as having more severe COVID-19 symptoms. Early and Late Cohorts were assessed similarly for dyspnea at the start of care. COVID-19 patients in the Early Cohort were more likely to have their vital signs monitored remotely (7.3% vs. 1.4%; p < 0.001), have received oxygen in their home (27.8% vs. 15.3%; p < 0.001), and received more virtual care than patients in the Late Cohort (2.04 visits vs. 0.86 visits; p < 0.001), although they had approximately two fewer total visits (12.48 vs. 14.45; p < 0.001). Patients in both cohorts had substantial improvement in dyspnea and functional ability during the course of HHC.

COVID-19 infection rates early in the pandemic among full time clinicians in a home health care and hospice organization.

BACKGROUND: Patient-facing health care workers (HCW) experience higher rates of COVID-19 infection, particularly at the start of the COVID-19 pandemic. However, rates of COVID-19 among front-line home health and hospice clinicians are relatively unknown. METHODS: Visit data from a home health care and hospice agency in New Jersey early in the pandemic was analyzed to examine COVID-19 infection rates separately for clinicians exposed to COVID-19-contagious patients, and those without exposure to known COVID-19 contagious patients. RESULTS: Between March 5 and May 31, 2020, among home health clinicians providing in-person care, clinicians treating at least one COVID-19 contagious patient had a case rate of 0.8% compared to 15.7% for clinicians with no exposure to known COVID-19 contagious patients. Among hospice clinicians providing in-person care, those who treated at least one COVID-19 contagious patient had a case rate of 6.5%, compared to 12.9% for clinicians with no known exposure to COVID-19 contagious patients. Non-White clinicians had a higher COVID-19 case rate than White clinicians (10.9% vs 6.2%). DISCUSSION: Lower rates of COVID-19 infection among clinicians providing care to COVID-19-contagious patients may result from greater attentiveness to infection control protocols and greater precautions in clinicians' personal lives. Greater exposure to COVID-19-contagious patients prior to patient diagnosis ("unknown exposures") may explain differences in infection rates between home health and hospice clinicians with workplace exposures. CONCLUSION: Clinicians providing in-person care to COVID-19-contagious patients experience lower rates of COVID-19 infection than clinicians providing face-to-face care with no known exposure to COVID-19 contagious patients. Our findings suggest there was a low incidence of potential workplace infections.

Description, Health Care Utilization, and Outcomes for Home Health Care (HHC) COVID-19 Patients Early in the Pandemic: A Comparison to the General HHC Population.

COVID-19 patients represent a new and distinct population in home health care. Little is known about health care utilization and incremental improvements in health for recovering COVID-19 patients after admission to home health care. Using a retrospective observational cohort study of 5452 episodes of home health care admitted to a New Jersey Home Health Agency between March 15 and May 31, 2020, this study describes COVID-19 Home Health Care (HHC) patients (n = 842) and compare them to the general HHC population (n = 4610). COVID HHC patients differ in significant ways from the typical HHC population. COVID patients were more likely to be 65 years of age and younger (41% vs 26%), be from a racial/ethnic minority (60% vs 31%), live with another person (85% vs 76%), have private insurance (28% vs 16%), and began HHC with greater independence in activities-of-daily-living (ADL/IADLs). COVID patients received fewer overall visits than their non-COVID counterparts (11.7 vs 16.3), although they had significantly more remote visits (1.7 vs 0.3). Multivariate analyses show that COVID patients early in the pandemic were 34% (CI, 28%-40%) less likely to be hospitalized and demonstrated significantly greater improvement in all the outcome measures examined compared to the general home health population.