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1.
BMC Res Notes ; 14(1): 374, 2021 Sep 26.
Article in English | MEDLINE | ID: covidwho-1817246

ABSTRACT

OBJECTIVE: COVID-19 has been introduced by the World Health Organization as a health emergency worldwide. Up to 9% of the patients with COVID-19 may be readmitted by 2 months after discharge. This study aimed to estimate the readmission rate and identify main risk factors for readmission in these patients. In this prospective study, 416 discharged COVID patients followed up with a minimum 1 month and the readmission rate was recorded. Evaluated characteristics included time of readmission, age and sex, main symptoms of disease, result of computed tomography scan, reverse transcription polymerase chain reaction test and treatment modalities. RESULTS: Regarding readmission, 51 patients of 416 discharged patients, was readmitted during the study period. The rate of readmission for 30 and 60 days after discharge was 7.6% and 8.1%, respectively. The median age of the readmitted patients was 67 years (IQR: 53-78). About 65% of readmitted patients had underlying disease. The most significant factor in readmission rate was related to the site of lung involvement (OR > 4). Age over 60 years, underlying disease especially diabetes (OR = 3.43), high creatinine level (≥ to 1.2 mg/dl) (OR = 2.15) were the most important predictors of readmission.


Subject(s)
COVID-19 , Aged , Humans , Middle Aged , Patient Readmission , Prospective Studies , Retrospective Studies , Risk Factors , SARS-CoV-2
2.
BMJ Open ; 12(4): e052665, 2022 Apr 06.
Article in English | MEDLINE | ID: covidwho-1779369

ABSTRACT

OBJECTIVE: We aimed at identifying baseline predictive factors for emergency department (ED) readmission, with hospitalisation/death, in patients with COVID-19 previously discharged from the ED. We also developed a disease progression velocity index. DESIGN AND SETTING: Retrospective cohort study of prospectively collected data. The charts of consecutive patients with COVID-19 discharged from the Reggio Emilia (Italy) ED (2 March 2 to 31 March 2020) were retrospectively examined. Clinical, laboratory and CT findings at first ED admission were tested as predictive factors using multivariable logistic models. We divided CT extension by days from symptom onset to build a synthetic velocity index. PARTICIPANTS: 450 patients discharged from the ED with diagnosis of COVID-19. MAIN OUTCOME MEASURE: ED readmission within 14 days, followed by hospitalisation/death. RESULTS: Of the discharged patients, 84 (18.7%) were readmitted to the ED, 61 (13.6%) were hospitalised and 10 (2.2%) died. Age (OR=1.05; 95% CI 1.03 to 1.08), Charlson Comorbidity Index 3 versus 0 (OR=11.61; 95% CI 1.76 to 76.58), days from symptom onset (OR for 1-day increase=0.81; 95% CI 0.73 to 0.90) and CT extension (OR for 1% increase=1.03; 95% CI 1.01 to 1.06) were associated in a multivariable model for readmission with hospitalisation/death. A 2-day lag velocity index was a strong predictor (OR for unit increase=1.21, 95% CI 1.08 to 1.36); the model including this index resulted in less information loss. CONCLUSIONS: A velocity index combining CT extension and days from symptom onset predicts disease progression in patients with COVID-19. For example, a 20% CT extension 3 days after symptom onset has the same risk as does 50% after 10 days.


Subject(s)
COVID-19 , Patient Readmission , COVID-19/epidemiology , Cohort Studies , Disease Progression , Emergency Service, Hospital , Humans , Patient Discharge , Retrospective Studies , Risk Factors
3.
Nurs Manage ; 53(4): 26-33, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1774423

ABSTRACT

Behaviors, treatments, and self-management strategies used by patients and caregivers at home.


Subject(s)
COVID-19 , Heart Failure , COVID-19/epidemiology , Caregivers , Heart Failure/epidemiology , Heart Failure/therapy , Humans , Pandemics , Patient Readmission
4.
West J Emerg Med ; 22(6): 1257-1261, 2021 Nov 05.
Article in English | MEDLINE | ID: covidwho-1761084

ABSTRACT

INTRODUCTION: Patients diagnosed with coronavirus disease 2019 (COVID-19) require significant healthcare resources. While published research has shown clinical characteristics associated with severe illness from COVID-19, there is limited data focused on the emergency department (ED) discharge population. METHODS: We performed a retrospective chart review of all ED-discharged patients from Wake Forest Baptist Health and Wake Forest Baptist Health Davie Medical Center between April 25-August 9, 2020, who tested positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) from a nasopharyngeal swab using real-time reverse transcription polymerase chain reaction (rRT-PCR) tests. We compared the clinical characteristics of patients who were discharged and had return visits within 30 days to those patients who did not return to the ED within 30 days. RESULTS: Our study included 235 adult patients who had an ED-performed SARS-CoV-2 rRT-PCR positive test and were subsequently discharged on their first ED visit. Of these patients, 57 (24.3%) had return visits to the ED within 30 days for symptoms related to COVID-19. Of these 57 patients, on return ED visits 27 were admitted to the hospital and 30 were not admitted. Of the 235 adult patients who were discharged, 11.5% (27) eventually required admission for COVID-19-related symptoms. With 24.3% patients having a return ED visit after a positive SARS-CoV-2 test and 11.5% requiring eventual admission, it is important to understand clinical characteristics associated with return ED visits. We performed multivariate logistic regression analysis of the clinical characteristics with independent association resulting in a return ED visit, which demonstrated the following: diabetes (odds ratio [OR] 2.990, 95% confidence interval [CI, 1.21-7.40, P = 0.0179); transaminitis (OR 8.973, 95% CI, 2.65-30.33, P = 0.004); increased pulse at triage (OR 1.04, 95% CI, 1.02-1.07, P = 0.0002); and myalgia (OR 4.43, 95% CI, 2.03-9.66, P = 0.0002). CONCLUSION: As EDs across the country continue to treat COVID-19 patients, it is important to understand the clinical factors associated with ED return visits related to SARS-CoV-2 infection. We identified key clinical characteristics associated with return ED visits for patients initially diagnosed with SARS-CoV-2 infection: diabetes mellitus; increased pulse at triage; transaminitis; and complaint of myalgias.


Subject(s)
COVID-19/diagnosis , Emergency Service, Hospital/statistics & numerical data , Patient Discharge , Patient Readmission , SARS-CoV-2/isolation & purification , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 Nucleic Acid Testing , COVID-19 Testing , Humans , Middle Aged , Retrospective Studies , SARS-CoV-2/genetics
6.
JAMA Netw Open ; 5(3): e221455, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1729077

ABSTRACT

Importance: Current guidelines recommend use of dexamethasone, 6 mg/d, up to 10 days or until discharge for patients hospitalized with COVID-19. Whether patients who received less than 10 days of corticosteroids during hospitalization for COVID-19 benefit from continuing treatment at discharge has not been determined. Objective: To assess whether continuing dexamethasone treatment at discharge is associated with reduced all-cause readmissions or mortality postdischarge. Design, Setting, and Participants: A retrospective cohort study was conducted at 15 medical centers within Kaiser Permanente Southern California. The population included adults who received less than 10 days of dexamethasone, 6 mg/d, until discharge during hospitalization for COVID-19 and were discharged alive between May 1 and September 30, 2020. Exposures: Continued dexamethasone treatment at discharge. Main Outcomes and Measures: All-cause readmissions or mortality within 14 days from discharge. Results: A total of 1164 patients with a median age of 55 (IQR, 44-66) years were identified. Most patients were of Hispanic ethnicity (822 [70.6%]) and male (674 [57.9%]) and required oxygen support during hospitalization (1048 [90.0%]). Of the 1164 patients, 692 (59.5%) continued dexamethasone, 6 mg/d, at discharge. A balanced cohort was created using propensity score and inverse probability of treatment weighting. The adjusted odds ratio (OR) for readmissions or mortality within 14 days was 0.87 (95% CI, 0.58-1.30) for patients who continued dexamethasone therapy at discharge compared with those who did not. Similar results were produced by a sensitivity analysis that restricted the treatment group to those who received exactly 10 days of dexamethasone (OR, 0.89; 95% CI, 0.55-1.43) and by subgroup analyses stratified by the duration of dexamethasone treatment as an inpatient (1-3 days: OR, 0.71; 95% CI, 0.43-1.16; 4-9 days: OR, 1.01; 95% CI, 0.48-2.12), oxygen requirement at discharge (room air: OR, 0.91; 95% CI, 0.53-1.59; supplemental oxygen use: OR, 0.76; 95% CI, 0.42-1.37), and disease duration at discharge (≤10 days: OR, 0.81; 95% CI, 0.49-1.33; >10 days: OR, 0.94; 95% CI, 0.48-1.86). Conclusions and Relevance: In this cohort study of patients with COVID-19, continuing treatment with dexamethasone, 6 mg/d, at discharge was not associated with a reduction in 14-day all-cause readmission or mortality. This finding suggests that dexamethasone should not be routinely prescribed beyond discharge for individuals with COVID-19.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , COVID-19/drug therapy , Dexamethasone/therapeutic use , Patient Discharge , Patient Readmission , Practice Patterns, Physicians' , SARS-CoV-2 , Adult , Aged , Anti-Inflammatory Agents/administration & dosage , COVID-19/mortality , California , Cohort Studies , Dexamethasone/administration & dosage , Female , Humans , Male , Middle Aged , Retrospective Studies
7.
J Am Heart Assoc ; 11(7): e023935, 2022 Apr 05.
Article in English | MEDLINE | ID: covidwho-1714485

ABSTRACT

Background The COVID-19 pandemic resulted in a rapid implementation of telemedicine into clinical practice. This study examined whether early outpatient follow-up via telemedicine is as effective as in-person visits for reducing 30-day readmissions in patients with heart failure. Methods and Results Using electronic health records from a large health system, we included patients with heart failure living in North Carolina (N=6918) who were hospitalized between March 16, 2020 and March 14, 2021. All-cause readmission within 30 days after discharge was examined using weighted logistic regression models. Overall, 7.6% (N=526) of patients received early telemedicine follow-up, 38.8% (N=2681) received early in-person follow-up, and 53.6% (N=3711) did not receive follow-up within 14 days of discharge. Compared with patients without early follow-up, those who received early follow-up were younger, were more likely to be Medicare beneficiaries, had more comorbidities, and were less likely to live in an disadvantaged neighborhood. Relative to in-person visits, those with telemedicine follow-up were of similar age, sex, and race but with generally fewer comorbidities. Overall, the 30-day readmission rate (19.0%) varied among patients who received telemedicine visits (15.0%), in-person visits (14.0%), or no follow-up (23.1%). After covariate adjustment, patients who received either telemedicine (odds ratio [OR], 0.55; 95% CI, 0.44-0.72) or in-person (OR, 0.52; 95% CI, 0.45-0.60) visits were similarly less likely to be readmitted within 30 days compared with patients with no follow-up. Conclusions During the COVID-19 pandemic, the use of telemedicine visits for early follow-up increased rapidly. Patients with heart failure who received outpatient follow-up either via telemedicine or in-person had better outcomes than those who received no follow-up.


Subject(s)
COVID-19 , Heart Failure , Telemedicine , Aged , COVID-19/epidemiology , Heart Failure/diagnosis , Heart Failure/epidemiology , Heart Failure/therapy , Humans , Medicare , Pandemics , Patient Readmission , United States
8.
CMAJ ; 194(4): E112-E121, 2022 01 31.
Article in English | MEDLINE | ID: covidwho-1686133

ABSTRACT

BACKGROUND: Disability-related considerations have largely been absent from the COVID-19 response, despite evidence that people with disabilities are at elevated risk for acquiring COVID-19. We evaluated clinical outcomes in patients who were admitted to hospital with COVID-19 with a disability compared with patients without a disability. METHODS: We conducted a retrospective cohort study that included adults with COVID-19 who were admitted to hospital and discharged between Jan. 1, 2020, and Nov. 30, 2020, at 7 hospitals in Ontario, Canada. We compared in-hospital death, admission to the intensive care unit (ICU), hospital length of stay and unplanned 30-day readmission among patients with and without a physical disability, hearing or vision impairment, traumatic brain injury, or intellectual or developmental disability, overall and stratified by age (≤ 64 and ≥ 65 yr) using multivariable regression, controlling for sex, residence in a long-term care facility and comorbidity. RESULTS: Among 1279 admissions to hospital for COVID-19, 22.3% had a disability. We found that patients with a disability were more likely to die than those without a disability (28.1% v. 17.6%), had longer hospital stays (median 13.9 v. 7.8 d) and more readmissions (17.6% v. 7.9%), but had lower ICU admission rates (22.5% v. 28.3%). After adjustment, there were no statistically significant differences between those with and without disabilities for in-hospital death or admission to ICU. After adjustment, patients with a disability had longer hospital stays (rate ratio 1.36, 95% confidence interval [CI] 1.19-1.56) and greater risk of readmission (relative risk 1.77, 95% CI 1.14-2.75). In age-stratified analyses, we observed longer hospital stays among patients with a disability than in those without, in both younger and older subgroups; readmission risk was driven by younger patients with a disability. INTERPRETATION: Patients with a disability who were admitted to hospital with COVID-19 had longer stays and elevated readmission risk than those without disabilities. Disability-related needs should be addressed to support these patients in hospital and after discharge.


Subject(s)
COVID-19/epidemiology , Disabled Persons/statistics & numerical data , Hospitalization/statistics & numerical data , Aged , Aged, 80 and over , Brain Injuries, Traumatic/epidemiology , COVID-19/mortality , Cohort Studies , Developmental Disabilities/epidemiology , Female , Hearing Loss/epidemiology , Hospital Mortality , Hospitals/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Ontario/epidemiology , Patient Readmission/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Vision Disorders/epidemiology
9.
Sci Rep ; 12(1): 2258, 2022 02 10.
Article in English | MEDLINE | ID: covidwho-1684108

ABSTRACT

Chronic kidney disease (CKD) has been recognized as a highly prevalent risk factor for both the severity of coronavirus disease 2019 (COVID-19) and COVID-19 associated adverse outcomes. In this multicenter observational cohort study, we aim to determine mortality and readmission rates of patients hospitalized for COVID-19 across varying CKD stages. We performed a multicenter cohort study among COVID-19 patients included in the Dutch COVIDPredict cohort. The cohort consists of hospitalized patients from March 2020 until July 2021 with PCR-confirmed SARS-CoV-2 infection or a highly suspected CT scan-based infection with a CORADS score ≥ 4. A total of 4151 hospitalized COVID-19 patients were included of who 389 had a history of CKD before admission. After adjusting for all confounding covariables, in patients with CKD stage 3a, stage 3b, stage 4 and patients with KTX (kidney transplantation), odds ratios of death and readmission compared to patients without CKD ranged from 1.96 to 8.94. We demonstrate an evident increased 12-week mortality and readmission rate in patients with chronic kidney disease. Besides justified concerns for kidney transplant patients, clinicians should also be aware of more severe COVID-19 outcomes and increased vulnerability in CKD patients.


Subject(s)
COVID-19/mortality , Patient Readmission/statistics & numerical data , Renal Insufficiency, Chronic/complications , Aged , COVID-19/complications , Female , Humans , Male , Middle Aged , Netherlands/epidemiology , Retrospective Studies , Risk Factors
10.
Obstet Gynecol ; 139(3): 381-390, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1672300

ABSTRACT

OBJECTIVE: To compare postpartum hospitalization length of stay (LOS) and hospital readmission among obstetric patients before (March 2017-February 2020; prepandemic) and during the coronavirus disease 2019 (COVID-19) pandemic (March 2020-February 2021). METHODS: We conducted a retrospective cohort study, using Epic Systems' Cosmos research platform, of obstetric patients who delivered between March 1, 2017, and February 28, 2021, at 20-44 weeks of gestation and were discharged within 7 days of delivery. The primary outcome was short postpartum hospitalization LOS (less than two midnights for vaginal births and less than three midnights for cesarean births) and secondary outcome was hospital readmission within 6 weeks of postpartum hospitalization discharge. Analyses compared outcomes before and during the pandemic using standardized differences and Bayesian logistic mixed-effects models, among all births and stratified by mode of delivery. RESULTS: Of the 994,268 obstetric patients in the study cohort, 742,113 (74.6%) delivered prepandemic and 252,155 (25.4%) delivered during the COVID-19 pandemic. During the COVID-19 pandemic, the percentage of short postpartum hospitalizations increased among all births (28.7-44.5%), vaginal births (25.4-39.5%), and cesarean births (35.3-55.1%), which was consistent with the adjusted analysis (all births: adjusted odds ratio [aOR] 2.35, 99% credible interval 2.32-2.39; vaginal births: aOR 2.14, 99% credible interval 2.11-2.18; cesarean births aOR 2.90, 99% credible interval 2.83-2.98). Although short postpartum hospitalizations were more common during the COVID-19 pandemic, there was no change in readmission in the unadjusted (1.4% vs 1.6%, standardized difference=0.009) or adjusted (aOR 1.02, 99% credible interval 0.97-1.08) analyses for all births or when stratified by mode of delivery. CONCLUSION: Short postpartum hospitalization LOS was significantly more common during the COVID-19 pandemic for obstetric patients with no change in hospital readmissions within 6 weeks of postpartum hospitalization discharge. The COVID-19 pandemic created a natural experiment, suggesting shorter postpartum hospitalization may be reasonable for patients who are self-identified or health care professional-identified as appropriate for discharge.


Subject(s)
COVID-19 , Length of Stay/statistics & numerical data , Patient Readmission/statistics & numerical data , Postnatal Care/statistics & numerical data , Adolescent , Adult , Female , Humans , Postpartum Period , Pregnancy , Retrospective Studies , Young Adult
11.
Int J Infect Dis ; 116: 328-330, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1654568

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate the association between intellectual and developmental disabilities (IDDs) and severe COVID-19 outcomes, 30-day readmission, and/or increased length of stay (LOS) using a large electronic administrative database. METHODS: Patients hospitalized with COVID-19 were identified between March 2020 and June 2021 from more than 900 hospitals in the United States. IDDs included intellectual disability, cerebral palsy, Down syndrome, autism spectrum disorder (ASD), and other intellectual disabilities. Outcomes included intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), 30-day readmission, mortality, and LOS. RESULTS: Among 643,765 patients with COVID-19, multivariate models showed that patients with any IDD were at a significantly greater risk of at least 1 severe outcome, 30-day readmission, or longer LOS than patients without any IDD. Compared with those without any IDD, patients with Down syndrome had the greatest odds of ICU admission (odds ratio [OR] and 95% confidence interval [CI]: 1.96 [1.73-2.21]), IMV (OR: 2.37 [2.07-2.70]), and mortality (OR: 2.33 [2.00-2.73]). Patients with ASD and those with Down syndrome both had over a 40% longer mean LOS. Patients with intellectual disabilities had a 23% (12-35%) increased odds of 30-day readmission. CONCLUSIONS: Results suggest that patients hospitalized with COVID-19 with IDD have a significantly increased risk of severe outcomes, 30-day readmission, and longer LOS.


Subject(s)
Autism Spectrum Disorder , COVID-19 , Autism Spectrum Disorder/complications , Autism Spectrum Disorder/epidemiology , Autism Spectrum Disorder/therapy , COVID-19/epidemiology , COVID-19/therapy , Child , Developmental Disabilities/epidemiology , Humans , Length of Stay , Patient Readmission , SARS-CoV-2 , United States/epidemiology
12.
Med Care ; 60(2): 125-132, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1627476

ABSTRACT

BACKGROUND: It is not yet known whether socioeconomic factors (ie, social determinants of health) are associated with readmission following hospitalization for coronavirus disease 2019 (COVID-19). METHODS: We conducted a retrospective cohort study of 6191 adult patients hospitalized with COVID-19 in a large New York City safety-net hospital system between March 1 and June 1, 2020. Associations between 30-day readmission and selected demographic characteristics, socioeconomic factors, prior health care utilization, and relevant features of the index hospitalization were analyzed using a multivariable generalized estimating equation model. RESULTS: The readmission rate was 7.3%, with a median of 7 days between discharge and readmission. The following were risk factors for readmission: age 65 and older [adjusted odds ratio (aOR): 1.32; 95% confidence interval (CI): 1.13-1.55], history of homelessness, (aOR: 2.03 95% CI: 1.49-2.77), baseline coronary artery disease (aOR: 1.68; 95% CI: 1.34-2.10), congestive heart failure (aOR: 1.34; 95% CI: 1.20-1.49), cancer (aOR: 1.68; 95% CI: 1.26-2.24), chronic kidney disease (aOR: 1.74; 95% CI: 1.46-2.07). Patients' sex, race/ethnicity, insurance, and presence of obesity were not associated with increased odds of readmission. A longer length of stay (aOR: 0.98; 95% CI: 0.97-1.00) and use of noninvasive supplemental oxygen (aOR: 0.68; 95% CI: 0.56-0.83) was associated with lower odds of readmission. Upon readmission, 18.4% of patients required intensive care, and 13.7% expired. CONCLUSION: We have found some factors associated with increased odds of readmission among patients hospitalized with COVID-19. Awareness of these risk factors, including patients' social determinants of health, may ultimately help to reduce readmission rates.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Hospitalization/statistics & numerical data , Patient Readmission/statistics & numerical data , Safety-net Providers/statistics & numerical data , Adult , Aged , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , New York City/epidemiology , Odds Ratio , Oxygen Inhalation Therapy/statistics & numerical data , Retrospective Studies , Risk Factors , SARS-CoV-2 , Socioeconomic Factors
13.
Ann Thorac Surg ; 113(3): 722-737, 2022 03.
Article in English | MEDLINE | ID: covidwho-1611622

ABSTRACT

The twelfth annual report from The Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) highlights outcomes for 26 688 continuous-flow left ventricular assist device (LVAD) patients over the past decade (2011-2020). In 2020, we observed the largest drop in yearly LVAD implant volumes since the registry's inception, which reflects the effects of the COVID-19 pandemic on cardiac surgical volumes in the United States. The 2018 heart transplant allocation policy change in the United States continues to affect LVAD implantation volumes and device strategy, with 78.1% of patients now receiving LVAD implants as destination therapy. Despite an older and sicker patient cohort, survival in the recent era (2016-2020) at 1 and 2 years continues to improve at 82.8% and 74.1%. Patient adverse event profile has also improved in the recent era, with significant reductions in stroke, gastrointestinal bleeding, infection, and device malfunction/pump thrombosis. Finally, we review the burden of readmissions after LVAD implant and highlight an opportunity to improve patient outcomes by reducing this frequent and vexing problem.


Subject(s)
Heart-Assist Devices , Patient Readmission/statistics & numerical data , Adult , Aged , Annual Reports as Topic , Female , Humans , Male , Middle Aged , Registries , United States
14.
Phys Ther ; 102(3)2022 03 01.
Article in English | MEDLINE | ID: covidwho-1597131

ABSTRACT

OBJECTIVES: Multiparticipant physical and occupational therapy provision has fluctuated significantly in skilled nursing facilities (SNFs) under shifts in Medicare reimbursement policy. Multiparticipant therapy includes group (2-6 individuals per therapist) and concurrent therapy (2 individuals per therapist). This study uses recent patient-level data to characterize multiparticipant therapy provision in SNFs to help anticipate shifts under new Medicare policy and the COVID-19 pandemic. METHODS: This secondary analysis used data on 1,016,984 post-acute rehabilitation stays in SNFs in 2018. This analysis identified patient predictors (eg, demographic, clinical) and organizational predictors (eg, ownership, quality, staffing) of receiving multiparticipant therapy using mixed-effects logistic regression. Among individuals who received any multiparticipant therapy, those patient or facility factors associated with high rates of multiparticipant therapy provision were also determined. RESULTS: Less than 3% of individuals received multiparticipant therapy in 2018. Patient functional and cognitive impairment and indicators of market regulation were associated with lower odds of multiparticipant therapy. Effect sizes for organizational factors associated with multiparticipant therapy provision were generally larger compared with patient factors. High multiparticipant therapy provision was concentrated in <2% of SNFs and was positively associated with for-profit ownership, contract staffing, and low 5-star quality ratings. CONCLUSION: SNF organizational characteristics tended to have stronger associations with multiparticipant therapy provision than patient factors, suggesting that changes in patient case-mix, as expected during the COVID-19 pandemic, may have less of an impact on multiparticipant therapy provision than organizational factors. Results suggest that for-profit SNFs in states with higher market regulation, SNFs providing high volumes of therapy, and SNFs utilizing high proportions of assistants and contract staff may be more responsive to Medicare policy by increasing multiparticipant therapy provision. IMPACT: This study may help identify SNFs that are more likely to increase multiparticipant therapy provision under new Medicare payment policy.


Subject(s)
COVID-19 , Skilled Nursing Facilities , Aged , Humans , Medicare , Pandemics , Patient Readmission , United States
15.
J Gerontol Nurs ; 48(1): 15-20, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1593449

ABSTRACT

The importance of health information technology use in nursing home (NH) care delivery is a major topic in research exploring methods to improve resident care. Topics of interest include how technology investments, infrastructure, and work-force development lead to better methods of nursing care delivery and outcomes. Value propositions, including perceived benefits, incentives, and system changes recognized by end-users, are important resources to inform NH leaders, policymakers, and stakeholders about technology. The purpose of the current research was to identify and disseminate value propositions from a community of stakeholders using a health information exchange (HIE). Researchers used a nominal group process, including 49 individual stakeholders participating in a national demonstration project to reduce avoidable hospitalizations in NHs. Stakeholders identified 41 total anticipated changes from using HIE. Ten stakeholder types were perceived to have experienced the highest impact from HIE in areas related to resident admissions, communication, and efficiency of care delivery. [Journal of Gerontological Nursing, 48(1), 15-20.].


Subject(s)
Health Information Exchange , Hospitalization , Humans , Nursing Homes , Patient Readmission , Skilled Nursing Facilities
16.
Ann Surg ; 275(1): 31-36, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1583930

ABSTRACT

OBJECTIVE: The purpose of this study was to determine the effect of COVID-19 vaccination on postoperative mortality, pulmonary and thrombotic complications, readmissions and hospital lengths of stay among patients undergoing surgery in the United States. BACKGROUND: While vaccination prevents COVID-19, little is known about its impact on postoperative complications. METHODS: This is a nationwide observational cohort study of all 1,255 Veterans Affairs facilities nationwide. We compared patients undergoing surgery at least 2 weeks after their second dose of the Pfizer BioNTech or Moderna vaccines, to contemporary propensity score matched controls. Primary endpoints were 30-day mortality and postoperative COVID-19 infection. Secondary endpoints were pulmonary or thrombotic complications, readmissions, and hospital lengths of stay. RESULTS: 30,681 patients met inclusion criteria. After matching, there were 3,104 in the vaccination group (1,903 received the Pfizer BioNTech, and 1,201 received the Moderna vaccine) and 7,438 controls. Full COVID-19 vaccination was associated with lower rates of postoperative 30-day COVID-19 infection (Incidence Rate Ratio and 95% confidence intervals, 0.09 [0.01,0.44]), pulmonary complications (0.54 [0.39, 0.72]), thrombotic complications (0.68 [0.46, 0.99]) and decreased hospital lengths of stay (0.78 [0.69, 0.89]). Complications were also low in vaccinated patients who tested COVID-19 positive before surgery but events were too few to detect a significant difference compared to controls. CONCLUSION: COVID-19 vaccination is associated with lower rates of postoperative morbidity. The benefit is most pronounced among individuals who have never had a COVID-19 infection before surgery.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Postoperative Complications/prevention & control , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Length of Stay/statistics & numerical data , Male , Matched-Pair Analysis , Middle Aged , Patient Readmission/statistics & numerical data , Poisson Distribution , Postoperative Complications/epidemiology , Propensity Score , Regression Analysis , Retrospective Studies , Treatment Outcome
17.
Am J Manag Care ; 27(12): e420-e425, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1567027

ABSTRACT

OBJECTIVES: Hospital at home (HAH) is a health care delivery model that substitutes hospital-level services in the home for inpatient hospitalizations. HAH has been shown to be safe and effective for medical patients but has not been investigated in surgical readmissions. We estimated the potential impact of an HAH program for patients readmitted within 60 days postoperatively and described the characteristics of eligible patients to aid in the design of future programs. STUDY DESIGN: This was a cross-sectional study of 60-day postoperative readmissions at a tertiary care center in 2018. METHODS: We identified the number of readmissions that may have been eligible for HAH, collected descriptive information, and estimated the financial margin that could have been generated had eligible readmissions been diverted to HAH. RESULTS: There were 2366 readmissions within 60 days of surgery in 2018. A total of 731 readmissions met inclusion criteria for HAH (30.1%), accounting for 4152 bed days. Of these readmissions, the most common diagnoses were infection, gastrointestinal complications, and cardiac complications. Patients' home addresses were within 16 miles of the hospital in 447 cases (61.1%). Avoidance of these readmissions and use of the beds for new admissions represented a potential backfill margin of $8.8 million, not incorporating the cost of HAH. CONCLUSIONS: Many 60-day postoperative readmissions may be amenable to HAH enrollment, representing a significant opportunity to improve patient experience and generate hospital revenue. This is of particular interest in the post-COVID-19 era. To maximize their impact, HAH programs should tailor clinical and operational services to this population.


Subject(s)
COVID-19 , Patient Readmission , Cross-Sectional Studies , Hospitals , Humans , SARS-CoV-2
18.
Am J Perinatol ; 39(4): 354-360, 2022 03.
Article in English | MEDLINE | ID: covidwho-1565753

ABSTRACT

OBJECTIVE: To determine whether early postpartum discharge during the coronavirus disease 2019 (COVID-19) pandemic was associated with a change in the odds of maternal postpartum readmissions. STUDY DESIGN: This is a retrospective analysis of uncomplicated postpartum low-risk women in seven obstetrical units within a large New York health system. We compared the rate of postpartum readmissions within 6 weeks of delivery between two groups: low-risk women who had early postpartum discharge as part of our protocol during the COVID-19 pandemic (April 1-June 15, 2020) and similar low-risk patients with routine postpartum discharge from the same study centers 1 year prior. Statistical analysis included the use of Wilcoxon's rank-sum and chi-squared tests, Nelson-Aalen cumulative hazard curves, and multivariate logistic regression. RESULTS: Of the 8,206 patients included, 4,038 (49.2%) were patients who had early postpartum discharge during the COVID-19 pandemic and 4,168 (50.8%) were patients with routine postpartum discharge prior to the COVID-19 pandemic. The rates of postpartum readmissions after vaginal delivery (1.0 vs. 0.9%; adjusted odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.39-1.45) and cesarean delivery (1.5 vs. 1.9%; adjusted OR: 0.65, 95% CI: 0.29-1.45) were similar between the two groups. Demographic risk factors for postpartum readmission included Medicaid insurance and obesity. CONCLUSION: Early postpartum discharge during the COVID-19 pandemic was associated with no change in the odds of maternal postpartum readmissions after low-risk vaginal or cesarean deliveries. Early postpartum discharge for low-risk patients to shorten hospital length of stay should be considered in the face of public health crises. KEY POINTS: · Early postpartum discharge was not associated with an increase in odds of hospital readmissions after vaginal delivery.. · Early postpartum discharge was not associated with an increase in odds of hospital readmissions after cesarean delivery.. · Early postpartum discharge for low-risk patients should be considered during a public health crisis..


Subject(s)
COVID-19 , Insurance, Health/statistics & numerical data , Medicaid/statistics & numerical data , Obesity, Maternal/epidemiology , Patient Discharge , Patient Readmission/statistics & numerical data , Postnatal Care/methods , Adult , Case-Control Studies , Cesarean Section , Cohort Studies , Delivery, Obstetric , Female , Humans , Length of Stay/statistics & numerical data , Logistic Models , Multivariate Analysis , Pregnancy , Proportional Hazards Models , Retrospective Studies , Risk Factors , SARS-CoV-2 , United States
19.
Am J Emerg Med ; 52: 166-173, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1562396

ABSTRACT

BACKGROUND: We aimed to determine the characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients. METHODS: PubMed, Embase, Web of Science, and Scopus databases were searched to retrieve articles on readmitted COVID-19 patients, available up to September 25, 2021. All studies comparing characteristics of readmitted and non-readmitted COVID-19 patients were included. We also included articles reporting the reasons for readmission in COVID-19 patients. Data were pooled and meta-analyzed using random or fixed-effect models, as appropriate. Subgroup analyses were conducted based on the place and duration of readmission. RESULTS: Our meta-analysis included 4823 readmitted and 63,413 non-readmitted COVID-19 patients. The re-hospitalization rate was calculated at 9.3% with 95% Confidence Interval (CI) [5.5%-15.4%], mostly associated with respiratory or cardiac complications (48% and 14%, respectively). Comorbidities including cerebrovascular disease (Odds Ratio (OR) = 1.812; 95% CI [1.547-2.121]), cardiovascular (2.173 [1.545-3.057]), hypertension (1.608 [1.319-1.960]), ischemic heart disease (1.998 [1.495-2.670]), heart failure (2.556 [1.980-3.300]), diabetes (1.588 [1.443-1.747]), cancer (1.817 [1.526-2.162]), kidney disease (2.083 [1.498-2.897]), chronic pulmonary disease (1.601 [1.438-1.783]), as well as older age (1.525 [1.175-1.978]), male sex (1.155 [1.041-1.282]), and white race (1.263 [1.044-1.528]) were significantly associated with higher readmission rates (P < 0.05 for all instances). The mortality rate was significantly lower in readmitted patients (OR = 0.530 [0.329-0.855], P = 0.009). CONCLUSIONS: Male sex, white race, comorbidities, and older age were associated with a higher risk of readmission among previously admitted COVID-19 patients. These factors can help clinicians and policy-makers predict, and conceivably reduce the risk of readmission in COVID-19 patients.


Subject(s)
COVID-19/complications , COVID-19/therapy , Patient Readmission/statistics & numerical data , Age Factors , Cardiovascular Diseases/complications , Diabetes Complications , Emergency Service, Hospital/statistics & numerical data , Humans , Kidney Diseases/complications , Lung Diseases/complications , Neoplasms/complications , Race Factors , Risk Factors , SARS-CoV-2 , Sex Factors
20.
J Med Virol ; 94(1): 44-53, 2022 01.
Article in English | MEDLINE | ID: covidwho-1544334

ABSTRACT

Recent studies reported that some recovered COVID-19 patients have tested positive for virus nucleic acid again. A systematic search was performed in Web of Science, PubMed, Scopus, and Google Scholar up to March 6, 2021. The pooled estimation of reinfection, recurrence, and hospital readmission among recovered COVID-19 patients was 3, 133, and 75 per 1000 patients, respectively. The overall estimation of reinfection among males compared to females was greater. The prevalence of recurrence in females compared to males was more common. Also, hospital readmission between sex groups was the same. There is uncertainty about long-term immunity after SARS-Cov-2 infection. Thus, the possibility of reinfection and recurrence after recovery is not unexpected. In addition, there is a probability of hospital readmission due to adverse events of COVID-19 after discharge. However, with mass vaccination of people and using the principles of prevention and appropriate management of the disease, frequent occurrence of the disease can be controlled.


Subject(s)
COVID-19/epidemiology , Patient Readmission/statistics & numerical data , Reinfection/epidemiology , SARS-CoV-2/isolation & purification , COVID-19 Vaccines/immunology , Female , Humans , Male , Recurrence , SARS-CoV-2/immunology , Sex Factors , Sex Ratio , Vaccination
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