Access to Post-Acute Care after Covid-19 and Non-Covid-19 Sepsis Hospitalization

ABSTRACT

INTRODUCTION: The COVID-19 pandemic disrupted access and delivery of routine continuing care for sepsis recovery, including provision of postacute services like skilled nursing facility (SNF) discharge, home healthcare (HH), and outpatient follow up. We hypothesized pandemic-related precautions and care disturbances would disparately impact postacute care for adults with sepsis due to COVID-19 vs non-COVID-19 pneumonia. METHOD(S) ENCOMPASS is an ongoing hybrid trial to test implementation of a multidisciplinary postsepsis transitional care program at 8 diverse hospitals (NCT04495946). In the current study, we analyzed community-dwelling trial participants (i.e., adults with clinically defined sepsis) enrolled July 2020-Nov 2021 with discharge diagnoses of COVID-19 (ICD10 U07.1) or non-COVID-19 pneumonia (ICD10 J13-18). Using EHR data, we examined discharge care setting (SNF or inpatient rehab, HH, or home with self care) and outpatient follow up within 14 days (in-person, virtual, or none) as primary and secondary outcomes. For each outcome, we fit multinomial regression models adjusted for patient (age, insurance), clinical (comorbidity burden, organ failure, length of stay) and community factors (rurality by zip code). RESULT(S) Among 410 participants with COVID-19 (n=151) or non-COVID-19 (n=259) pneumonia (median, at enrollment age=70, CCI=5, SOFA score=4), 52 (13%) died in hospital and 18 (4%) discharged to hospice. of remaining patients, 134 (39%) were discharged to home with self care, 118 (35%) to HH, and 88 (26%) to SNF or inpatient rehab. Survivors with vs without COVID-19 had similar adjusted odds of discharge to HH (OR=1.17 95%CI=0.65-2.10) and SNF or inpatient rehab (OR=1.60 95%CI=0.81-3.14) compared to home. Outpatient visit completion was similar for COVID-19 and non-COVID-19 survivors (26% vs 30%, p=0.43), but patients with vs without COVID-19 had higher odds of virtual (OR=4.76 95%CI=2.11-10.75) compared to no completed follow-up. CONCLUSION(S) In an ongoing postsepsis care trial, COVID-19 and non-COVID-19 survivors had similar provision of postacute services. COVID-19 was associated with increased virtual outpatient follow up, highlighting the value of telehealth to reduce exposure risk while maintaining close follow up of patients recovering from serious illness during the pandemic.