Surviving COVID-19 After Hospital Discharge: Symptom, Functional, and Adverse Outcomes of Home Health Recipients.
Ann Intern Med
; 174(3): 316-325, 2021 03.
Article
in English
| MEDLINE | ID: covidwho-965717
ABSTRACT
BACKGROUND:
Little is known about recovery from coronavirus disease 2019 (COVID-19) after hospital discharge.OBJECTIVE:
To describe the home health recovery of patients with COVID-19 and risk factors associated with rehospitalization or death.DESIGN:
Retrospective observational cohort.SETTING:
New York City.PARTICIPANTS:
1409 patients with COVID-19 admitted to home health care (HHC) between 1 April and 15 June 2020 after hospitalization. MEASUREMENTS Covariates and outcomes were obtained from the mandated OASIS (Outcome and Assessment Information Set). Cox proportional hazards models were used to estimate the hazard ratio (HR) of risk factors associated with rehospitalization or death.RESULTS:
After an average of 32 days in HHC, 94% of patients were discharged and most achieved statistically significant improvements in symptoms and function. Activity-of-daily-living dependencies decreased from an average of 6 (95% CI, 5.9 to 6.1) to 1.2 (CI, 1.1 to 1.3). Risk for rehospitalization or death was higher for male patients (HR, 1.45 [CI, 1.04 to 2.03]); White patients (HR, 1.74 [CI, 1.22 to 2.47]); and patients with heart failure (HR, 2.12 [CI, 1.41 to 3.19]), diabetes with complications (HR, 1.71 [CI, 1.17 to 2.52]), 2 or more emergency department visits in the past 6 months (HR, 1.78 [CI, 1.21 to 2.62]), pain daily or all the time (HR, 1.46 [CI, 1.05 to 2.05]), cognitive impairment (HR, 1.49 [CI, 1.04 to 2.13]), or functional dependencies (HR, 1.09 [CI, 1.00 to 1.20]). Eleven patients (1%) died, 137 (10%) were rehospitalized, and 23 (2%) remain on service.LIMITATIONS:
Care was provided by 1 home health agency. Information on rehospitalization and death after HHC discharge is not available.CONCLUSION:
Symptom burden and functional dependence were common at the time of HHC admission but improved for most patients. Comorbid conditions of heart failure and diabetes, as well as characteristics present at admission, identified patients at greatest risk for an adverse event. PRIMARY FUNDING SOURCE No direct funding.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Patient Discharge
/
Patient Readmission
/
COVID-19
/
Home Care Services
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Topics:
Long Covid
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
North America
Language:
English
Journal:
Ann Intern Med
Year:
2021
Document Type:
Article
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