Outcomes of hospitalized patients with COVID-19 during the course of the pandemic in a fully integrated health system.
PLoS One
; 17(2): e0263417, 2022.
Artigo
em Inglês
| MEDLINE | ID: covidwho-1910515
ABSTRACT
BACKGROUND:
Given the rapid spread of COVID-19 and its associated morbidity and mortality, healthcare providers throughout the world have been forced to constantly update and change their care delivery models.OBJECTIVE:
To assess the outcomes of COVID-19 hospitalized patients during the course of the pandemic in a well-integrated health system.METHODS:
The study used data from the electronic health medical records to assess trends in clinical profile and outcomes of hospitalized adult COVID-19 patients hospitalized in our 5-hospital health system from March 2020-May 2021 (n = 6865). Integration of the health system began in February 2020 and was fully actualized by March 30, 2020.RESULTS:
Mortality decreased from 15% during first peak (March-May 2020; the rate includes 19% in March-April and 10% in May 2020) to 6% in summer-fall 2020, increased to 13% during the second peak (November 2020-January 2021), and dropped to 7% during the decline period (February-May 2021) (p<0.01). Resource utilization followed a similar pattern including a decrease in ICU use from 35% (first peak) to 16% (decline period), mechanical ventilation from 16% (first peak, including 45% in March 2020) to 9-11% in subsequent periods (p<0.01). Independent predictors of inpatient mortality across multiple study periods included older age, male sex, higher multi-morbidity scores, morbid obesity, and indicators of severe illness on admission such as oxygen saturation ≤90% and high qSOFA score (all p<0.05). However, admission during the first peak remained independently associated with increased mortality even after adjustment for patient-related factors odds ratio = 1.8 (1.4-2.4) (p<0.0001).CONCLUSIONS:
The creation of a fully integrated health system allowed us to dynamically respond to the everchanging COVID-19 landscape. In this context, despite the increasing patient acuity, our mortality and resource utilization rates have improved during the pandemic.
Texto completo:
Disponível
Coleções:
Bases de dados internacionais
Base de dados:
MEDLINE
Assunto principal:
Prestação Integrada de Cuidados de Saúde
/
COVID-19
/
Hospitalização
/
Unidades de Terapia Intensiva
Tipo de estudo:
Estudo prognóstico
Limite:
Adulto
/
Idoso
/
Feminino
/
Humanos
/
Masculino
/
Meia-Idade
Idioma:
Inglês
Revista:
PLoS One
Assunto da revista:
Ciência
/
Medicina
Ano de publicação:
2022
Tipo de documento:
Artigo
País de afiliação:
Journal.pone.0263417
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