Key Points Question What are the mortality and readmission rates in patients with COVID-19 pneumonia discharged according to an expected practice approach with supplemental home oxygen? Findings In this cohort study of 621 patients with COVID-19 discharged with supplemental home oxygen from emergency department and inpatient encounters at 2 large urban medical centers, the all-cause mortality rate was 1.3% and the all-cause 30-day return hospital admission rate was 8.5%. No patients died in the ambulatory setting or in transit when returning to acute care setting. Meaning In this study, a careful and systematic expected practice approach to treatment of patients with COVID-19 using home oxygen was associated with low all-cause mortality and low 30-day return admission rates.

Background We sought to compare the outcomes of patients treated with intravenous (IV)-only vs. oral transitional antimicrobial therapy for infective endocarditis (IE) after implementing a new Expected Practice within The Los Angeles County Department of Health Services (LAC DHS). Methods We conducted a multi-centered, retrospective cohort study of adults with definite or possible IE treated with IV-only vs. oral therapy at the three acute care, public hospitals in the LAC DHS system between December 2018 to June 2022. The primary outcome was clinical success at 90 days, defined as being alive, and without recurrence of bacteremia or treatment-emergent infectious complications. Results We identified 257 patients with IE treated with IV-only (n=211) or oral transitional (n=46) therapy who met study inclusion criteria. Study arms were similar for many demographics; however, the IV cohort was older, and had more aortic valve involvement, hemodialysis patients, and central venous catheters present. In contrast, the oral cohort had a higher percentage of IE caused by methicillin-resistant S. aureus. There was no significant difference between the groups in clinical success at 90 days or last follow-up. There was no difference in recurrence of bacteremia or readmission rates. However, patients treated with oral therapy had significantly fewer adverse events. Multivariable regression adjustments did not find significant associations between any selected variables and clinical success across treatment groups. Conclusions These results demonstrate similar outcomes of real-world use of oral vs. IV-only therapy for IE, in accord with prior randomized controlled trials and meta-analyses.

Importance: Primary health care is rapidly developing as an occupational therapy practice area. Yet, to date, little evidence supports occupational therapy’s feasibility and efficacy in primary care settings. Objective: To report on the implementation and preliminary clinical outcomes of a Lifestyle Redesign® (LR)–occupational therapy (LR–OT) diabetes management intervention in a primary care clinic. Design: Patients were randomized to be offered LR–OT or to a no-contact comparison group (data not reported). We assessed implementation outcomes using mixed methods. Setting: Safety-net primary care clinic. Participants: Clinic providers and staff; English- or Spanish-speaking clinic patients ages 18–75 yr with diabetes and a current hemoglobin A1c (HbA1c) ≥ 9.0%. Intervention: Eight 1-hr individual sessions of LR–OT focused on diabetes management. Outcomes and Measures: Clinical and health behavior outcomes were assessed via electronic medical record (EMR) review and self-report surveys of patients receiving LR–OT at initial evaluation and discharge. We assessed implementation outcomes (acceptability, appropriateness, feasibility, fidelity, efficiency, and timeliness) using patient and staff surveys, interviews, focus groups, and observations. Results: Seventy-three patients were offered LR–OT: 51 completed one or more sessions, and 38 completed the program. Clinical outcomes among program completers indicate beneficial changes in HbA1c, diabetes self-care, and health status. Implementation challenges included a need for patient and staff education, securing adequate workspace, and establishing a referral process. Factors contributing to implementation success included strong buy-in from clinic leadership, colocation, and shared EMR documentation. Conclusions and Relevance: LR–OT is a feasible approach to enhancing service delivery and clinical outcomes in primary care. What This Article Adds: This study provides insight into factors that may create challenges or contribute to the success of implementing occupational therapy services within primary health care settings. In addition, this study provides preliminary evidence of occupational therapy’s effectiveness in improving clinical outcomes among ethnically diverse, low-income patients with diabetes in a safety-net primary care setting.