Discharge characteristics and care transitions of hospitalized patients with COVID-19

Loerinc, Leah; Scheel, Amy; Evans, Sean; Shabto, Julie M.; O’Keefe, Ghazala; O’Keefe, James B

doi:10.1016/j.hjdsi.2020.100512

Cited by 49 publications

(87 citation statements)

References 20 publications

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“…Our readmission rate was similar to those found by other investigators 7 , 10 , 12 , but lower than those observed in other studies 6 , 9 , 13 , 14 . The higher readmission rate observed in some studies can be related to the longer follow-up period in some of them 6 , 14 and to the higher incidence of diseases such as obesity, hypertension, diabetes, asthma and chronic renal failure 6 , 9 , 14 .…”

Section: Discussionsupporting

confidence: 91%

“…As in other similar studies, worsening SARS-CoV-2 pneumonia, bacterial infection, venous thromboembolism, heart failure, acute renal failure, and neurological or psychiatric conditions were common causes of hospital readmission 5 , 7 , 13 . The administration of more effective and less toxic treatments, determining the dose and rate of decrease of steroids, and the development of prognostic scores could lead to fewer or milder exacerbations of SARS-CoV-2 pneumonia 28 , 29 .…”

Section: Discussionsupporting

confidence: 75%

“…Another characteristic of readmissions is their lower mortality compared to the index admission 6 , 13 . It cannot be ruled out that this finding could be influenced by the possible death of the most fragile patients during the index admission.…”

Section: Discussionmentioning

confidence: 99%

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Frequency, risk factors, and outcomes of hospital readmissions of COVID-19 patients

Ramos‐Martínez

Parra-Ramirez

Morrás

et al. 2021

Sci Rep

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To determine the proportion of patients with COVID-19 who were readmitted to the hospital and the most common causes and the factors associated with readmission. Multicenter nationwide cohort study in Spain. Patients included in the study were admitted to 147 hospitals from March 1 to April 30, 2020. Readmission was defined as a new hospital admission during the 30 days after discharge. Emergency department visits after discharge were not considered readmission. During the study period 8392 patients were admitted to hospitals participating in the SEMI-COVID-19 network. 298 patients (4.2%) out of 7137 patients were readmitted after being discharged. 1541 (17.7%) died during the index admission and 35 died during hospital readmission (11.7%, p = 0.007). The median time from discharge to readmission was 7 days (IQR 3–15 days). The most frequent causes of hospital readmission were worsening of previous pneumonia (54%), bacterial infection (13%), venous thromboembolism (5%), and heart failure (5%). Age [odds ratio (OR): 1.02; 95% confident interval (95% CI): 1.01–1.03], age-adjusted Charlson comorbidity index score (OR: 1.13; 95% CI: 1.06–1.21), chronic obstructive pulmonary disease (OR: 1.84; 95% CI: 1.26–2.69), asthma (OR: 1.52; 95% CI: 1.04–2.22), hemoglobin level at admission (OR: 0.92; 95% CI: 0.86–0.99), ground-glass opacification at admission (OR: 0.86; 95% CI:0.76–0.98) and glucocorticoid treatment (OR: 1.29; 95% CI: 1.00–1.66) were independently associated with hospital readmission. The rate of readmission after hospital discharge for COVID-19 was low. Advanced age and comorbidity were associated with increased risk of readmission.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 75%

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Frequency, risk factors, and outcomes of hospital readmissions of COVID-19 patients

Ramos‐Martínez

Parra-Ramirez

Morrás

et al. 2021

Sci Rep

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“…1 ). Eventually, 36 studies were included in the present systematic review and 28 were incorporated in the meta-analysis [ 7 , 9 , 11 , [13] , [14] , [15] , [16] , 19 , 20 , 23 , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] ]. Overall, 28 articles were included in phase 1 to determine risk factors and outcome of readmitted COVID-19 patients, and 19 articles were included in phase 2 to determine the cause of readmissions.…”

Section: Resultsmentioning

confidence: 99%

Characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients: A systematic review and meta-analysis

Akbari

Fathabadi

Razmi

et al. 2022

The American Journal of Emergency Medicine

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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.

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“…Patients over age 75 were at greatest risk for death and/or readmission. Improved strategies for post-discharge care of COVID-19 patients are needed to address the sustained vulnerability of these patients [23].…”

Section: Discussionmentioning

confidence: 99%

Determinants of hospital outcomes for COVID-19 infections in a large Pennsylvania Health System

Shaw

Yang

Mowery

et al. 2021

Preprint

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There is growing evidence that racial and ethnic minorities bear a disproportionate burden from COVID-19. Temporal changes in the pandemic epidemiology and diversity in the clinical course require careful study to identify determinants of poor outcomes. We analyzed 6255 individuals admitted with PCR-confirmed COVID-19 to one of 5 hospitals in the University of Pennsylvania Health System between March 2020 and March 2021, using electronic health records to assess risk factors and outcomes through 8 weeks post-admission. Discharge, readmission and mortality outcomes were analyzed in a multi-state model with multivariable Cox models for each transition. Mortality varied markedly over time, with cumulative incidence (95% CI) 30 days post-admission of 19.1% (16.9, 21.3) in March-April 2020, 5.7% (4.2, 7.5) in July-October 2020 and 10.5% (9.1,12.0) in January-March 2021; 26% of deaths occurred after discharge. Average age (SD) at admission varied from 62.7 (17.6) to 54.8 (19.9) to 60.5 (18.1); mechanical ventilation use declined from 21.3% to 9-11%. Compared to Caucasian, Black race was associated with more severe disease at admission, higher rates of co-morbidities and low-income resident zip code. Between-race risk differences in mortality risk diminished in multivariable models; while admitting hospital, increasing age, admission early in the pandemic, and severe disease and low blood pressure at admission were associated with increased mortality hazard. Hispanic ethnicity was associated with fewer baseline co-morbidities and lower mortality hazard (0.57, 95% CI: 0.37, .087). Multi-state modeling allows for a unified framework to analyze multiple outcomes throughout the disease course. Morbidity and mortality for hospitalized COVID-19 patients varied over time but post-discharge mortality remained non-trivial. Black race was associated with more risk factors for morbidity and with treatment at hospitals with lower mortality. Multivariable models suggest there are not between-race differences in outcomes. Future work is needed to better understand the identified between-hospital differences in mortality.

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Discharge characteristics and care transitions of hospitalized patients with COVID-19

Cited by 49 publications

References 20 publications

Frequency, risk factors, and outcomes of hospital readmissions of COVID-19 patients

Frequency, risk factors, and outcomes of hospital readmissions of COVID-19 patients

Characteristics, risk factors, and outcomes associated with readmission in COVID-19 patients: A systematic review and meta-analysis

Determinants of hospital outcomes for COVID-19 infections in a large Pennsylvania Health System

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