Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles.
Department of Emergency Medicine, Keck School of Medicine at University of Southern California, Los Angeles.
JAMA Netw Open. 2021 Apr 1;4(4):e213990. doi: 10.1001/jamanetworkopen.2021.3990.
To optimize patient outcomes and preserve critical acute care access during the COVID-19 pandemic, the Los Angeles County Department of Health Services developed the SAFE @ HOME O2 Expected Practice (expected practice), enabling ambulatory oxygen management for COVID-19.
To assess outcomes of patients with COVID-19 pneumonia discharged via the expected practice approach to home or quarantine housing with supplemental home oxygen.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included 621 adult patients with COVID-19 pneumonia who were discharged from 2 large urban public hospitals caring primarily for patients receiving Medicaid from March 20 to August 19, 2020. Patients were included in the analysis cohort if they received emergency or inpatient care for COVID-19 and were discharged with home oxygen.
Patients receiving at least 3 L per minute of oxygen, stable without other indication for inpatient care, were discharged from either emergency or inpatient encounters with home oxygen equipment, educational resources, and nursing telephone follow-up within 12 to 18 hours of discharge. Nurses provided continued telephone follow up as indicated, always with physician back-up.
All-cause mortality and all-cause 30-day return admission.
A total of 621 patients with COVID-19 pneumonia (404 male [65.1%] and 217 female [34.9%]) were discharged with home oxygen. Median age of these patients was 51 years (interquartile range, 45-61 years), with 149 (24.0%) discharged from the emergency department and 472 (76%) discharged from inpatient encounters. The all-cause mortality rate was 1.3% (95% CI, 0.6%-2.5%) and the 30-day return hospital admission rate was 8.5% (95% CI, 6.2%-10.7%) with a median follow-up time of 26 days (interquartile range, 15-55 days). No deaths occurred in the ambulatory setting.
In this cohort study, patients with COVID-19 pneumonia discharged on home oxygen had low rates of mortality and return admission within 30 days of discharge. Ambulatory management of COVID-19 with home oxygen has an acceptable safety profile, and the expected practice approach may help optimize outcomes, by ensuring right care in the right place at the right time and preserving access to acute care during the COVID-19 pandemic.
为了优化患者的治疗效果并在 COVID-19 大流行期间保护重要的急性护理服务，洛杉矶县卫生署制定了 SAFE@HOME O2 预期实践（预期实践），从而实现了 COVID-19 患者的门诊吸氧管理。
评估通过预期实践方式出院至居家或隔离住所、并接受补充家用氧气的 COVID-19 肺炎患者的结局。
设计、地点和参与者：这项回顾性队列研究纳入了 621 名患有 COVID-19 肺炎的成年患者，他们于 2020 年 3 月 20 日至 8 月 19 日从两家大型城市公立医院出院，这些医院主要为接受医疗补助的患者提供服务。如果患者因 COVID-19 接受了急诊或住院治疗，且出院时伴有家用氧气，则将其纳入分析队列。
至少接受 3 L/分钟氧气、没有其他住院治疗指征且病情稳定的患者，在急诊或住院期间接受治疗后，将在出院后 12 至 18 小时内，携带家用氧气设备、教育资源和护士电话随访出院。护士会根据需要继续进行电话随访，始终有医生提供支持。
全因死亡率和全因 30 天内再次入院。
共有 621 名患有 COVID-19 肺炎的患者（404 名男性[65.1%]和 217 名女性[34.9%]）接受了家用氧气治疗。这些患者的中位年龄为 51 岁（四分位距，45-61 岁），其中 149 名（24.0%）从急诊部门出院，472 名（76%）从住院部门出院。全因死亡率为 1.3%（95%CI，0.6%-2.5%），30 天内再次入院率为 8.5%（95%CI，6.2%-10.7%），中位随访时间为 26 天（四分位距，15-55 天）。在门诊环境中未发生死亡事件。
在这项队列研究中，接受家用氧气治疗的 COVID-19 肺炎出院患者的死亡率和 30 天内再次入院率较低。使用家用氧气对 COVID-19 进行门诊管理具有可接受的安全性，预期实践方法可以通过确保在正确的时间、在正确的地点提供正确的护理，并在 COVID-19 大流行期间保护急性护理服务的可及性，来帮助优化治疗效果。
