Tukpah Ann-Marcia C, Patel Jhillika, Amundson Beret, Linares Miguel, Sury Meera, Sullivan Julie, Jocelyn Tajmah, Kissane Brenda, Weinhouse Gerald, Lange-Vaidya Nancy, Lamas Daniela, Ismail Khalid, Pavuluri Chandan, Cho Michael H, Gay Elizabeth B, Moll Matthew
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Arch Public Health. 2023 Mar 14;81(1):39. doi: 10.1186/s13690-023-01033-2.
There are known disparities in COVID-19 resource utilization that may persist during the recovery period for some patients. We sought to define subpopulations of patients seeking COVID-19 recovery care in terms of symptom reporting and care utilization to better personalize their care and to identify ways to improve access to subspecialty care.
Prospective study of adult patients with prior COVID-19 infection seen in an ambulatory COVID-19 recovery center (CRC) in Boston, Massachusetts from April 2021 to April 2022. Hierarchical clustering with complete linkage to differentiate subpopulations was done with four sociodemographic variables: sex, race, language, and insurance status. Outcomes included ICU admission, utilization of supplementary care, self-report of symptoms.
We included 1285 COVID-19 patients referred to the CRC with a mean age of 47 years, of whom 71% were female and 78% White. We identified 3 unique clusters of patients. Cluster 1 and 3 patients were more likely to have had intensive care unit (ICU) admissions; Cluster 2 were more likely to be White with commercial insurance and a low percentage of ICU admission; Cluster 3 were more likely to be Black/African American or Latino/a and have commercial insurance. Compared to Cluster 2, Cluster 1 patients were more likely to report symptoms (ORs ranging 2.4-3.75) but less likely to use support groups, psychoeducation, or care coordination (all p < 0.05). Cluster 3 patients reported greater symptoms with similar levels of community resource utilization.
Within a COVID-19 recovery center, there are distinct groups of patients with different clinical and socio-demographic profiles, which translates to differential resource utilization. These insights from different subpopulations of patients can inform targeted strategies which are tailored to specific patient needs.
已知在新冠病毒病（COVID-19）资源利用方面存在差异，在某些患者的康复期可能持续存在。我们试图根据症状报告和医疗利用情况来界定寻求COVID-19康复护理的患者亚群，以更好地实现个性化护理，并确定改善专科护理可及性的方法。
对2021年4月至2022年4月在马萨诸塞州波士顿的一个门诊COVID-19康复中心就诊的既往感染过COVID-19的成年患者进行前瞻性研究。使用完全连锁法进行分层聚类以区分亚群，所用的四个社会人口学变量为：性别、种族、语言和保险状况。结局指标包括重症监护病房（ICU）入院情况、补充护理的利用情况、症状的自我报告。
我们纳入了1285例转诊至该康复中心的COVID-19患者，平均年龄47岁，其中71%为女性，78%为白人。我们识别出3个独特的患者集群。集群1和3的患者更有可能入住过重症监护病房（ICU）；集群2的患者更有可能是白人，有商业保险，且入住ICU的比例较低；集群3的患者更有可能是黑人/非裔美国人或拉丁裔，且有商业保险。与集群2相比，集群1的患者更有可能报告症状（比值比范围为2.4至3.75），但使用支持小组、心理教育或护理协调服务的可能性较小（所有p<0.05）。集群3的患者报告的症状更多，社区资源利用水平相似。
在一个COVID-19康复中心内，存在具有不同临床和社会人口学特征的不同患者群体，这导致了不同的资源利用情况。来自不同患者亚群的这些见解可为针对特定患者需求量身定制的策略提供依据。
