Cao Ying Jessica, Wang Yang, Mullahy John, Burns Marguerite, Liu Yao, Smith Maureen
Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
Robert M. La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, WI, USA.
Health Serv Insights. 2023 Apr 14;16:11786329231166522. doi: 10.1177/11786329231166522. eCollection 2023.
The COVID-19 pandemic changed care delivery. But the mechanisms of changes were less understood.
Examine the extent to which the volume and pattern of hospital discharge and patient composition contributed to the changes in post-acute care (PAC) utilization and outcomes during the pandemic.
Retrospective cohort study. Medicare claims data on hospital discharges in a large healthcare system from March 2018 to December 2020.
Medicare fee-for-service beneficiaries, 65 years or older, hospitalized for non-COVID diagnoses.
Hospital discharges to Home Health Agencies (HHA), Skilled Nursing Facilities (SNF), and Inpatient Rehabilitation Facilities (IRF) versus home. Thirty- and ninety-day mortality and readmission rates. Outcomes were compared before and during the pandemic with and without adjustment for patient characteristics and/or interactions with the pandemic onset.
During the pandemic, hospital discharges declined by 27%. Patients were more likely to be discharged to HHA (+4.6%, 95% CI [3.2%, 6.0%]) and less likely to be discharged to either SNF (-3.9%, CI [-5.2%, -2.7%]) or to home (-2.8% CI [-4.4%, -1.3%]). Thirty- and ninety-day mortality rates were significantly higher by 2% to 3% points post-pandemic. Readmission were not significantly different. Up to 15% of the changes in discharge patterns and 5% in mortality rates were attributable to patient characteristics.
Shift in discharge locations were the main driver of changes in PAC utilization during the pandemic. Changes in patient characteristics explained only a small portion of changes in discharge patterns and were mainly channeled through general impacts rather than differentiated responses to the pandemic.
2019冠状病毒病（COVID-19）大流行改变了医疗服务的提供方式。但这些变化的机制尚不太清楚。
研究在大流行期间，医院出院量和模式以及患者构成在多大程度上导致了急性后护理（PAC）利用率和结局的变化。
回顾性队列研究。使用了2018年3月至2020年12月期间一个大型医疗系统中医疗保险住院报销数据。
65岁及以上因非COVID诊断住院的医疗保险按服务付费受益人。
出院至家庭健康机构（HHA）、熟练护理机构（SNF）和住院康复机构（IRF）与出院回家的情况。30天和90天死亡率及再入院率。在大流行之前和期间，对结局进行比较，同时对患者特征和/或与大流行开始的相互作用进行调整和未调整。
在大流行期间，医院出院量下降了27%。患者出院至HHA的可能性增加（+4.6%，95%可信区间[3.2%，6.0%]），而出院至SNF（-3.9%，可信区间[-5.2%，-2.7%]）或回家（-2.8%，可信区间[-4.4%，-1.3%]）的可能性降低。大流行后30天和90天死亡率显著高出2至3个百分点。再入院率无显著差异。高达15%的出院模式变化和5%的死亡率变化可归因于患者特征。
出院地点的改变是大流行期间PAC利用率变化的主要驱动因素。患者特征的变化仅解释了出院模式变化的一小部分，并且主要是通过一般影响而非对大流行的差异化反应来传导的。
