Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
PLoS One. 2024 Sep 27;19(9):e0309155. doi: 10.1371/journal.pone.0309155. eCollection 2024.
During the initial wave of coronavirus disease of 2019 (COVID-19), patients were rapidly discharged from acute hospitals in anticipation of an expected influx of patients with COVID-19. Patients that were no longer receiving acute medical care but were waiting for their next destination (i.e., delayed hospital discharge) were particularly affected. The objectives of this study were to examine the impact of COVID-19 onset on healthcare utilization and mortality among those who experienced delayed discharge from acute care. We conducted a population-based retrospective cohort study using linked administrative data. We included persons discharged from acute care who experienced a delayed hospital stay between April 1, 2019 and September 30, 2020. The onset of COVID-19 was the exposure (March 1, 2020), while the period of April 1, 2019 to February 29, 2020 was considered as a comparator. Primary outcomes included healthcare utilization and mortality following discharge, stratified by care setting (homecare, inpatient rehabilitation or long-term care). Multivariable logistic, zero-inflated Poisson regressions, and Cox proportional hazard models were used to examine the impact of COVID-19 on outcomes while adjusting for covariates. Those discharged home were more likely to receive homecare and physician visits within 30 days during COVID-19. The type of visits examined included both in-person as well as virtual visits. Individuals discharged to inpatient rehabilitation experienced lower rates of general physician visits but higher rates of specialist and homecare visits. Patients discharged to long-term care were significantly less likely to receive a physician visit following COVID-19, and significantly more likely to be readmitted within 7-days. There were no significant differences in mortality irrespective of discharge destination during the two time periods. Overall, the onset of the initial wave of COVID-19 significantly impacted healthcare utilization among those with a delayed discharge but varied depending on destination, with those in long-term care being most impacted.
在 2019 年冠状病毒病（COVID-19）的初始浪潮中，预计会有大量 COVID-19 患者涌入，因此急性医院迅速将患者出院。那些不再接受急性医疗护理但正在等待下一个目的地（即延迟出院）的患者受到了特别影响。本研究的目的是研究 COVID-19 发病对经历急性护理延迟出院患者的医疗保健利用和死亡率的影响。我们使用链接的行政数据进行了一项基于人群的回顾性队列研究。我们纳入了在 2019 年 4 月 1 日至 2020 年 9 月 30 日期间经历延迟住院的急性护理出院患者。COVID-19 的发病是暴露（2020 年 3 月 1 日），而 2019 年 4 月 1 日至 2 月 29 日期间则作为对照。主要结局包括出院后的医疗保健利用和死亡率，按护理场所（家庭护理、住院康复或长期护理）分层。多变量逻辑、零膨胀泊松回归和 Cox 比例风险模型用于在调整协变量的情况下检查 COVID-19 对结局的影响。那些出院回家的人在 COVID-19 期间更有可能在 30 天内接受家庭护理和医生就诊。检查的就诊类型包括面对面和虚拟就诊。出院到住院康复的人接受普通医生就诊的次数较少，但接受专科医生和家庭护理就诊的次数较多。出院到长期护理的患者在 COVID-19 后接受医生就诊的可能性显著降低，在 7 天内再次入院的可能性显著增加。在两个时期，无论出院目的地如何，死亡率均无显著差异。总体而言，COVID-19 初始浪潮的爆发对延迟出院患者的医疗保健利用产生了重大影响，但因出院目的地而异，长期护理患者受到的影响最大。
