Study tracks hospital readmission risks for COVID-19 patients in Alberta, Ontario |  CBC News

Study tracks hospital readmission risks for COVID-19 patients in Alberta, Ontario | CBC News

A new study offers a closer look at potential factors that may lead to some COVID-19 patients being readmitted to hospital within a month of discharge.

At about 9 percent, the researchers say, the readmission rate is similar to that of other diseases, but socioeconomic factors and gender appear to play a larger role in predicting which patients are most likely to experience relapse when sent home.

Research published Monday in the Canadian Medical Association Journal looked at 46,412 adults who were hospitalized with COVID-19 in Alberta and Ontario during the early part of the pandemic. About 18 percent – 8,496 patients – died in hospital between January 2020 and October 2021, which is a higher rate than normal for other respiratory infections.

Of those repatriated, about 9 percent returned to hospital within 30 days of leaving, while 2 percent died.

The combined rate of readmission or death was similar in each province, at 9.9 percent or 783 patients in Alberta, and 10.6 percent or 2,390 patients in Ontario.

For those wondering if patients were discharged too soon, the report found that most spend less than a month in the hospital and that patients who stayed longer were actually returned at a slightly higher rate.

“We initially wondered, ‘Have people been sent home too soon? Co-author Dr. Finley McAllister, professor of general internal medicine at the University of Alberta, Edmonton, said there was no association between length of hospital stay and readmission rates, which is reassuring.

“So it looked like doctors were identifying the right patients to send home.”

check peaks

Craig Gein, an associate professor of microbiology, immunology and infectious diseases at the University of Calgary who was not involved in the research, said the study indicates that the health care system has been able to withstand the stresses of the pandemic.

“We’ve heard a lot about how severe this disease is, and there has always been a little bit of a fear that because of the capacity of healthcare, maybe people will be taken out of the system,” Jane said. “There was a significant increase in loss of life but this was not due to the patient treatment system.

“Caution was not sacrificed despite the truly unprecedented stress being put on staff and systems during the peak periods of those early waves.”

Jin said the study also provides important insight into the power of vaccines in preventing dangerous outcomes.

The study found that of all patients admitted with COVID-19 in both provinces, 91% were not vaccinated in Alberta and 95% in Ontario.

The report found that readmitted patients tended to be male, elderly, with multiple comorbidities and previous hospital visits and admissions. They were more likely to be out of home care or into a long-term care facility.

McAlister also found that socioeconomic status was a factor, noting that hospitals traditionally use a scoring system called LACE to predict outcomes by looking at length of stay, age, comorbidities and previous emergency room visits, but that “this has not been a good predictor of post-COVID patients.”

“Including things like socioeconomic status, male gender and where they were actually laid off also had a huge impact as well. It goes back to the full message we see over and over again with COVID: Socioeconomic deprivation appears to be even more important for COVID than other medical conditions” .

Knowing this can help transportation coordinators and family doctors identify patients who need extra help when they leave the hospital, McAllister said.

Indications of “deprivation”

On its own, LACE had only a modest ability to predict readmission or death, but adding variables including patient neighborhood and gender improved accuracy by 12 percent, adds supporting co-author Dr. Saint Michael in Toronto.

The study did not explore the extent to which socioeconomic status itself was a factor, but it did look at ZIP codes associated with so-called “deprivation” indicators such as lower education and income among the population.

Readmissions were about the same regardless of neighborhood, but patients from ZIP codes that scored high on the Denial Index were more likely to accept COVID-19 as a start, Verma notes.

Verma adds that reliance on postal codes has limitations in assessing socioeconomic status because urban postal codes can have significant variance in their demographics. He also noted that the study did not include patients who did not have a ZIP code.

About half of patients have returned with breathing difficulties, McAllister said, which is the most common diagnosis for readmission of any kind.

He suspected that many of these problems were difficult to prevent, noting that “they may just be a progression of the underlying disease.”

Looking at readmissions is just the tip of the iceberg. – Dr. Finley McAllister-doctor. Finley McAllister

He added that it is clear, however, that many people who appear to have survived COVID are unable to fully beat the disease.

“Looking at re-entries is just the tip of the iceberg. There is some data from [World Health Organization] He said that roughly half to two-thirds of individuals who have COVID severe enough to be admitted to hospital end up with lung problems or heart problems afterward, if you do enough detailed examinations.

“If patients are given quality-of-life scores and symptom questionnaires, they report significantly more disability levels than we capture in analyzes of hospital admissions or emergency room visits.”

The research period predates the Omicron boom that emerged in late 2021 but McAllister said there was no reason to suspect there was much difference between today’s patients.

He said that although Omicron’s results have been shown to be less severe than the delta variant, they are comparable to the wild type of the novel coronavirus that started the pandemic.

“If you don’t get vaccinated and you get Omicron, it’s still not a walk in the park,” he said.

2022-05-16 17:33:17

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