Objectives
Severe cases of COVID-19 have overwhelmed hospital systems across the nation. To better understand patient’s journey within hospital setting, this study described the treatment journey of COVID-19 patients from hospital admission to 30 days after discharge for inpatients and hospital-based outpatients.
Methods
A retrospective cohort study was conducted using a large geographically diverse all-payer hospital administrative database (Premier Healthcare Database). Patients were identified by their first discharges between April 1 and July 31, 2020, with a principal or secondary discharge diagnosis of COVID-19 (ICD-10 diagnosis code, U07.1).
Results
Of 369,894 patients, 39% were inpatients and 61% were outpatients. Inpatients were older (median age 64 vs. 44 years) and more likely to be male (52% vs. 44%) and have baseline comorbidity (60% vs. 19%) compared to outpatients. (All p<0.05). Among inpatients, 80% originated from home, 9% from another acute care facility, and 94% were admitted through emergency department (ED). Of these patients, 23% were admitted to intensive care unit, 16% (n=22,665) died during initial hospitalization, 48% were discharged home, 14% to skilled nursing facility, 11% to home health, 6% were transferred to another hospital, and 3% to hospice. Within 30 days, an additional 0.7% (n=1,009) died, 4% were readmitted to same hospital, and 2% visited ED due to COVID-19. Among outpatients, 66% were ED outpatient visits. During initial visit, 91% were sent home, 2% were transferred to an acute care hospital, and 0.3% (n=712) died. An additional 0.4% (n=802) died, 7% visited ED, and 4% were hospitalized due to COVID-19 during follow-up visits within 30 days.
Conclusions
This study shows that COVID-19 is associated with high-level of ED utilization, ICU admission, and in-hospital mortality. Over one-third of inpatients required post-hospital healthcare services. Such info may help healthcare providers better allocate resources to take care of COVID-19 patients during the pandemic.
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