JMIR Rehabil Assist Technol . Patient Outcomes and Lessons-Learned from Treating Patients with Severe COVID-19 at a Long-Term Acute Care Hospital: A Single-Center Retrospective Analysis

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JMIR Rehabil Assist Technol


. 2022 Jan 11.
doi: 10.2196/31502. Online ahead of print.
Patient Outcomes and Lessons-Learned from Treating Patients with Severe COVID-19 at a Long-Term Acute Care Hospital: A Single-Center Retrospective Analysis


Peter Grevelding ¹ , Henry Charles Hrdlicka ¹ , Stephen Holland ² , Lorraine Cullen ^{2 3 1} , Amanda Meyer ^{2 1} , Catherine Connors ² , Darielle Cooper ² , Allison Greco ²



Affiliations

• PMID: 35023835
• DOI: 10.2196/31502

Abstract

Background: With the continuation of the COVID-19 pandemic, shifting active COVID-19 care from short-term acute care hospitals (STACHs) to long-term acute care hospitals (LTACHs) could decrease STACH census during critical stages of the pandemic and maximize limited resources.
Objective: To describe characteristics, clinical management, and patient outcomes during and after acute COVID-19 phase in an LTACH in the Northeastern United States.
Methods: A single-center, group comparative retrospective analysis of electronic medical records of patients treated for COVID-19-related impairments, from March 19, 2020 through August 14, 2020, and a Reference population of medically complex patients discharged between December 1, 2019 and February 29, 2020. This study was conducted to evaluate patient outcomes in response to the facility's holistic treatment approach.
Results: Of the 127 total COVID-19 admissions, 118 were discharged by the data cut-off. At admission, 29.9% (38/127) of patients tested-positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at admission. The mean (95% confidence interval; CI)) age of the COVID-19 cohort was younger compared to the Reference cohort [63.3 (61.1, 65.4) vs 65.5 (63.2, 67.8); p=0.0365]. There were similar proportions of males and females between cohorts (p=0.3825), however, the COVID-19 cohort observed a greater proportion of patients of a non-white/Caucasian than the Reference cohort [p=0.0013; Odd's ratio (95% CI) = 2.79 (1.5, 5.2)]. The mean (95% CI) length-of-stay of the COVID-19 cohort was also similar to that of the Reference [25.5 (23.2, 27.9) vs 29.9 (24.7, 35.2); p=0.8369]. Interestingly, a positive correlation between patient age and length-of-stay was observed in the COVID-19 cohort (p=0.019, r2=0.05), but not the Reference. Ambulation assistance scores improved for both the Reference and COVID-19 cohorts from admission to discharge (p<0.0001). However, the mean (95% CI) assistance score of the COVID-19 cohort was greater than the Reference at discharge [4.9 (4.6, 5.3) vs 4.1 (3.7, 4.7); p=0.0012]. Similarly, the mean (95% CI) change in gait distance was greater in the COVID-19 cohort compared to the Reference [221.1 (163.2, 279.2) vs 146.4 (85.6, 207.3); p=0.0007]. Of the 16 patients mechanically ventilated at admission, 94% (15/16) were weaned before discharge (mean 11.3 days). Of the 75 patients admitted with a restricted diet, 75% (56/75) were discharged on a regular diet.
Conclusions: The majority of patients treated at an LTACH for severe COVID-19 and related complications benefited from coordinated care and rehabilitation. In comparison to the Reference cohort, patients treated for COVID-19 were discharged with greater improvements in ambulation distance and assistance needs during a similar length of stay. These findings indicate other patients with COVID-19 would benefit from LTACH level of care.