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OBJECTIVES: The multifaceted long-term impairments resulting from critical illness and COVID-19 require interdisciplinary management approaches in the recovery phase of illness. Operational insights into the structure and process of recovery clinics (RCs) from heterogeneous health systems are needed. This study describes the structure and process characteristics of existing and newly implemented ICU-RCs and COVID-RCs in a subset of large health systems in the United States. DESIGN: Cross-sectional survey. SETTING: Thirty-nine RCs, representing a combined 156 hospitals within 29 health systems participated. PATIENTS: None. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: RC demographics, referral criteria, and operating characteristics were collected, including measures used to assess physical, psychologic, and cognitive recoveries. Thirty-nine RC surveys were completed (94% response rate). ICU-RC teams included physicians, pharmacists, social workers, physical therapists, and advanced practice providers. Funding sources for ICU-RCs included clinical billing (n = 20, 77%), volunteer staff support (n = 15, 58%), institutional staff/space support (n = 13, 46%), and grant or foundation funding (n = 3, 12%). Forty-six percent of RCs report patient visit durations of 1 hour or longer. ICU-RC teams reported use of validated scales to assess psychologic recovery (93%), physical recovery (89%), and cognitive recovery (86%) more often in standard visits compared with COVID-RC teams (psychologic, 54%; physical, 69%; and cognitive, 46%). CONCLUSIONS: Operating structures of RCs vary, though almost all describe modest capacity and reliance on volunteerism and discretionary institutional support. ICU- and COVID-RCs in the United States employ varied funding sources and endorse different assessment measures during visits to guide care coordination. Common features include integration of ICU clinicians, interdisciplinary approach, and focus on severe critical illness. The heterogeneity in RC structures and processes contributes to future research on the optimal structure and process to achieve the best postintensive care syndrome and postacute sequelae of COVID outcomes.

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Introduction: As an increasing number of patients present for ambulatory care following acute COVID-19, we set out to characterize and identify clinical predictors of prolonged symptoms and antibody seroconversion. We hypothesized that patients who present with a high symptom burden are more likely have prolonged post-acute sequelae of COVID-19 (PASC). Methods: All adults with confirmed SARS-CoV-2 infection evaluated at a single ambulatory center between April and September 2020 were studied retrospectively using a logit model and ANOVA; the importance of variables associated with prolonged symptoms and seroconversion was determined using machine learning methodology. Results: The most common initial symptoms of 276 subjects were fatigue, dyspnea, cough, fever, and myalgia, with ~30% experiencing all five. Those with prolonged sequelae (>4 weeks) reported higher initial symptom burden compared to those without PASC (mean 8.2 vs. 3.3 symptoms, p<0.0001). Anosmia (odds ratio, OR 23.0), myalgia (OR 12.8), and dyspnea (OR 10.8) had highest predictive values for prolonged sequelae. Neither lung function, nor pre-existing lung disease correlated with PASC pulmonary symptoms (p=0.17, p=0.5, respectively). Natural post-COVID-19 seroconversion rate was 78%, with male gender having higher and corticosteroid treatment and elevated creatinine having lower likelihood of seroconversion. Conclusion: Ambulatory PASC patients display a broad range of symptoms. A high initial symptom burden correlates with prolonged sequelae. In unvaccinated individuals, antibody seroconversion may be influenced by gender, corticosteroid use, and renal function.

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