Background The burden and presentation of post-acute sequela of SARS-CoV-2 infection (PASC) are a developing major public health concern. Objectives To characterize the burden of PASC in community-dwelling individuals and understand the experiences of people living with PASC. Methods This mixed-methods study of COVID-19 positive community-dwelling persons involved surveys and in-depth interviews. Main outcome was self-report of possible PASC symptoms 3 weeks or longer after positive COVID-19 test. In-depth interviews were guided by a semi-structured interview guide with open-ended questions and probes based on emerging literature on PASC and the impact of COVID-19. Results With a survey response rate of 70%, 442 participants were included in this analysis, mean (SD) age 45.4 (16.2) years, 71% female, 12% Black/African American. Compared to those with no PASC symptoms, persons who reported PASC symptoms were more likely to be older (mean age: 46.5 vs. 42; p = 0.013), female (74.3% vs. 61.2%; p = 0.010), to have pre-existing conditions (49.6% vs. 34%; p = 0.005), and to have been hospitalized for COVID-19 (14.2% vs. 2.9%; p = 0.002). About 30% of the participants experienced severe fatigue; the proportion of persons reporting severe fatigue was 7-fold greater in those with PASC symptoms (Adjusted Prevalence Ratio [aPR] 6.73, 95%CI: 2.80–16.18). Persons with PASC symptoms were more likely to report poor quality of life (16% vs. 5%, p<0.001) and worse mental health functioning (Mean difference: -1.87 95%CI: -2.38, -1.37, p<0.001). Themes from in-depth interviews revealed PASC was experienced as debilitating. Conclusions In this study, the prevalence of PASC among community-dwelling adults was substantial. Participants reported considerable coping difficulties, restrictions in everyday activities, invisibility of symptoms and experiences, and impediments to getting and receiving PASC care.
Aims Historically, patients with non-ST elevation acute coronary syndrome (NSTE-ACS) are monitored as inpatients following successful percutaneous coronary intervention (PCI), but accumulating evidence demonstrates that accelerated discharge is safe, reduces cost, and enhances patient satisfaction. This quality improvement project examined the impact of implementing a post-PCI streamlined discharge process for NSTE-ACS patients on length of stay (LOS), major adverse cardiovascular events, and provider utilization at a university-affiliated hospital system. Methods and results Clinical characteristics, the timing of admission, PCI, and discharge data were collected prospectively from patients presenting to the catheterization laboratory for intervention for NSTE-ACS during 90-day historical control and implementation periods. The knowledge to action implementation model was employed to establish a peer-coaching based educational tool for educating interventional cardiologists and inpatient clinicians regarding patients with low-risk characteristics suitable for same-day discharge (SDD) following PCI. Patient characteristics were similar between the historical and implementation periods. Although total hospital LOS did not decrease (51 ± 24 vs. 41 ± 18 h; P = 0.14), the discharge process reduced LOS after PCI among low-risk patients (22 ± 6 vs. 17 ± 8 h; P = 0.003). Complication and readmission rates were unchanged by SDD. Provider utilization of the discharge process increased four-fold during the implementation period (8% vs. 32%; P = 0.02). Conclusions Implementation of an accelerated discharge process following PCI for low-risk NSTE-ACS patients reduced post-PCI LOS without increasing readmissions or complications. Increased utilization of the process throughout the implementation period may be attributed to peer coaching.
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