COVID-19 hospital prevalence as a risk factor for mortality: an observational study of a multistate cohort of 62 hospitals

Fakih, Mohamad G.; Ottenbacher, Allison; Yehia, Baligh R.; Fogel, Richard I.; Miller, Collin; Winegar, Angela L.; Jesser, Christine; Cacchione, Joseph

doi:10.1136/bmjqs-2021-013721

Cited by 13 publications

(13 citation statements)

References 32 publications

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“…On the other hand, it contrasted with the results of a study carried out in 85 hospitals in the United States of America in which there was no signi cant association of in-hospital case-fatality rate with overall hospital COVID-19 case volume but rather with more rapid COVID-19 case-growth (32). Other studies indicated, in speci c periods, high COVID-19 hospital prevalence as a risk factor for mortality (33,34). It is important to note that to provide high-quality care, hospitals need resources, investments, teamwork, and expertise.…”

Section: Discussionmentioning

confidence: 55%

COVID-19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data

Portela

Martins

Lima

et al. 2023

Preprint

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Background The COVID-19 pandemic occurred in an unfavorable political context in Brazil, and problems accumulated in the Unified Health System (SUS) over time. The preparedness and response of the healthcare system, involving the SUS and a private sector, was affected by large socioeconomic inequities across the country. This work was aimed at studying variations in COVID-19 inpatient mortality in Brazil throughout the pandemic in the period from 2020–2022, focusing on differences across public, private and philanthropic (private nonprofit) inpatient healthcare units, providers and nonproviders of services to the Unified Health System (SUS). Methods This cross-sectional study used secondary data from the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics (IBGE). The main data source was the SIVEP-Gripe, which comprises data on severe acute respiratory illness records prospectively collected. We also employed the National Record of Health Establishments, the SUS’ Hospitalization Information System (SIH-SUS) and municipalities' data from IBGE. We considered adult COVID-19 hospitalizations registered in SIVEP-Gripe from February 2020 to December 2022 in inpatient healthcare units with a minimum of 150 cases in the period. Data analyses explored the occurrence of hospitalizations and inpatient mortality over time and across the groups of hospitals defined by juridical ownership and participation in SUS. Moreover, general linear mixed models were estimated to identify independent effects on COVID-19 inpatient mortality of characteristics of patients, healthcare processes, healthcare units and municipalities. Results Approximately 70% of the COVID-19 hospitalizations in Brazil were covered by the SUS, but SUS hospitals had worse inpatient mortality than others. Northern Brazil experienced the highest chances of inpatient mortality, with no significant differentiation among inpatient care unit types. Black individuals had higher chances of COVID-19 inpatient mortality in all regions of the country, as well as indigenous individuals in the North and mixed-race individuals in the South. Additionally, inpatient mortality was higher in the first (Apr-Aug 2020) and second (Dec 2020-May 2021) pandemic waves, becoming lower in 2022, even during the third wave (Jan-Feb 2022). Conclusions COVID-19 exposed SUS healthcare weaknesses resulting from long-term disinvestment, and its lower performance is a problem to be addressed.

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Section: Discussionmentioning

confidence: 55%

COVID-19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data

Portela

Martins

Lima

et al. 2023

Preprint

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“…Moreover, obesity, liver disease and diabetes were independently associated with increased risk of COVID-19 mortality. 17 18 …”

Section: Discussionmentioning

confidence: 99%

Experience of the United Arab Emirates in the use of monoclonal antibody drug sotrovimab in high-risk vaccinated and unvaccinated patients with COVID-19: an observational cohort study

Abdalateef

Meheiri²,

Nassef

et al. 2023

BMJ Open

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ObjectivesMonoclonal antibodies can slow COVID-19 progression. This study describes the experience of using sotrovimab in patients with COVID-19 at high risk for disease progression and hospitalisation within the United Arab Emirates (UAE).DesignObservational cohort study.SettingA tertiary hospital in the Emirate of Sharjah, UAE.ParticipantsPatients with mild or moderate COVID-19 at high risk for disease progression.InterventionsInfusion with a single 500 mg dose of the monoclonal antibody drug sotrovimab.Primary and secondary outcome measuresAny adverse effect within 24 hours, disease progression within 5 days, emergency department visit within 10 days, hospital admission within 10 days or mortality within 28 days of infusion.Results3227 high-risk COVID-19 patients were infused with sotrovimab during the mild (n=3107, 96.3%) or moderate (n=120, 3.7%) disease stages. The incidence of at least one outcome was recorded in 196 (6.1%) of the patients (60.7 per 1000 patients). The most common outcome was disease progression within 5 days of infusion in 129 patients (4.0%), followed by emergency department visits by 90 patients (2.8%) within 10 days. Twenty-nine (0.9%) patients were hospitalised within 10 days of infusion with only two deaths (0.1%). Patients infused with sotrovimab during the moderate disease stage had 11 times greater odds of developing at least one outcome compared with patients infused during the mild stage (adjusted OR, aOR 10.86, 95% CI 7.14 to 16.54). SARS-CoV-2 vaccinated (aOR 12.8, 95% CI 7.3 to 20.5) and unvaccinated (aOR 7.2, 95% CI 3.4 to 15.3) patients infused with sotrovimab during the moderate disease stage had similar odds of at least one outcome compared with patients infused during the mild stage.ConclusionsAmong high-risk sotrovimab-infused COVID-19 patients, there were relatively low incidences of disease progression and hospitalisation. Regardless of vaccination history, monoclonal antibody intervention during the early stages of COVID-19 results in better outcomes.

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“…Studies describe the rapid adjustments hospitals made to staffing, space, and how services were provided to patients [ 27 , 33 – 35 ], but we know little about how the pandemic affected ongoing quality improvement efforts. Our study helps explain why quality and safety performance appears to have worsened during the pandemic [ 6 , 7 , 36 ]. Participants in our study described going into survival mode and focusing only on the most immediate challenges related to the pandemic.…”

Section: Discussionmentioning

confidence: 99%

Effect of COVID-19 on the implementation of a multifaceted intervention to improve teamwork and quality for hospitalized patients: a qualitative interview study

Terwilliger

Manojlovich

Johnson

et al. 2022

BMC Health Serv Res

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Background Healthcare organizations made major adjustments to deliver care during the COVID pandemic, yet little is known about how these adjustments shaped ongoing quality and safety improvement efforts. We aimed to understand how COVID affected four U.S. hospitals’ prospective implementation efforts in an ongoing quality improvement initiative, the REdesigning SystEms to Improve Teamwork and Quality for Hospitalized Patients (RESET) project, which implemented complementary interventions to redesign systems of care for medical patients. Methods We conducted individual semi-structured interviews with 40 healthcare professionals to determine how COVID influenced RESET implementation. We used conventional qualitative content analysis to inductively code transcripts and identify themes in MAXQDA 2020. Results We identified three overarching themes and nine sub-themes. The three themes were (1) COVID exacerbated existing problems and created new ones. (2) RESET and other quality improvement efforts were not the priority during the pandemic. (3) Fidelity of RESET implementation regressed. Conclusion COVID had a profound impact on the implementation of a multifaceted intervention to improve quality and teamwork in four hospitals. Notably, COVID led to a diversion of attention and effort away from quality improvement efforts, like RESET, and sites varied in their ability to renew efforts over time. Our findings help explain how COVID adversely affected hospitals’ quality improvement efforts throughout the pandemic and support the need for research to identify elements important for fostering hospital resilience.

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COVID-19 hospital prevalence as a risk factor for mortality: an observational study of a multistate cohort of 62 hospitals

Cited by 13 publications

References 32 publications

COVID-19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data

COVID-19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data

Experience of the United Arab Emirates in the use of monoclonal antibody drug sotrovimab in high-risk vaccinated and unvaccinated patients with COVID-19: an observational cohort study

Effect of COVID-19 on the implementation of a multifaceted intervention to improve teamwork and quality for hospitalized patients: a qualitative interview study

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