Identification of Functional Limitations and Discharge Destination in Patients With COVID-19

Abstract

Objective The objectives of this study were to identify functional limitations in COVID-19 patients admitted to acute care hospitals, to evaluate functional limitations by demographic, medical and encounter characteristics, and to examine functional limitations in relation to discharge destination. Design and Setting This is a cross sectional, retrospective study of adult patients with COVID-19 who were discharged from two different types of hospitals (academic medical center and a community hospital) within one healthcare system between January 1 and April 30, 2020. Participants Patients were identified from the Cedars-Sinai COVID-19 data registry who had a new onset positive test for SARS-CoV-2. A total of 273 cases were identified, which included 230 cases that were discharged alive and 43 patients who expired and were excluded from the study sample. Interventions Not applicable Main Outcome Measures Functional limitations in COVID-19 patients in acute care hospitals and the predictors for discharge disposition. Results A total of 230 records were analyzed including demographic, encounter, medical, and functional variables. In a propensity-score matched cohort based on age and comorbidity, 88.2% had functional physical health deficits, 72.5% had functional mental health deficits, and 17.6% experienced sensory deficits. In the matched cohort, individuals discharged to an institution experienced greater physical (62.7% vs. 25.5%, p<.001) and mental health (49.0% vs. 23.5%, p=.006) deficits than patients discharged home. Marital status (OR 3.17, p=.011) and physical function deficits (OR 3.63, p=0.025) were associated with an increase odds ratio of discharge to an institution. Conclusions This research highlights that functional status is a strong predictor for discharge destination to an institution for COVID-19 patients. Patients who were older, in the acute care hospital longer, and with comorbidities were more likely to be discharged to an institution. Rehabilitation is a significant aspect of the healthcare system for these vulnerable patients. The challenges of adjusting the role of rehabilitation providers and systems during the pandemic needs further exploration. Moreover, additional research is needed to look more closely at the many facets and timing of functional status needs, to shed light in utilization of interdisciplinary rehabilitation services, and to guide providers and healthcare systems in facilitating optimal recovery and patient outcomes.

Effects of a Comprehensive Pulmonary Rehabilitation in Severe Post-COVID-19 Patients

“…After participation in PR, further care of the patients was possible in the home environment with the support of walking aids, home care, the help of relatives or oxygen supplementation. These results are in contrast to the findings of Roberts et al showing that physical function deficits in COVID-19 patients were associated with an increased odds ratio of discharge to an institution from acute care hospitals [ 7 ]. In Switzerland, patients with severe COVID-19 infection and persistent significant functional deficits were given the option to be transferred to an inpatient rehabilitation program for post-acute treatment.…”

“…Complications include respiratory failure, non-pulmonary complications such as acute myocardial injury, renal failure or thromboembolic events, septic shock, and multiple organ failure in severe cases. Therefore, a large number of patients with severe COVID-19 suffer from functional physical and partly psychological limitations [ 6 , 7 ].…”

“…A significant number of patients with COVID-19 admitted to rehabilitation have spent time in the intensive care unit (ICU) and have symptoms common to other ICU patients, including dyspnea, anxiety, depression, prolonged pain, impaired physical function and poor quality of life [ 7 , 8 ]. Although the lung is the primary target of coronavirus infection, clinical signs of central (i.e., dizziness, headache, and/or impaired consciousness) and/or peripheral nervous system (i.e., taste and/or smell impairment) involvement have been reported, especially in patients requiring mechanical ventilation [ 9 ].…”

Activity Measure for Post-Acute Care “6-Clicks” for the Prediction of Short-term Clinical Outcomes in Individuals Hospitalized With COVID-19: A Retrospective Cohort Study

“…6 However, other factors may be necessary to identify individuals who require additional services in the acute and early post-acute phase. For example, three recent studies have reported significant associations between impairments in physical function and important outcomes like discharge destination 7 , hospital readmission, 8 and mortality 9 in this population. These results are consistent with a small but growing number of reports highlighting prognostic significance of physical function in hospitalized patients, 10 suggesting that routine assessment of physical function in the hospital may help guide the delivery of care, particularly during a pandemic when resources are stretched.…”

A Hospital's Legal Responsibility For Patient Rights During The Covid-19 Pandemic - A Review From The Health Sector's Law Regulations

“…West Java has the most, with approximately 1,200 units, while Maluku has the fewest, with only 22 ventilators. The average number of ventilators available in each hospital is approximately 3-4 units, which is considered insufficient to handle the surge in patient volume (Roberts et al, 2021;Vlachos et al, 2021).…”