Medical Complexity and Healthcare Utilization Among Patients Attending Three U.S. Post- COVID Clinics

Abstract

Background Patients who do not fully recover or develop new symptoms following SARS-CoV-2 infection require follow-up and sometimes seek care at specialized multidisciplinary care clinics. We aimed to describe the clinical characteristics and care needs of patients at three such post-COVID clinics. Methods We conducted a multisite retrospective electronic chart review of 984 patients, aged ≥ 18 years, who visited one of three post-COVID clinics at least 28 days after a clinical or polymerase chain reaction (PCR)-confirmed diagnosis of SARS-CoV-2 infection between January 20, 2020, and March 31, 2021. The clinics were located in Omaha, Nebraska, New York City, New York, and Dallas, Texas. Patient records were obtained through September 30, 2021. Data on clinical evaluations and healthcare provider visits were abstracted by trained clinical personnel using a standardized health record abstraction tool. Results The median age was 52 years (range 18–89 years), 59.9% were female, and 69.0% were White. Of 984 patients, 79.9% had SARS-CoV-2 infection that was confirmed by PCR, 32.1% had three or more comorbid conditions, and 39.4% had been hospitalized. During post-COVID follow-up, the most common symptoms were shortness of breath (59.2%), post-exertional malaise (45.6%), fatigue (43.2%), and brain fog (42.8%). Nearly one in three patients had a diagnosis of post-viral fatigue syndrome (30.1%), and pulmonary system conditions (24.4%) were also common. Overall, the 984 participants attended 3914 visits (median 3; range 1–46) over a median follow-up period of 107 days (range 1–560) between first and last post-COVID follow-up visits. Of the 984 patients, 64.3% were referred for subspecialty care notably pulmonology, cardiology, and neurology. More than a third of patients were referred for rehabilitation therapy (37.9%) including physical, occupational, speech, and psychotherapy. Conclusion Adult patients at post-COVID clinics have a wide range of symptoms and conditions that highlight the medical complexity of these patients and their need for high levels of care, including multiple health care visits and referrals for therapy. This underscores the need for well-coordinated, multidisciplinary care, and planning of health resources for post-COVID-19 follow-up care.