Service line care delivery model for COVID-19 patient-centric care

Mannan, Ashiq; Sutingco, Nick; Djurkovic, Svet; Reyes, Mary; Desai, Mehul; Groves, Soleyah; García, Iván; Azizi, Wali; Miner, Andrew S.; Elgawly, Sam; Trimble, Greg; Weisbruch, Paul; Osborn, Erik; Dean, Steven M.; Haider, Maruf; Erario, Madeline; Horgas, Patricia; Hodson, Erin; Lam, Brian; Bautista, James A.; Racila, Andrei; Kolacevski, Andrej; Henry, Linda; Motew, Stephen J.; Venkatesan, Chapy; Huston, Ann; Gerber, Naomi Lynn H.; Jones, J. Stephen; Younossi, Zobair M.

doi:10.37765/ajmc.2022.88731

Cited by 4 publications

(4 citation statements)

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“…mAb have been well described for reducing severity of early variants (eg, delta, omicron BM but not omicron BQ). 20 What remains to be answered is how frequently do patients who received mAb experience PASC; and which symptoms persist. Further, does symptom severity and resolution appear similar to patients who did not receive mAb treatment.…”

Section: Introductionmentioning

confidence: 99%

Post-Acute SARS-CoV-2 Symptoms are Fewer, Less Intense Over Time in People Treated with Mono-Clonal Antibodies for Acute Infection

Price¹,

Gerber²,

Stepanova³

et al. 2023

IJGM

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Many with post-acute SARS-CoV-2 (PASC) have persistent symptoms impacting physical and cognitive function, decreased health and health-related life quality. Monoclonal antibody (mAb) treatment was available to acutely infected patients which might improve these outcomes. Purpose: To compare patient perception of PASC symptoms for those receiving bamlanivimab or casirivimab and imdevimab (mAbs) to those not receiving this treatment (non-mAbs). To compare changes between these groups in symptoms, function and quality of life over a 6-month follow-up. Patients and Methods: Consented adults >28 days post-infection with positive SARS-CoV-2 qPCR or antigen test and SARS-CoV-2 infection between March of 2020 and July of 2022 were enrolled. This prospective, repeated measure observational study reports baseline through 6-month follow-up. Extensive sociodemographic data, detailed medical history, COVID-19 symptom history, and standardized measures of well-being, depression, anxiety, stigma, cognition, symptom assessment, distress, and health status were collected. Results: 323 participants [101 mAb, 221 non-mAb, 52.7±15.5 years, 47.7% male, body mass index (BMI) 31.4±8.4] were analyzed. Fewer symptoms at baseline were reported in mAb versus non-mAb participants (1.06±1.31 vs 1.78±2.15, respectively p=0.0177) 6 months: (0.911±1.276 mAb vs.1.75±2.22 non-mAb, p=0.0427). Both groups showed significant within-group decreases in symptom number (52 to 21 mAb, 126 to 63 non-mAb) and symptom burden (p=0.0088 mAb, p<0.00001 non-mAb). mAb patients had significantly shorter infection-to-baseline interval (days) (120.4±55.3 mAb vs 194.0±89.3 non-mAb, p<0.00001); less frequent history of myocardial infarction (0.0 vs 3.9%, p=0.0464); headache (2.0% vs.11.8%, p=0.0046), rash (3.1% vs 9.9%, p=0.0377), and miscellaneous muscle complaints (2.0% vs 12.3%, p=0.0035), plus significantly better 6-month mood. (2.2% vs 13.2%, p=0.0390). Conclusion: mAb treated participants had reduced symptom burden and consistently reported fewer symptoms than non-mAb at all time points despite less time since acute illness. Both groups reported a statistically significant decrease in symptoms by 6-month visit with no statistically significant differences between them at follow-up.

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Section: Introductionmentioning

confidence: 99%

Post-Acute SARS-CoV-2 Symptoms are Fewer, Less Intense Over Time in People Treated with Mono-Clonal Antibodies for Acute Infection

Price¹,

Gerber²,

Stepanova³

et al. 2023

IJGM

View full text Add to dashboard Cite

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Section: Methodsmentioning

confidence: 99%

“…Participants, as well as the local SARS-CoV-2 population treated within our health system, were described in previous publications. 12,[19][20][21][22][23] This study conforms to all STROBE guidelines, was reviewed and approved ethically by the Inova Institutional Review Board (IRB# U20-09-4279) and Western Institutional Review Board (WIRB; IRB# 1294366) as human subjects research, complies with the Declaration of Helsinki, and informed consent was obtained from all participants.…”

Section: Methodsmentioning

confidence: 99%

“…These included sociodemographic status, past medical history (PMH), participation in (remote and current) regular exercise (30 minutes, 5x/week or a total of 150 minutes/week), measures of cognition (Color Word interference Test (CWIT), Coding, Arithmetic, Matrix Reasoning), a clinical assessment of health behavior change, and a variety of PROs (eg, Edmonton Symptom Assessment System (ESAS), EuroQol-5 dimension healthrelated quality of life instrument (EQ5D)) Full protocol and instrument description can be found in our prior publications. 12,20 Fatigue Symptoms A special emphasis was also placed upon assessing fatigue -one of the most commonly reported symptoms in assessed PASC patients using the Functional Assessment of Chronic Illness Therapy -Fatigue (FACIT-F). The FACIT-F includes 4 subscales of well-being: physical (PWB, range 0-28), emotional (EWB, 0-24), social (SWB, 0-28) and functional (FWB, 0-28); and a fatigue subscale domain (FS, 0-52), which adds up to a total FACIT-F score (0-160).…”

Section: Study Measuresmentioning

confidence: 99%

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Severe, Persistent, Disruptive Fatigue Post-SARS-CoV-2 Disproportionately Affects Young Women

Price,

de Avila,

Stepanova

et al. 2023

IJGM

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Introduction Post-acute SARS-CoV-2 (PASC) symptoms are often persistent, disruptive, and difficult to treat effectively. Fatigue is often among the most frequently reported symptoms and may indicate a more challenging road to recovery. Purpose To describe the natural history, symptomology, and risk profile of long-term post-acute SARS-CoV-2. Patients and Methods Participants treated for SARS-CoV-2 within a large, community health system in the US were enrolled prospectively in a longitudinal, observational PASC study examining participants at enrollment and 6 months. Medical history, symptom reporting, validated measures of cognition, and patient-reported outcomes (PROs), were performed for all participants and repeated during study follow-up visits. Results A total of 323 participants completed baseline evaluations. Sixty one participants indicated clinically significant fatigue (23.1% at baseline); a representative sample of 141 enrollees also completed a baseline Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) in-depth fatigue reporting questionnaire, 37 had severe fatigue. The severely fatigued (FACIT-F ≤29.7) were significantly younger, female, had more anxiety and depression, had a higher resting heart rate, reported more sick days, and were less physically active post-COVID. They were more likely to have a diagnosis of chronic kidney disease (13.5% vs 2.9%) but less likely to have a history of cancer (8.1% vs 23.1). Participants who were severely fatigued reported health, diet, weight, and sleep were worse than those not severely fatigued post-COVID (p = 0.02 to 0.0002). Fatigue was significantly correlated with impairment of all PROs administered after COVID-19 infection. Conclusion Fatigue is a common symptom post-COVID-19 infection and is associated with lower reported well-being and function. Those with severe fatigue tended to be younger and female and have a past medical history of anxiety, depression, kidney disease, and more sedentary lifestyles.

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The impact of variants and vaccination on the mortality and resource utilization of hospitalized patients with COVID-19

et al. 2022

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Background COVID-19 outcomes among hospitalized patients may have changed due to new variants, therapies and vaccine availability. We assessed outcomes of adults hospitalized with COVID-19 from March 2020–February 2022. Methods Data were retrieved from electronic health medical records of adult COVID-19 patients hospitalized in a large community health system. Duration was split into March 2020–June 2021 (pre-Delta period), July–November 2021 (Delta period), and December 2021–February 2022 (Omicron period). Results Of included patients (n = 9582), 75% were admitted during pre-Delta, 9% during Delta, 16% during Omicron period. The COVID-positive inpatients were oldest during Omicron period but had lowest rates of COVID pneumonia and resource utilization (p < 0.0001); 46% were vaccinated during Delta and 61% during Omicron period (p < 0.0001). After adjustment for demographics and comorbidities, vaccination was associated with lower inpatient mortality (OR = 0.47 (0.34–0.65), p < 0.0001). The Omicron period was independently associated with lower risk of inpatient mortality (OR = 0.61 (0.45–0.82), p = 0.0010). Vaccination and Omicron period admission were also independently associated with lower healthcare resource utilization (p < 0.05). Magnitudes of associations varied between age groups with strongest protective effects seen in younger patients. Conclusion Outcomes of COVID-19 inpatients were evolving throughout the pandemic and were affected by changing demographics, virus variants, and vaccination. Key point In this observational study of almost 10,000 patients hospitalized from March 2020–February 2022 with COVID-19, age and having multiple comorbidities remained consistent risk factors for mortality regardless of the variant. Vaccination was high in our hospitalized patients. Vaccination conveyed less severe illness and was associated with lower inpatient mortality.

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Service line care delivery model for COVID-19 patient-centric care

Cited by 4 publications

References 0 publications

Post-Acute SARS-CoV-2 Symptoms are Fewer, Less Intense Over Time in People Treated with Mono-Clonal Antibodies for Acute Infection

Post-Acute SARS-CoV-2 Symptoms are Fewer, Less Intense Over Time in People Treated with Mono-Clonal Antibodies for Acute Infection

Severe, Persistent, Disruptive Fatigue Post-SARS-CoV-2 Disproportionately Affects Young Women

The impact of variants and vaccination on the mortality and resource utilization of hospitalized patients with COVID-19

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