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

OBJECTIVES: The objectives of this study were to identify functional limitations in patients with coronavirus 2019 (COVID-19) admitted to acute care hospitals; to evaluate functional limitations by demographic, medical, and encounter characteristics; and to examine functional limitations in relation...

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Autores principales: Roberts, Pamela, Wertheimer, Jeffrey, Park, Eunice, Nuño, Miriam, Riggs, Richard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: by the American Congress of Rehabilitation Medicine 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709477/
https://www.ncbi.nlm.nih.gov/pubmed/33278363
http://dx.doi.org/10.1016/j.apmr.2020.11.005
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author Roberts, Pamela
Wertheimer, Jeffrey
Park, Eunice
Nuño, Miriam
Riggs, Richard
author_facet Roberts, Pamela
Wertheimer, Jeffrey
Park, Eunice
Nuño, Miriam
Riggs, Richard
author_sort Roberts, Pamela
collection PubMed
description OBJECTIVES: The objectives of this study were to identify functional limitations in patients with coronavirus 2019 (COVID-19) 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 2 different types of hospitals (academic medical center and a community hospital) within 1 health care system from January 1 to April 30, 2020. PARTICIPANTS: Patients were identified from the Cedars-Sinai COVID-19 data registry who had a new-onset positive test for severe acute respiratory syndrome coronavirus 2. A total of 273 patients were identified, which included 230 patients who were discharged alive and 43 patients who died and were excluded from the study sample. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional limitations in patients with COVID-19 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 (odds ratio, 3.17; P=.011) and physical function deficits (odds ratio, 3.63; P=.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 patients with COVID-19. 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 health care 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 use of interdisciplinary rehabilitation services, and to guide providers and health care systems in facilitating optimal recovery and patient outcomes.
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spelling pubmed-77094772020-12-02 Identification of Functional Limitations and Discharge Destination in Patients With COVID-19 Roberts, Pamela Wertheimer, Jeffrey Park, Eunice Nuño, Miriam Riggs, Richard Arch Phys Med Rehabil Original Research OBJECTIVES: The objectives of this study were to identify functional limitations in patients with coronavirus 2019 (COVID-19) 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 2 different types of hospitals (academic medical center and a community hospital) within 1 health care system from January 1 to April 30, 2020. PARTICIPANTS: Patients were identified from the Cedars-Sinai COVID-19 data registry who had a new-onset positive test for severe acute respiratory syndrome coronavirus 2. A total of 273 patients were identified, which included 230 patients who were discharged alive and 43 patients who died and were excluded from the study sample. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional limitations in patients with COVID-19 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 (odds ratio, 3.17; P=.011) and physical function deficits (odds ratio, 3.63; P=.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 patients with COVID-19. 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 health care 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 use of interdisciplinary rehabilitation services, and to guide providers and health care systems in facilitating optimal recovery and patient outcomes. by the American Congress of Rehabilitation Medicine 2021-03 2020-12-02 /pmc/articles/PMC7709477/ /pubmed/33278363 http://dx.doi.org/10.1016/j.apmr.2020.11.005 Text en © 2020 by the American Congress of Rehabilitation Medicine. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Original Research
Roberts, Pamela
Wertheimer, Jeffrey
Park, Eunice
Nuño, Miriam
Riggs, Richard
Identification of Functional Limitations and Discharge Destination in Patients With COVID-19
title Identification of Functional Limitations and Discharge Destination in Patients With COVID-19
title_full Identification of Functional Limitations and Discharge Destination in Patients With COVID-19
title_fullStr Identification of Functional Limitations and Discharge Destination in Patients With COVID-19
title_full_unstemmed Identification of Functional Limitations and Discharge Destination in Patients With COVID-19
title_short Identification of Functional Limitations and Discharge Destination in Patients With COVID-19
title_sort identification of functional limitations and discharge destination in patients with covid-19
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709477/
https://www.ncbi.nlm.nih.gov/pubmed/33278363
http://dx.doi.org/10.1016/j.apmr.2020.11.005
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