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Heterogeneity in COVID-19 patient volume, characteristics and outcomes across US Department of Veterans Affairs facilities: an observational cohort study
OBJECTIVE: Studies describe COVID-19 patient characteristics and outcomes across populations, but reports of variation across healthcare facilities are lacking. The objectives were to examine differences in COVID-19 patient volume and mortality across facilities, and understand whether facility vari...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941674/ https://www.ncbi.nlm.nih.gov/pubmed/34006034 http://dx.doi.org/10.1136/bmjopen-2020-044646 |
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author | Bravata, Dawn M Myers, Laura J Perkins, Anthony J Keyhani, Salomeh Zhang, Ying Zillich, Alan J Dysangco, Andrew Lindsey, Reese Sharmitha, Dev Myers, Jennifer Austin, Charles Sexson, Ali Arling, Greg |
author_facet | Bravata, Dawn M Myers, Laura J Perkins, Anthony J Keyhani, Salomeh Zhang, Ying Zillich, Alan J Dysangco, Andrew Lindsey, Reese Sharmitha, Dev Myers, Jennifer Austin, Charles Sexson, Ali Arling, Greg |
author_sort | Bravata, Dawn M |
collection | PubMed |
description | OBJECTIVE: Studies describe COVID-19 patient characteristics and outcomes across populations, but reports of variation across healthcare facilities are lacking. The objectives were to examine differences in COVID-19 patient volume and mortality across facilities, and understand whether facility variation in mortality was due primarily to differences in patient versus facility characteristics. DESIGN: Observational cohort study with multilevel mixed effects logistic regression modelling. SETTING: The Veterans Health Administration (VA) is the largest healthcare system in the USA. PARTICIPANTS: Patients with COVID-19. MAIN OUTCOME: All-cause mortality within 45 days after COVID-19 testing (March–May, follow-up through 16 July 2020). RESULTS: Among 13 510 patients with COVID-19, 3942 (29.2%) were admitted (2266/3942 (57.5%) ward; 1676/3942 (42.5%) intensive care unit (ICU)) and 679/3942 (17.2%) received mechanical ventilation. Marked heterogeneity was observed across facilities in median age (range: 34.3–83.9 years; facility mean: 64.7, SD 7.2 years); patient volume (range: 1–737 at 160 facilities; facility median: 48.5, IQR 14–105.5); hospital admissions (range: 1–286 at 133 facilities; facility median: 11, IQR 1–26.5); ICU caseload (range: 1–85 at 115 facilities; facility median: 4, IQR 0–12); and mechanical ventilation (range: 1–53 at 90 facilities; facility median: 1, IQR 0–5). Heterogeneity was also observed in facility mortality for all patients with COVID-19 (range: 0%–29.7%; facility median: 8.9%, IQR 2.4%–13.7%); inpatients (range: 0%–100%; facility median: 18.0%, IQR 5.6%–28.6%); ICU patients (range: 0%–100%; facility median: 28.6%, IQR 14.3%–50.0%); and mechanical ventilator patients (range: 0%–100%; facility median: 52.7%, IQR 33.3%–80.6%). The majority of variation in facility mortality was attributable to differences in patient characteristics (eg, age). CONCLUSIONS: Marked heterogeneity in COVID-19 patient volume, characteristics and mortality were observed across VA facilities nationwide. Differences in patient characteristics accounted for the majority of explained variation in mortality across sites. Variation in unadjusted COVID-19 mortality across facilities or nations should be considered with caution. |
format | Online Article Text |
id | pubmed-7941674 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-79416742021-03-09 Heterogeneity in COVID-19 patient volume, characteristics and outcomes across US Department of Veterans Affairs facilities: an observational cohort study Bravata, Dawn M Myers, Laura J Perkins, Anthony J Keyhani, Salomeh Zhang, Ying Zillich, Alan J Dysangco, Andrew Lindsey, Reese Sharmitha, Dev Myers, Jennifer Austin, Charles Sexson, Ali Arling, Greg BMJ Open Health Services Research OBJECTIVE: Studies describe COVID-19 patient characteristics and outcomes across populations, but reports of variation across healthcare facilities are lacking. The objectives were to examine differences in COVID-19 patient volume and mortality across facilities, and understand whether facility variation in mortality was due primarily to differences in patient versus facility characteristics. DESIGN: Observational cohort study with multilevel mixed effects logistic regression modelling. SETTING: The Veterans Health Administration (VA) is the largest healthcare system in the USA. PARTICIPANTS: Patients with COVID-19. MAIN OUTCOME: All-cause mortality within 45 days after COVID-19 testing (March–May, follow-up through 16 July 2020). RESULTS: Among 13 510 patients with COVID-19, 3942 (29.2%) were admitted (2266/3942 (57.5%) ward; 1676/3942 (42.5%) intensive care unit (ICU)) and 679/3942 (17.2%) received mechanical ventilation. Marked heterogeneity was observed across facilities in median age (range: 34.3–83.9 years; facility mean: 64.7, SD 7.2 years); patient volume (range: 1–737 at 160 facilities; facility median: 48.5, IQR 14–105.5); hospital admissions (range: 1–286 at 133 facilities; facility median: 11, IQR 1–26.5); ICU caseload (range: 1–85 at 115 facilities; facility median: 4, IQR 0–12); and mechanical ventilation (range: 1–53 at 90 facilities; facility median: 1, IQR 0–5). Heterogeneity was also observed in facility mortality for all patients with COVID-19 (range: 0%–29.7%; facility median: 8.9%, IQR 2.4%–13.7%); inpatients (range: 0%–100%; facility median: 18.0%, IQR 5.6%–28.6%); ICU patients (range: 0%–100%; facility median: 28.6%, IQR 14.3%–50.0%); and mechanical ventilator patients (range: 0%–100%; facility median: 52.7%, IQR 33.3%–80.6%). The majority of variation in facility mortality was attributable to differences in patient characteristics (eg, age). CONCLUSIONS: Marked heterogeneity in COVID-19 patient volume, characteristics and mortality were observed across VA facilities nationwide. Differences in patient characteristics accounted for the majority of explained variation in mortality across sites. Variation in unadjusted COVID-19 mortality across facilities or nations should be considered with caution. BMJ Publishing Group 2021-03-08 /pmc/articles/PMC7941674/ /pubmed/34006034 http://dx.doi.org/10.1136/bmjopen-2020-044646 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Health Services Research Bravata, Dawn M Myers, Laura J Perkins, Anthony J Keyhani, Salomeh Zhang, Ying Zillich, Alan J Dysangco, Andrew Lindsey, Reese Sharmitha, Dev Myers, Jennifer Austin, Charles Sexson, Ali Arling, Greg Heterogeneity in COVID-19 patient volume, characteristics and outcomes across US Department of Veterans Affairs facilities: an observational cohort study |
title | Heterogeneity in COVID-19 patient volume, characteristics and outcomes across US Department of Veterans Affairs facilities: an observational cohort study |
title_full | Heterogeneity in COVID-19 patient volume, characteristics and outcomes across US Department of Veterans Affairs facilities: an observational cohort study |
title_fullStr | Heterogeneity in COVID-19 patient volume, characteristics and outcomes across US Department of Veterans Affairs facilities: an observational cohort study |
title_full_unstemmed | Heterogeneity in COVID-19 patient volume, characteristics and outcomes across US Department of Veterans Affairs facilities: an observational cohort study |
title_short | Heterogeneity in COVID-19 patient volume, characteristics and outcomes across US Department of Veterans Affairs facilities: an observational cohort study |
title_sort | heterogeneity in covid-19 patient volume, characteristics and outcomes across us department of veterans affairs facilities: an observational cohort study |
topic | Health Services Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941674/ https://www.ncbi.nlm.nih.gov/pubmed/34006034 http://dx.doi.org/10.1136/bmjopen-2020-044646 |
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