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Mortality and Readmission Rates Among Patients With COVID-19 After Discharge From Acute Care Setting With Supplemental Oxygen

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are the mortality and readmission rates in patients with COVID-19 pneumonia discharged according to an expected practice approach with supplemental home oxygen?

Findings  In this cohort study of 621 patients with COVID-19 discharged with supplemental home oxygen from emergency department and inpatient encounters at 2 large urban medical centers, the all-cause mortality rate was 1.3% and the all-cause 30-day return hospital admission rate was 8.5%. No patients died in the ambulatory setting or in transit when returning to acute care setting.

Meaning  In this study, a careful and systematic expected practice approach to treatment of patients with COVID-19 using home oxygen was associated with low all-cause mortality and low 30-day return admission rates.

Abstract

Importance  To optimize patient outcomes and preserve critical acute care access during the COVID-19 pandemic, the Los Angeles County Department of Health Services developed the SAFE @ HOME O2 Expected Practice (expected practice), enabling ambulatory oxygen management for COVID-19.

Objective  To assess outcomes of patients with COVID-19 pneumonia discharged via the expected practice approach to home or quarantine housing with supplemental home oxygen.

Design, Setting, and Participants  This retrospective cohort study included 621 adult patients with COVID-19 pneumonia who were discharged from 2 large urban public hospitals caring primarily for patients receiving Medicaid from March 20 to August 19, 2020. Patients were included in the analysis cohort if they received emergency or inpatient care for COVID-19 and were discharged with home oxygen.

Interventions  Patients receiving at least 3 L per minute of oxygen, stable without other indication for inpatient care, were discharged from either emergency or inpatient encounters with home oxygen equipment, educational resources, and nursing telephone follow-up within 12 to 18 hours of discharge. Nurses provided continued telephone follow up as indicated, always with physician back-up.

Main Outcomes and Measures  All-cause mortality and all-cause 30-day return admission.

Results  A total of 621 patients with COVID-19 pneumonia (404 male [65.1%] and 217 female [34.9%]) were discharged with home oxygen. Median age of these patients was 51 years (interquartile range, 45-61 years), with 149 (24.0%) discharged from the emergency department and 472 (76%) discharged from inpatient encounters. The all-cause mortality rate was 1.3% (95% CI, 0.6%-2.5%) and the 30-day return hospital admission rate was 8.5% (95% CI, 6.2%-10.7%) with a median follow-up time of 26 days (interquartile range, 15-55 days). No deaths occurred in the ambulatory setting.

Conclusions and Relevance  In this cohort study, patients with COVID-19 pneumonia discharged on home oxygen had low rates of mortality and return admission within 30 days of discharge. Ambulatory management of COVID-19 with home oxygen has an acceptable safety profile, and the expected practice approach may help optimize outcomes, by ensuring right care in the right place at the right time and preserving access to acute care during the COVID-19 pandemic.

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Article Information

Accepted for Publication: February 8, 2021.

Published: April 1, 2021. doi:10.1001/jamanetworkopen.2021.3990

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Banerjee J et al. JAMA Network Open.

Corresponding Author: Brad Spellberg, MD, Los Angeles County + University of Southern California (LAC+USC) Medical Center, 2051 Marengo St, Los Angeles, CA 90033 (bspellberg@dhs.lacounty.gov).

Author Contributions: Dr Banerjee had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Banerjee, Coffey, Wald-Dickler, Holtom, Shoenberger, Bowdish, Yee, Spellberg.

Acquisition, analysis, or interpretation of data: Banerjee, Canamar, Voyageur, Tangpraphaphorn, Lemus, Coffey, Wald-Dickler, Holtom, Shoenberger, Bowdish, Spellberg.

Drafting of the manuscript: Banerjee, Tangpraphaphorn, Lemus, Coffey, Wald-Dickler, Holtom, Bowdish, Spellberg.

Critical revision of the manuscript for important intellectual content: Banerjee, Canamar, Voyageur, Tangpraphaphorn, Coffey, Wald-Dickler, Holtom, Shoenberger, Bowdish, Yee.

Statistical analysis: Banerjee, Canamar, Tangpraphaphorn, Bowdish.

Obtained funding: Coffey.

Administrative, technical, or material support: Voyageur, Tangpraphaphorn, Lemus, Coffey, Holtom, Shoenberger, Yee, Spellberg.

Supervision: Lemus, Coffey, Holtom, Yee, Spellberg.

Conflict of Interest Disclosures: None reported.

References
1.
Rutherford  P , Anderson  A , Kotagal  U ,  et al  Achieving Hospital-wide Patient Flow. Institute for Healthcare Improvement; 2017.
2.
Del Rio  C , Malani  PN .  COVID-19-New insights on a rapidly changing epidemic.   JAMA. 2020;323(14):1339-1340. doi:10.1001/jama.2020.3072 PubMedGoogle ScholarCrossref
3.
Del Rio  C , Malani  PN .  2019 Novel coronavirus-important information for clinicians.   JAMA. 2020;323(11):1039-1040. doi:10.1001/jama.2020.1490 PubMedGoogle ScholarCrossref
4.
Del Rio  C , Malani  P .  Translating science on COVID-19 to improve clinical care and support the public health response.   JAMA. 2020;323(24):2464-2465. doi:10.1001/jama.2020.9252 PubMedGoogle ScholarCrossref
5.
Omer  SB , Malani  P , Del Rio  C .  The COVID-19 pandemic in the US.   JAMA. 2020;323(18):1767-1768. doi:10.1001/jama.2020.5788PubMedGoogle Scholar
6.
Soni  SM , Giboney  P , Yee  HF  Jr .  Development and implementation of expected practices to reduce inappropriate variations in clinical practice.   JAMA. 2016;315(20):2163-2164. doi:10.1001/jama.2016.4255 PubMedGoogle ScholarCrossref
7.
Bailey  MK , Weiss  AJ , Barrett  ML , Jiang  HJ . Characteristics of 30-day all-cause hospital readmissions, 2010-2016. Published 2019. Accessed October 5, 2020. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb248-Hospital-Readmissions-2010-2016.jsp
8.
Tenforde  MW , Billig Rose  E , Lindsell  CJ ,  et al; CDC COVID-19 Response Team.  Characteristics of adult outpatients and inpatients with COVID-19 - 11 academic medical centers, United States, March-May 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(26):841-846. doi:10.15585/mmwr.mm6926e3 PubMedGoogle ScholarCrossref
9.
Yadaw  AS , Li  YC , Bose  S , Iyengar  R , Bunyavanich  S , Pandey  G .  Clinical features of COVID-19 mortality: development and validation of a clinical prediction model.   Lancet Digit Health. 2020;2(10):e516-e525. doi:10.1016/S2589-7500(20)30217-X PubMedGoogle ScholarCrossref
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