COVID-19 Post-hospitalization Health Care Utilization: A Living Review

Prepared by: Evidence Synthesis Program (ESP) Durham VA Health Care System Durham, NC Jennifer M. Gierisch, PhD, MPH, Co-Director Karen M. Goldstein, MD, MSPH, Co-Director Recommended citation: Sharpe JA, Burke C, Gordon AM, Gierisch JM, Allen KD, Goode AP, Ballengee L, Shepherd-Banigan M, Hughes JM, Hastings SN, Van Houtven C, Goldstein KM, Zullig LL, Kosinski AS, Dickerson SW, Cantrell S, Ear B, Williams JW Jr. COVID-19 Post-hospitalization Health Care Utilization: A Living Review. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-010; 2022.

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Takeaway

After updating the search, the review includes 19 cohort studies. We continue to conclude that a substantial proportion of adults with COVID-19 post-hospitalization required continued care in a skilled nursing or rehabilitation facility or utilized home health services post-discharge. However, short-term readmission rates were modest. These data suggest that health care systems will need post-acute care services including home health, and rehabilitation capacity to support patients' needs following discharge.

Context

SARS-CoV-2 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. At its peak, more than 26 of every 100,000 adult Americans were hospitalized for COVID-19. The objective for this review was to determine short-and long-term health care utilization following a COVID-19–related hospitalization.

Key Findings

We identified 6 eligible cohort studies (4982 participants) conducted in Europe or the United States early in the pandemic. ROB was assessed as low in the largest study, unclear in 4 studies, and high in 1 study. Most surviving patients were discharged home, but a substantial proportion were discharged to a skilled nursing facility or rehabilitation facility (median 13%; range 6.7% to 29.2%; n=4 studies, 930 patients). After discharge, 4.5% (range 1.9% to 11.1%; n=5 studies, 4552 patients) were readmitted to the hospital at a median of 37 days follow up. One high ROB study, restricted to higher severity patients (n=161), reported high rates of home health services and home oxygen requirement. Other outcomes including emergency department visits, palliative care use, home health, and durable medical equipment-mobility aids were reported infrequently. Study heterogeneity precluded meta-analysis, and the certainty of evidence for all outcomes was very low.

See also

COVID-19 Post-hospitalization Healthcare Utilization: A Living Review (Management eBrief)

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