The report is a product of the VA/HSR&D Evidence Synthesis Program.
COVID-19 Post-hospitalization Healthcare Utilization: A Living Review
Coronavirus disease-2019 (COVID-19) was declared a pandemic in March 2020. Early research efforts optimized treatment approaches and reduced mortality rates, increasing the number of survivors who suffered from sequelae of COVID-19. Yet, severe illness and hospitalization are more common in older patients and those with underlying health conditions. Investigators with VA’s Evidence Synthesis Program (ESP) Center in Durham, NC conducted a living review to determine the prevalence of short-term (<3 months) and long-term (≥3 months) healthcare utilization among adults discharged after hospitalization for COVID-19.
A living rapid review updates a systematic review, incorporating relevant new evidence as it becomes available. This review was requested by national VA operations leadership that is managing COVID-19 clinical care procedures and policies.
Investigators searched MEDLINE and EMBASE on September 2, 2020, as well as the Covid-19 Portfolio server from National Institutes of Health (NIH) iCite. Eligible studies reported on hospital discharge disposition or healthcare utilization in adults hospitalized for COVID-19. Nearly 2,500 articles were assessed for the following: author/year, location, clinical setting, study date, number of patients, patient characteristics, the highest level of care received, the occurrence of intubation during hospitalization, duration of hospitalization, and medical comorbidities (i.e., heart disease, lung disease, diabetes). Of the 135 articles given a full-text review, the investigators identified 6 eligible cohort studies (4,982 participants) that met review criteria.
Summary of Findings
A low certainty of evidence showed that most patients hospitalized with COVID-19 were discharged home, and a portion were discharged to either skilled nursing or rehabilitation facilities. After discharge, 5% (range 2% to 11%; n=5 studies, 4,552 patients) of these patients were readmitted to the hospital at a median of 37 days follow-up. This is lower than rates observed in other chronic diseases. The use of emergency department visits, palliative care use, home health, and durable medical equipment-mobility aids were reported infrequently.
The investigators plan to update this living review through August 2022, or until conclusions are supported by a moderate certainty of evidence.
Understanding how hospitalizations for COVID-19 influence patients’ downstream medical use can assist health systems, including VA, and rehabilitation departments in preparing to care for these patients. VA and other healthcare systems should consider treatments to address COVID-related symptoms, potentially reducing costly healthcare use and rehospitalization. Interventions including home healthcare, medication, assistive devices, and respiratory, physical, or occupational therapy could decrease the risk of future medical utilization. Ample evidence suggests that exercise-based interventions targeting functional limitations can reduce re-hospitalization rates in other patients, which may translate to patients after COVID-19 hospitalization.
Research Gaps/Future Research
Findings from this living review will help direct future research to address gaps in the clinical knowledge on healthcare utilization among adults discharged after hospitalization for COVID-19. There is a lack of studies on:
- Type, frequency, and dose of home-based health services post-hospitalization;
- Use of physical or occupational therapy services post-discharge; and
- Rehabilitation services providing during hospitalization.
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, Cantrell S, Ear B, Williams JW. COVID-19 Post-Hospitalization Health Care Utilization. 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; 2021.
To view the full report, go to https://vaww.hsrd.research.va.gov/publications/esp/covid19-post-hosp.cfm (VA intranet only)
ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
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