Temporal changes in post-acute care for survivors of critical illness from covid-19

SESSION TITLE: Cultural Diversity Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Post-COVID clinics were variably implemented nationwide to help improve post-acute care, including for survivors of critical illness with post-intensive care syndrome (PICS). However, little is known about how post-acute care changed over the course of the pandemic and if disparities in utilization exist. METHODS: We retrospectively collected demographic, clinical, and utilization data up to 18 months after discharge for all patients with COVID-19 admitted to an ICU at three Mass General Brigham hospitals during two waves of the pandemic, from March 11-May 31, 2020 (wave one) and December 1, 2020 – February 28, 2021 (wave two). We used chi-square (or Fisher’s exact) tests to compare hospital discharge needs, prevalence of PICS symptoms, and outpatient utilization between waves. RESULTS: In wave one, 472 patients were discharged and 299 (63.3%) survived to at least one month; in wave two, 158 patients were discharged and 73 (46.2%) survived to at least one month. There were notable demographic differences, with patients identifying as Hispanic / Latinx, Black, and non-English-speaking constituting a larger proportion of wave one compared to wave two (wave 1 vs. wave 2 Hispanic / Latinx: 43.0% vs. 24.7%, Black: 10.0% vs 5.5%, and non-English speaking: 44.3% vs 27.4%, respectively, p<0.001). [DO1] A greater proportion of wave two patients were discharged with home oxygen (wave 1: 25.3% vs wave 2: 42.5%, p < 0.01),[DO2] but there were no differences in rates of tracheostomy, gastrostomy tubes, and hemodialysis at discharge. Wave two patients had higher severity of illness (median SOFA score: wave 1: 4 [2-8] vs. wave 2: 7 [5-8], p<0.01) and increased hospital readmission rates (wave 1: 38.3% vs. wave 2: 58.9%, p <0.01), but the prevalence of PICS was consistently high (wave 1: 85.3% vs wave 2: 84.9%, p=0.53). Post-COVID clinics referral rates were similar across waves (wave 1: 35.7% vs wave 2: 41.1%, p=0.39), however fewer patients completed visits in wave two (26.7% vs 16.4%, p=0.07). In multivariable analyses, limited English proficiency was associated with decreased odds of post-COVID clinic visit in wave one (adjusted odds ratio [aOR] = 0.75, 95% CI 0.66-0.86, p < 0.01), but not in wave two (aOR = 1.31, 95% CI 0.78-2.21, p=0.31). There was no statistically significant difference in readmission rates during either wave among patients with post-COVID clinic follow up in wave one (38.8% vs 37.5%, p = 0.89), though the rate was lower in wave two (41.7% vs 62.3%, p=0.21). CONCLUSIONS: Despite differences in the demographics and inpatient illness severity across waves, the overall burden of PICS remained high. There was a trend towards decreased utilization of post-COVID clinics in wave two despite consistent referral rates. CLINICAL IMPLICATIONS: Given the disparity in post-COVID utilization by language early in the pandemic and overall decreased utilization in wave two, further research is necessary to understand the factors contributing to lower utilization among these high-risk patients to ensure equitable access to post-acute care. DISCLOSURES: No relevant relationships by George Alba No relevant relationships by Lisa Bebell No disclosure on file for Leslie Chang No relevant relationships by Nupur Dandawate No relevant relationships by Alexander Gavralidis No relevant relationships by Patrick Gordan No relevant relationships by Kathryn Hibbert No relevant relationships by Cher Huang No relevant relationships by Sirus Jesudasen No disclosure on file for Aran Kadar No disclosure on file for Peggy Lai No relevant relationships by Emily Moin No relevant relationships by Daniel Okin Consultant relationship with United Therapeutics Please note: 1 day by Alison Witkin, value=Consulting fee Removed 04/01/2023 by Alison Witkin, source=Web Response Consultant relationship with Actelion Pharmaceuticals Please note: 2022-2023 Added 03/31/2023 by Alison Witkin, source=Web Response, value=Consulting fee