Post-COVID clinic utilization among critical illness survivors of two waves of SARS-CoV-2 infection

Background Post-COVID clinics were implemented to improve post-acute care for patients with COVID-19, including critical illness survivors, many of whom experience post-intensive care syndrome (PICS). Whether post-acute care changed over the course of the pandemic and if inequities in utilization exist remains unclear. Research Question Among COVID-19 critical illness survivors, what were the patterns of post-discharge care during different pandemic waves and are there inequities in outpatient utilization? Study Design and Methods In this retrospective cohort study, we describe sociodemographics, illness severity, outpatient utilization, and PICS burden up to 18 months after discharge for COVID-19 patients admitted to an intensive care unit (ICU) at three Boston area hospitals during two waves (W1 and W2) of hospitalizations during the pandemic. Multivariable logistic regression models identified variables associated with follow-up in post-COVID clinics and adverse post-discharge healthcare outcomes, including readmissions, ED visits, and all-cause post-discharge mortality. Results 319/478 (66.7%) W1 and 80/187 (42.8%) W2 patients survived to hospital discharge. During W1, there was a higher proportion of patients with limited English proficiency (LEP) admitted to the ICU (45.5% vs 30.0%, p = 0.012) and a lower severity of illness on admission (SOFA: 4 [IQR 2-8] vs 6 [IQR 4-8], p = 0.013). PICS symptoms were common across both waves (80.6% vs 78.8%, p = 0.72). In multivariable analyses, LEP was associated with decreased odds of post-COVID clinic follow-up [adjusted OR (aOR)= 0.80, 95% CI 0.70-0.92, p < 0.01] and increased odds of adverse post-discharge healthcare outcomes (aOR=1.49, 95% CI 1.11-2.0, p < 0.01). Interpretation The overall burden of PICS was high across waves. LEP was associated with inequities in post-COVID clinic follow-up and worse post-discharge outcomes, suggesting that language is an important target for further interventions to support equitable recovery after critical illness.