To date, there has been a lack of information on the characteristics and outcomes of patients hospitalized with COVID-19 and discharged into the home environment. Researchers Kathryn Bowles and Margaret McDonald – both from the Visiting Nurse Service of New York (VNSNY) – are working to change that.
Over the past few months, Bowles and McDonald have analyzed OASIS data and other information associated with hundreds of patients recovering from acute aconavirus home stays. The goal of their analysis, Bowles told Home Health Care News, is to show the value of home care at a time when new infections are skyrocketing and hospital beds are scarce.
According to the U.S. Centers for Medicare & Medicaid Services (CMS), only one in ten patients hospitalized with COVID-19 will be discharged home with home health services.
“We knew that nationwide only 11% of [hospital discharges] receive home health services after COVID-19 – and that seems very small to us, ”said Bowles, who serves as vice president and director of the VNSNY Center for Home Care Policy and Research. “We had hoped we could demonstrate the value of home health care, and we raised awareness that home health care is a resource that can be used to support community recovery.”
In addition to her role at VNSNY, Bowles is Professor and Van Ameringen Chair of Excellence in Nursing at the University of Pennsylvania’s School of Nursing. McDonald, the deputy director of the VNSNY Policy and Research Center, agreed with these views.
The researchers’ findings on COVID-19 patient characteristics and outcomes were officially published in the Annals of Internal Medicine On Monday.
“We continue to face that [emergency] and hospital stays are on the rise again, “said McDonald. “I’m really glad this is being released at this point.”
“You were very sick”
Bowles and McDonald helped transform the VNSNY Center for Home Care Policy and Research a well-known research power plant, one that has spent millions of dollars on dozens of groundbreaking projects focused on home care over the past three decades.
Like most of her earlier work, her newly published look at COVID-19 in the home environment leverages VNSNY’s vast data infrastructure and position as the largest nonprofit home care organization in the country. The focus of their COVID-19 analysis on the New York-based VNSNY was particularly illuminating given that New York City and the surrounding area were once the global epicenter of the pandemic.
New York reported its first confirmed COVID-19 case on March 1. Since then, the state has had more than 601,000 total cases, including more than 33,000 deaths.
“Given that we were in the epicenter of the pandemic and had the largest nonprofit home care agency in the country, we knew we had access to great data on patients coming out of hospitals,” Bowles said.
As part of their most recent project, Bowles and McDonald conducted a retrospective observational cohort study analyzing medical information from 1,409 COVID-19 patients enrolled in VNSNY’s home health services between April 1 and June 15 after hospitalization . Referrals came from 64 hospitals, with the median age of the patients being 67 years – much younger than the typical Medicare home health patient.
In fact, about 43% of the patients were younger than 65 years. The somewhat surprising age of the patients was likely linked to the devastating effects COVID-19 had on older populations, McDonald noted.
“We believe the influence was that we met with survivors from the hospital,” she said. “And unfortunately the oldest of the ‘older population’ did not survive [hospital stays]especially in the early days. “
Upon admission to the home health care system, the majority of patients had multiple comorbidities and risk factors for re-hospitalization, such as: B. Difficulty following medical instructions or fatigue on admission. The most common comorbid conditions were high blood pressure, diabetes, and chronic lung disease.
42% of the patients who studied Bowles and McDonald experienced daily or constant pain. 84% reported difficulty breathing with every effort and 50% reported symptoms of anxiety. The vast majority of the 1,409 patients had severe functional impairments, with 85% requiring help with four or more daily living activities (ADLs).
“They were very sick when they entered home health care,” Bowles said.
This changed in a remarkable way after in-home services were provided.
After an average of 32 days of care, 94% of patients with COVID-19 who related to home care were discharged from service. Exactly 1,241 patients – or 88% of the total sample – were discharged without adverse health events such as re-hospitalization or death.
In contrast to the poor symptoms and functional profile of patients on admission to home health, most patients had “statistically significant improvements” in pain, breathing, cognition, and anxiety at discharge. Functional improvements were also common in most patients, Bowles and McDonald found.
“I was happily surprised at the recovery, which took place in a relatively short amount of time,” said McDonald. “After 30 or 32 days, we could see that people were recovering.”
The value of home health care
Bowles and McDonald hoped that home health officials could use their findings to better prepare to care for COVID-19 patients in the community.
A key finding was how similar COVID-19 patients are to sepsis survivors.
“The uptake characteristics of COVID-19 survivors are very similar to those of sepsis survivors enrolled in the HHC (Home Health Care) nationally,” said their study in Annals of Internal Medicine. “Recent evidence suggests that early home health visits combined with week 1 outpatient follow-up visits decreased the number of re-hospitalizations for sepsis survivors.”
Another aspect of her research was the balance between face-to-face phone visits and video visits.
In total, the 1,409 patients cared for at home received 13,926 family doctor visits. More than 75% of these visits were in person, with 16% and 8% being done by phone and video, respectively.
“[The care team] appreciated the personal visits and continued to use them as often as they could, ”said Bowles. “And they were let into the house by the patients.”
Registered nurses accounted for 52% of the visits and physical therapists for 37% of the visits. The rest was provided by social workers as well as occupational therapists and speech therapists. The patients received an average of 11 visits.
In addition to home health officials, Bowles and McDonald hoped that the health system as a whole would use their findings to move care further into the home if possible.
“An important recommendation in preparation for post-acute care peaks due to COVID-19 was to expand the use of HHC to provide qualified nursing and rehabilitation services at home, thus preventing the transmission to other patients that can occur in inpatient facilities.” They write. “This advice was forward-looking as our study shows that discharged COVID-19 survivors from HHC showed excellent symptom improvement and functional outcomes, highlighting that post-acute support from HHC provides the opportunity to facilitate the recovery of future patients with COVID-19 support.”
