Post-COVID-19 Clinic Utilization Among Survivors of Critical Illness in Two Waves of SARS-CoV-2 Infection

Abstract

Background

Post-COVID-19 clinics were implemented to improve postacute care for patients with COVID-19, including survivors of critical illness, many of whom experience post-intensive care syndrome (PICS). Whether postacute care changed over the course of the pandemic and if inequities in utilization exist remain unclear.

Research Question

Among survivors of COVID-19 critical illness, what were the patterns of postdischarge 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 patients with COVID-19 admitted to an ICU at three Boston, Massachusetts, area hospitals during two waves (wave 1 and wave 2) of hospitalizations during the pandemic. Multivariable logistic regression models identified variables associated with follow-up in post-COVID-19 clinics and adverse postdischarge health care outcomes, including readmissions, ED visits, and all-cause postdischarge mortality.

Results

A total of 319 of 478 wave 1 patients (66.7%) and 80 of 187 wave 2 patients (42.8%) survived to hospital discharge. During wave 1, there was a higher proportion of patients with limited English proficiency (LEP) admitted to the ICU (45.5% vs 30.0%, P = .012) and a lower severity of illness on admission (Sequential Organ Failure Assessment score 4; interquartile range, 2-8 vs 6; interquartile range, 4-8; P = .013). PICS symptoms were common across both waves (80.6% vs 78.8%, P = .72). In multivariable analyses, LEP was associated with decreased odds of post-COVID-19 clinic follow-up (adjusted OR, 0.80; 95% CI, 0.70-0.92; P < .01) and increased odds of adverse postdischarge health care outcomes (adjusted OR, 1.49; 95% CI, 1.11-2.0; P < .01).

Interpretation

The overall burden of PICS was high across waves. LEP was associated with inequities in post-COVID-19 clinic follow-up and worse postdischarge outcomes, suggesting that language is an important target for further interventions to support equitable recovery after critical illness.