High levels of COVID-19 in the county where a hospital is located appear to be reducing survival rates among hospital patients with the virus, according to a new study from researchers at Perelman School of Medicine at University of Pennsylvania and at UnitedHealth Group. These results were published in JAMA Internal Medicine.
“We know that individual risk factors such as age and gender, comorbidities such as obesity, and whether someone lives in a nursing home, are all part of determining whether patients have a good or bad outcome. But our research shows that where a patient is admitted is also important, “said lead investigator David Asch, MD, director of the Center for Healthcare Innovation and Professor of Medicine at University of Pennsylvania.
The team analyzed nearly 40,000 COVID-19 patients admitted to 955 hospitals nationwide between January 1 and June 30, 2020. They examined the proportion of these patients who died in hospital within 30 days of being admitted or discharged to hospital, which may indicate a probable death from the virus. They found that, on average, nearly 12 percent of patients admitted with COVID-19 died to hospitals nationwide, but mortality rates were in hospitals with the best outcomes at 9 percent compared to nearly 16 percent for the group of hospitals with the worst outcomes. .
Data were also broken down into two periods – one stretching from January to the end of April – widely seen as the most challenging time of the first COVID-19 surge – and another from early May to late June – when case numbers began to decline. Over the two periods, 398 of the hospitals studied had sufficient COVID-19 patients to compare mortality. Patients had an early mortality rate of more than 16 percent compared to about 9 percent in the group since May and June. All but one of the hospitals improved their survival rate – in fact, 94 percent improved their numbers by 25 percent or more.
“COVID-19 results in U.S. hospitals have improved dramatically, and very rapidly,” said Natalie Sheils, PhD, a research scientist at UnitedHealth Group. “But the death rate of more than 9 percent among hospitalized patients remains very high, and COVID-19 remains a dangerous disease.”
While these data may link to more knowledge about COVID-19 and treatment for its patients, the analysis found a different, conventional feature.
“Development, in general, is likely to come from experience of how to manage oxygenation for these patients, as well as new treatments such as dexamethasone,” Asch explained. ‘explain the difference in outcomes across hospitals and the difference in their development. The biggest factor associated with their results or improvement, based on our data, was the rate of COVID-19 transmission in the hospital hospital. surrounding community. “
The team found that hospitals in counties with higher COVID-19 case rates had worse outcomes. Hospitals in counties where case rates decreased had the greatest improvement over time.
“With the current increase in winter, I am concerned that hospitals will bring some of the positive benefits in the summer,” Asch said. “Not only will raw death rates go up, but death rates could also rise. “
It was the association between high community case rates and high mortality that prompted the goal of “smoothing the loop.” The idea was to keep rates as low as possible – even over a longer period of time – as issues were becoming worse at the same time than issues were spread out over time. The findings of this study seem to support this view. Although vaccines are being approved for emergency use, the vaccine is likely to be widely available months away.
“If it is the COVID-19 community burden that determines how well the patients in our hospital are doing, as our study shows, then the advice has not changed. best: stay away, wash your hands, mask up, “said Asch. “Hospitals need our help.”
Other authors studied included Nazmul Islam, Yong Chen, Rachel M. Werner, John Buresh, and Jalpa A. Doshi.