Risk Factors for Re-admission in Covid-19 Patients from a Tertiary Care Health System: Quality Control (QC) and Quality Improvement (QI) Project

Abstract

The COVID-19 pandemic has made a significant impact on public health globally and has unleashed an array of deficiencies that have already crippled our health care system. It also brought out the health care disparities among minorities and thrust health inequity to the limelight. Hospital readmission is one descriptive marker for overall patient clinical prognosis. Prior to SARS-CoV-2 Pandemic (COVID-19), 30-day-all cause readmission rates was highest in patients with heart failure, psychoses, chronic lung disease, and peripheral vascular disease status post-surgical procedure. However, pneumonia is the most common reason for unplanned patient readmission. COVID-19 continues to evolve, from the rising versality in variants to the clinical concerns of longer haulers. This study followed by a review will illustrate COVID-19 post-acute disease role on readmission diagnosis and rates. The aim is to identify most common reason for readmission and overall patient clinical prognosis. Readmitted patients in this study were older. In this QC/QI project the frequent symptom on readmission was respiratory illness and the primary diagnostic codes on readmission were noted to be respiratory failure and “COVID-19 sequelae.” Readmitted patients in this study were older (>61yrs of age), with an equal sex distribution, more likely to have multiple comorbidities, majority were of African American ethnicity, reflecting the disproportionate impact ofCOVID-19 on this group. About 70% of readmissions had a Charlson Comorbidity index of 3 and above reflecting the chronic conditions present in this cohort. Less than 40% of patients were up to date with their COVID 19 immunization and overall mortality rate was close to 12%. Based on our QC/QI analysis, a comprehensive and coordinated approach that addresses important metrics comprising optimal medical management of comorbidities, COVID 19/Pneumococcal immunizations, focus on mental health treatment and homelessness is essential to decrease the risk for readmissions in this population.