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The association between hospital COVID-19 burden and mortality

During the COVID-19 pandemic, many hospitals have faced COVID-19 patient surges ­– and experienced high COVID-19 burden – while others have not ­– and over a year since initial COVID-19 surges in the U.S., many hospitals across the country are actually still overwhelmed by COVID-19 patients. What role has this influx of COVID-19 patients had on hospital outcomes?

A new research report from the University of California, San Francisco (UCSF), co-authored by CarePort CEO and founder Lissy Hu, MD and Tom Martin, CarePort director of post-acute care analytics, assesses the variation in COVID-19 mortality across more than 14,000 COVID-19 patients at 117 U.S. hospitals. The report examines whether COVID-19 burden, which is the number of COVID-19 patients admitted to a hospital in April 2020 divided by the hospital’s certified bed count, was associated with mortality in this large sample of U.S. hospitals. The study population included over 14,000 COVID-19 patients, 20.9% of whom had died at five weeks of follow-up.

In this study, patients admitted to the most burdened hospitals had a higher likelihood of dying. This relationship, which persisted after adjusting for age, sex, and comorbid conditions,

suggests a threshold at which patient surges may result in excess mortality. Notably, however, when adjusting for race and average gross income, COVID-19 burden was not associated with in-hospital mortality. However, prior studies of hospitalized patients have not found race

to be predictive of mortality, after adjusting for other factors. Further, the relationship between COVID-19 burden and mortality was not significant when restricting the sample to larger hospitals with more than 20 patients. This suggests that larger hospitals may be more resilient in the face of patient surges – whether increased availability of staff who can be redeployed to patients, increased experience managing severe respiratory failure, or other factors.

Interestingly, in-hospital mortality varied widely across hospitals within this study, even among the most burdened hospitals. The reasons for this variability – whether patient management, hospital staffing, or the use of investigational or advanced therapies – are unknown.

So why does this correlation between hospitals experiencing high-burden and mortality exist? Higher hospital volume is typically associated with better patient outcomes, as patients want to seek high-quality care with the most experienced physicians. As hospitals experienced unprecedented surges during COVID-19, however, that has not been the case. Many hospitals simply didn’t – and still may not ­– have adequate staffing resources to meet the increased patient load; studies have already shown that periods of high ICU demand during the COVID-19 pandemic resulted in increased mortality. Despite an initial focus on ventilators and other equipment, the UCSF study indicates that hospitals’ COVID-19 mortality rates may also be correlated with staffing resources.

Read the full Journal of Hospital Medicine report here.

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