Comparison of Outcomes and Process of Care for Patients Treated at Hospitals Dedicated for COVID-19 Care vs Other Hospitals

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Abstract

Importance: Early in the SARS-CoV-2 pandemic, the M Health Fairview Hospital System established dedicated hospitals for establishing cohorts and caring for patients with COVID-19, yet the association between treatment at COVID-19-dedicated hospitals and mortality and complications is not known.

Objective: To analyze the mortality rate and complications associated with treatment at the COVID-19-dedicated hospitals.

Design, Setting, and Participants: This retrospective cohort study evaluated data prospectively collected from March 1, 2020, through June 30, 2021, from 11 hospitals in Minnesota, including 2 hospitals created solely to care for patients with COVID-19. Data obtained included demographic characteristics, treatments, and outcomes of interest for all patients with a confirmed COVID-19 infection admitted to this hospital system during the study period.

Exposures: Patients were grouped based on whether they received treatment from 1 of the 2 COVID-19-dedicated hospitals compared with the remainder of the hospitals within the hospital system.

Main Outcomes and Measures: Multivariate analyses, including risk-adjusted logistic regression and propensity score matching, were performed to evaluate the primary outcome of in-hospital mortality and secondary outcomes, including complications and use of COVID-specific therapeutics.

Results: There were 5504 patients with COVID-19 admitted during the study period (median age, 62.5 [IQR, 45.0-75.6] years; 2854 women [51.9%]). Of these, 2077 patients (37.7%) (median age, 63.4 [IQR, 50.7-76.1] years; 1080 men [52.0%]) were treated at 1 of the 2 COVID-19-dedicated hospitals compared with 3427 (62.3%; median age, 62.0 [40.0-75.1] years; 1857 women (54.2%) treated at other hospitals. The mortality rate was 11.6% (n = 241) at the dedicated hospitals compared with 8.0% (n = 274) at the other hospitals (P < .001). However, risk-adjusted in-hospital mortality was significantly lower for patients in the COVID-19-dedicated hospitals in both the unmatched group (n = 2077; odds ratio [OR], 0.75; 95% CI, 0.59-0.95) and the propensity score-matched group (n = 1317; OR, 0.78; 95% CI, 0.58-0.99). The rate of overall complications in the propensity score-matched group was significantly lower (OR, 0.81; 95% CI, 0.66-0.99) and the use of COVID-19-specific therapeutics including deep vein thrombosis prophylaxis (83.9% vs 56.9%; P < .001), high-dose corticosteroids (56.1% vs 22.2%; P < .001), remdesivir (61.5% vs 44.5%; P < .001), and tocilizumab (7.9% vs 2.0; P < .001) was significantly higher.

Conclusions and Relevance: In this cohort study, COVID-19-dedicated hospitals had multiple benefits, including providing high-volume repetitive treatment and isolating patients with the infection. This experience suggests improved in-hospital mortality for patients treated at dedicated hospitals owing to improved processes of care and supports the use of establishing cohorts for future pandemics.

Original languageEnglish (US)
Article numbere220873
JournalJAMA Network Open
Volume5
Issue number3
DOIs
StatePublished - 2022

Bibliographical note

Funding Information:
Conflict of Interest Disclosures: Dr Olson reported receiving grants from The Ultran Group Grant funding for COVID-19 therapeutics outside the submitted work. No other disclosures were reported.

Funding Information:
Funding/Support: Dr Usher was supported by Agency for Healthcare Research and Quality (AHRQ) grant R01HS026732 and Dr Tignanelli was supported by a AHRQ/Patient-Centered Outcomes Research Institute (PCORI) K12 grant. This research was supported by the) and AHRQ/PCORI grant K12HS026379 and the National Institutes of Health National Center for Advancing Translational Sciences grant KL2TR002492. Additional support for Minnesota Learning Health System Mentored Career Development Program (MN-LHS) scholars is offered by the University of Minnesota Office of Academic Clinical Affairs and the Division of Health Policy and Management, University of Minnesota School of Public Health. Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ, PCORI, or MN-LHS.

Publisher Copyright:
© 2022 Bergman ZR et al.

Keywords

  • Aged
  • COVID-19/complications
  • Cohort Studies
  • Female
  • Hospital Mortality
  • Hospitalization
  • Hospitals, Special
  • Humans
  • Male
  • Middle Aged
  • Minnesota/epidemiology
  • Multivariate Analysis
  • Odds Ratio
  • Outcome and Process Assessment, Health Care
  • Propensity Score
  • Quality of Health Care
  • Retrospective Studies
  • SARS-CoV-2

PubMed: MeSH publication types

  • Journal Article
  • Comparative Study

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