Variations in long-term care home resident hospitalizations before and during the COVID-19 pandemic in Ontario
To examine how the COVID-19 pandemic affected the demographic and clinical characteristics, in-hospital care, and outcomes of long-term care residents admitted to general medicine wards for non-COVID-19 reasons. We conducted a retrospective cohort study of long-term care residents admitted to genera...
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| Vydáno v: | PloS one Ročník 17; číslo 11; s. e0264240 |
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| Hlavní autoři: | , , , , , , , , , , , |
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| Jazyk: | angličtina |
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Public Library of Science
04.11.2022
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| ISSN: | 1932-6203, 1932-6203 |
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| Abstract | To examine how the COVID-19 pandemic affected the demographic and clinical characteristics, in-hospital care, and outcomes of long-term care residents admitted to general medicine wards for non-COVID-19 reasons. We conducted a retrospective cohort study of long-term care residents admitted to general medicine wards, for reasons other than COVID-19, in four hospitals in Toronto, Ontario between January 1, 2018 and December 31, 2020. We used an autoregressive linear model to estimate the change in monthly admission volumes during the pandemic period (March-December 2020) compared to the previous two years, adjusting for any secular trend. We summarized and compared differences in the demographics, comorbidities, interventions, diagnoses, imaging, psychoactive medications, and outcomes of residents before and during the pandemic. Our study included 2,654 long-term care residents who were hospitalized for non-COVID-19 reasons between January 2018 and December 2020. The crude rate of hospitalizations was 79.3 per month between March-December of 2018-2019 and 56.5 per month between March-December of 2020. The was an adjusted absolute difference of 27.0 (95% CI: 10.0, 43.9) fewer hospital admissions during the pandemic period, corresponding to a relative drop of 34%. Residents admitted during the pandemic period had similar demographics and clinical characteristics but were more likely to be admitted for delirium (pandemic: 7% pre-pandemic: 5%, p = 0.01) and were less likely to be admitted for pneumonia (pandemic: 3% pre-pandemic: 6%, p = 0.004). Residents admitted during the pandemic were more likely to be prescribed antipsychotics (pandemic: 37%, pre-pandemic: 29%, p <0.001) and more likely to die in-hospital (pandemic:14% pre-pandemic: 10%, p = 0.04) Better integration between long-term care and hospitals systems, including programs to deliver urgent medical care services within long-term care homes, is needed to ensure that long-term care residents maintain equitable access to acute care during current and future public health emergencies. |
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| AbstractList | Objectives To examine how the COVID-19 pandemic affected the demographic and clinical characteristics, in-hospital care, and outcomes of long-term care residents admitted to general medicine wards for non-COVID-19 reasons. Methods We conducted a retrospective cohort study of long-term care residents admitted to general medicine wards, for reasons other than COVID-19, in four hospitals in Toronto, Ontario between January 1, 2018 and December 31, 2020. We used an autoregressive linear model to estimate the change in monthly admission volumes during the pandemic period (March-December 2020) compared to the previous two years, adjusting for any secular trend. We summarized and compared differences in the demographics, comorbidities, interventions, diagnoses, imaging, psychoactive medications, and outcomes of residents before and during the pandemic. Results Our study included 2,654 long-term care residents who were hospitalized for non-COVID-19 reasons between January 2018 and December 2020. The crude rate of hospitalizations was 79.3 per month between March-December of 2018-2019 and 56.5 per month between March-December of 2020. The was an adjusted absolute difference of 27.0 (95% CI: 10.0, 43.9) fewer hospital admissions during the pandemic period, corresponding to a relative drop of 34%. Residents admitted during the pandemic period had similar demographics and clinical characteristics but were more likely to be admitted for delirium (pandemic: 7% pre-pandemic: 5%, p = 0.01) and were less likely to be admitted for pneumonia (pandemic: 3% pre-pandemic: 6%, p = 0.004). Residents admitted during the pandemic were more likely to be prescribed antipsychotics (pandemic: 37%, pre-pandemic: 29%, p <0.001) and more likely to die in-hospital (pandemic:14% pre-pandemic: 10%, p = 0.04) Conclusions and implications Better integration between long-term care and hospitals systems, including programs to deliver urgent medical care services within long-term care homes, is needed to ensure that long-term care residents maintain equitable access to acute care during current and future public health emergencies. To examine how the COVID-19 pandemic affected the demographic and clinical characteristics, in-hospital care, and outcomes of long-term care residents admitted to general medicine wards for non-COVID-19 reasons. We conducted a retrospective cohort study of long-term care residents admitted to general medicine wards, for reasons other than COVID-19, in four hospitals in Toronto, Ontario between January 1, 2018 and December 31, 2020. We used an autoregressive linear model to estimate the change in monthly admission volumes during the pandemic period (March-December 2020) compared to the previous two years, adjusting for any secular trend. We summarized and compared differences in the demographics, comorbidities, interventions, diagnoses, imaging, psychoactive medications, and outcomes of residents before and during the pandemic. Our study included 2,654 long-term care residents who were hospitalized for non-COVID-19 reasons between January 2018 and December 2020. The crude rate of hospitalizations was 79.3 per month between March-December of 2018-2019 and 56.5 per month between March-December of 2020. The was an adjusted absolute difference of 27.0 (95% CI: 10.0, 43.9) fewer hospital admissions during the pandemic period, corresponding to a relative drop of 34%. Residents admitted during the pandemic period had similar demographics and clinical characteristics but were more likely to be admitted for delirium (pandemic: 7% pre-pandemic: 5%, p = 0.01) and were less likely to be admitted for pneumonia (pandemic: 3% pre-pandemic: 6%, p = 0.004). Residents admitted during the pandemic were more likely to be prescribed antipsychotics (pandemic: 37%, pre-pandemic: 29%, p <0.001) and more likely to die in-hospital (pandemic:14% pre-pandemic: 10%, p = 0.04) Better integration between long-term care and hospitals systems, including programs to deliver urgent medical care services within long-term care homes, is needed to ensure that long-term care residents maintain equitable access to acute care during current and future public health emergencies. Objectives To examine how the COVID-19 pandemic affected the demographic and clinical characteristics, in-hospital care, and outcomes of long-term care residents admitted to general medicine wards for non-COVID-19 reasons. Methods We conducted a retrospective cohort study of long-term care residents admitted to general medicine wards, for reasons other than COVID-19, in four hospitals in Toronto, Ontario between January 1, 2018 and December 31, 2020. We used an autoregressive linear model to estimate the change in monthly admission volumes during the pandemic period (March-December 2020) compared to the previous two years, adjusting for any secular trend. We summarized and compared differences in the demographics, comorbidities, interventions, diagnoses, imaging, psychoactive medications, and outcomes of residents before and during the pandemic. Results Our study included 2,654 long-term care residents who were hospitalized for non-COVID-19 reasons between January 2018 and December 2020. The crude rate of hospitalizations was 79.3 per month between March-December of 2018–2019 and 56.5 per month between March-December of 2020. The was an adjusted absolute difference of 27.0 (95% CI: 10.0, 43.9) fewer hospital admissions during the pandemic period, corresponding to a relative drop of 34%. Residents admitted during the pandemic period had similar demographics and clinical characteristics but were more likely to be admitted for delirium (pandemic: 7% pre-pandemic: 5%, p = 0.01) and were less likely to be admitted for pneumonia (pandemic: 3% pre-pandemic: 6%, p = 0.004). Residents admitted during the pandemic were more likely to be prescribed antipsychotics (pandemic: 37%, pre-pandemic: 29%, p <0.001) and more likely to die in-hospital (pandemic:14% pre-pandemic: 10%, p = 0.04) Conclusions and implications Better integration between long-term care and hospitals systems, including programs to deliver urgent medical care services within long-term care homes, is needed to ensure that long-term care residents maintain equitable access to acute care during current and future public health emergencies. ObjectivesTo examine how the COVID-19 pandemic affected the demographic and clinical characteristics, in-hospital care, and outcomes of long-term care residents admitted to general medicine wards for non-COVID-19 reasons.MethodsWe conducted a retrospective cohort study of long-term care residents admitted to general medicine wards, for reasons other than COVID-19, in four hospitals in Toronto, Ontario between January 1, 2018 and December 31, 2020. We used an autoregressive linear model to estimate the change in monthly admission volumes during the pandemic period (March-December 2020) compared to the previous two years, adjusting for any secular trend. We summarized and compared differences in the demographics, comorbidities, interventions, diagnoses, imaging, psychoactive medications, and outcomes of residents before and during the pandemic.ResultsOur study included 2,654 long-term care residents who were hospitalized for non-COVID-19 reasons between January 2018 and December 2020. The crude rate of hospitalizations was 79.3 per month between March-December of 2018-2019 and 56.5 per month between March-December of 2020. The was an adjusted absolute difference of 27.0 (95% CI: 10.0, 43.9) fewer hospital admissions during the pandemic period, corresponding to a relative drop of 34%. Residents admitted during the pandemic period had similar demographics and clinical characteristics but were more likely to be admitted for delirium (pandemic: 7% pre-pandemic: 5%, p = 0.01) and were less likely to be admitted for pneumonia (pandemic: 3% pre-pandemic: 6%, p = 0.004). Residents admitted during the pandemic were more likely to be prescribed antipsychotics (pandemic: 37%, pre-pandemic: 29%, p <0.001) and more likely to die in-hospital (pandemic:14% pre-pandemic: 10%, p = 0.04).Conclusions and implicationsBetter integration between long-term care and hospitals systems, including programs to deliver urgent medical care services within long-term care homes, is needed to ensure that long-term care residents maintain equitable access to acute care during current and future public health emergencies. To examine how the COVID-19 pandemic affected the demographic and clinical characteristics, in-hospital care, and outcomes of long-term care residents admitted to general medicine wards for non-COVID-19 reasons.OBJECTIVESTo examine how the COVID-19 pandemic affected the demographic and clinical characteristics, in-hospital care, and outcomes of long-term care residents admitted to general medicine wards for non-COVID-19 reasons.We conducted a retrospective cohort study of long-term care residents admitted to general medicine wards, for reasons other than COVID-19, in four hospitals in Toronto, Ontario between January 1, 2018 and December 31, 2020. We used an autoregressive linear model to estimate the change in monthly admission volumes during the pandemic period (March-December 2020) compared to the previous two years, adjusting for any secular trend. We summarized and compared differences in the demographics, comorbidities, interventions, diagnoses, imaging, psychoactive medications, and outcomes of residents before and during the pandemic.METHODSWe conducted a retrospective cohort study of long-term care residents admitted to general medicine wards, for reasons other than COVID-19, in four hospitals in Toronto, Ontario between January 1, 2018 and December 31, 2020. We used an autoregressive linear model to estimate the change in monthly admission volumes during the pandemic period (March-December 2020) compared to the previous two years, adjusting for any secular trend. We summarized and compared differences in the demographics, comorbidities, interventions, diagnoses, imaging, psychoactive medications, and outcomes of residents before and during the pandemic.Our study included 2,654 long-term care residents who were hospitalized for non-COVID-19 reasons between January 2018 and December 2020. The crude rate of hospitalizations was 79.3 per month between March-December of 2018-2019 and 56.5 per month between March-December of 2020. The was an adjusted absolute difference of 27.0 (95% CI: 10.0, 43.9) fewer hospital admissions during the pandemic period, corresponding to a relative drop of 34%. Residents admitted during the pandemic period had similar demographics and clinical characteristics but were more likely to be admitted for delirium (pandemic: 7% pre-pandemic: 5%, p = 0.01) and were less likely to be admitted for pneumonia (pandemic: 3% pre-pandemic: 6%, p = 0.004). Residents admitted during the pandemic were more likely to be prescribed antipsychotics (pandemic: 37%, pre-pandemic: 29%, p <0.001) and more likely to die in-hospital (pandemic:14% pre-pandemic: 10%, p = 0.04).RESULTSOur study included 2,654 long-term care residents who were hospitalized for non-COVID-19 reasons between January 2018 and December 2020. The crude rate of hospitalizations was 79.3 per month between March-December of 2018-2019 and 56.5 per month between March-December of 2020. The was an adjusted absolute difference of 27.0 (95% CI: 10.0, 43.9) fewer hospital admissions during the pandemic period, corresponding to a relative drop of 34%. Residents admitted during the pandemic period had similar demographics and clinical characteristics but were more likely to be admitted for delirium (pandemic: 7% pre-pandemic: 5%, p = 0.01) and were less likely to be admitted for pneumonia (pandemic: 3% pre-pandemic: 6%, p = 0.004). Residents admitted during the pandemic were more likely to be prescribed antipsychotics (pandemic: 37%, pre-pandemic: 29%, p <0.001) and more likely to die in-hospital (pandemic:14% pre-pandemic: 10%, p = 0.04).Better integration between long-term care and hospitals systems, including programs to deliver urgent medical care services within long-term care homes, is needed to ensure that long-term care residents maintain equitable access to acute care during current and future public health emergencies.CONCLUSIONS AND IMPLICATIONSBetter integration between long-term care and hospitals systems, including programs to deliver urgent medical care services within long-term care homes, is needed to ensure that long-term care residents maintain equitable access to acute care during current and future public health emergencies. |
| Audience | Academic |
| Author | Jones, Aaron Mowbray, Fabrice I. Jung, Hae Young Costa, Andrew P. Verma, Amol A. Brown, Kevin A. Lail, Sharan Razak, Fahad Malikov, Kamil Falk, Lindsey Stall, Nathan M. Malecki, Sarah L. |
| AuthorAffiliation | 3 Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada 5 Women’s College Hospital Research Institute, Toronto, Ontario, Canada 10 Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada University of Florence, ITALY 4 Department of Medicine, University of Toronto, Toronto, Ontario, Canada 2 Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada 7 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada 8 Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada 9 St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada 6 Public Health Ontario, Toronto, Ontario, Canada 1 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada |
| AuthorAffiliation_xml | – name: 10 Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada – name: 6 Public Health Ontario, Toronto, Ontario, Canada – name: 5 Women’s College Hospital Research Institute, Toronto, Ontario, Canada – name: University of Florence, ITALY – name: 8 Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada – name: 3 Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada – name: 4 Department of Medicine, University of Toronto, Toronto, Ontario, Canada – name: 7 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada – name: 9 St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada – name: 1 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada – name: 2 Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada |
| Author_xml | – sequence: 1 givenname: Aaron orcidid: 0000-0002-6282-3614 surname: Jones fullname: Jones, Aaron – sequence: 2 givenname: Fabrice I. surname: Mowbray fullname: Mowbray, Fabrice I. – sequence: 3 givenname: Lindsey surname: Falk fullname: Falk, Lindsey – sequence: 4 givenname: Nathan M. surname: Stall fullname: Stall, Nathan M. – sequence: 5 givenname: Kevin A. surname: Brown fullname: Brown, Kevin A. – sequence: 6 givenname: Kamil surname: Malikov fullname: Malikov, Kamil – sequence: 7 givenname: Sarah L. orcidid: 0000-0003-3457-0696 surname: Malecki fullname: Malecki, Sarah L. – sequence: 8 givenname: Sharan surname: Lail fullname: Lail, Sharan – sequence: 9 givenname: Hae Young surname: Jung fullname: Jung, Hae Young – sequence: 10 givenname: Andrew P. orcidid: 0000-0001-9212-5641 surname: Costa fullname: Costa, Andrew P. – sequence: 11 givenname: Amol A. surname: Verma fullname: Verma, Amol A. – sequence: 12 givenname: Fahad surname: Razak fullname: Razak, Fahad |
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| CitedBy_id | crossref_primary_10_1371_journal_pone_0306569 crossref_primary_10_1136_bmjopen_2022_067689 crossref_primary_10_1177_13872877251319560 crossref_primary_10_1007_s10433_023_00787_6 crossref_primary_10_3390_healthcare12161573 crossref_primary_10_1177_11786329241300827 |
| Cites_doi | 10.1136/bmjopen-2020-043828 10.1111/jgs.16625 10.1001/jamanetworkopen.2021.18441 10.1093/jamia/ocaa225 10.1001/jamahealthforum.2021.4599 10.1097/MLR.0b013e3181589bb6 10.1371/journal.pmed.1002249 10.1503/cmaj.202636 10.1001/jama.2020.13484 10.1001/jamainternmed.2021.0224 10.1016/j.jamda.2021.01.068 10.1097/MLR.0b013e31819432e5 10.1371/journal.pone.0262807 10.1161/STROKEAHA.120.030792 10.2196/21608 10.1001/jamanetworkopen.2021.19028 10.1161/JAHA.116.005256 10.1111/jgs.17227 10.15585/mmwr.mm7029a1 10.1016/S2468-2667(20)30061-X 10.1097/PEC.0000000000002484 10.1016/j.jamda.2020.07.038 10.1016/j.jamda.2021.04.008 |
| ContentType | Journal Article |
| Copyright | COPYRIGHT 2022 Public Library of Science 2022 Jones et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Copyright: © 2022 Jones et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 2022 Jones et al 2022 Jones et al |
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| DOI | 10.1371/journal.pone.0264240 |
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| SubjectTerms | Ambulatory care Antipsychotics Autoregressive models Benzodiazepines Care and treatment Comorbidity Coronaviruses COVID-19 Demography Hospital care Hospitalization Hospitals Internal medicine Laboratories Length of stay Long term health care Long-term care Long-term care of the sick Magnetic resonance imaging Medical personnel Medicine Medicine and Health Sciences Mental disorders Mortality Nursing home patients Pandemics Patient admissions People and places Pneumonia Prevention Psychotropic drugs Public health Sensitivity analysis Services Tomography Ultrasonic imaging |
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| Title | Variations in long-term care home resident hospitalizations before and during the COVID-19 pandemic in Ontario |
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