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
Hlavní autoři: Jones, Aaron, Mowbray, Fabrice I., Falk, Lindsey, Stall, Nathan M., Brown, Kevin A., Malikov, Kamil, Malecki, Sarah L., Lail, Sharan, Jung, Hae Young, Costa, Andrew P., Verma, Amol A., Razak, Fahad
Médium: Journal Article
Jazyk:angličtina
Vydáno: San Francisco Public Library of Science 04.11.2022
Public Library of Science (PLoS)
Témata:
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
Ontario
Canada
Ontario Canada
ISSN:1932-6203, 1932-6203
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Shrnutí: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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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0264240