Post-acute home health care associated with improved symptoms and function in COVID-19 survivors

1. Patients were significantly less likely to experience symptoms such as pain, dyspnea, and anxiety after utilization of home health care.

2. A substantial reduction was observed in the percentage of patients requiring assistance with each of the 9 activities of daily living that were examined.

Evidence Rating Level: 2 (Good)

Study Rundown: Previously hospitalized COVID-19 survivors are often afflicted by a number of long-term symptoms or complications even after resolution of their initial bout of the illness. While the vast majority of this vulnerable population is discharged home, their recovery needs have yet to be clearly identified. This retrospective study was designed to investigate the recovery trajectory of COVID-19 survivors who subsequently received home health care (HHC). At the time of admission to HHC, the most common comorbidities were hypertension, diabetes, and COPD, and all but 6% of patients had at least 1 risk factor for rehospitalization. Nearly nine-tenths of patients had functional dependence in several activities of daily living. After 11 visits spread across roughly 1 month of care, significant improvements were noted in pain, dyspnea, cognitive alertness, anxiety, and functional status. The risk of rehospitalization or death was found to be significantly higher for patients who were male, white, and had more complex health needs as indicated by frequent emergency department use as well as the presence of comorbidities such as heart failure, diabetes with complications, and cognitive impairment. This study had several limitations, including the single-center design, the lower average age of HHC recipients compared to the typical utilizing population, and the limited knowledge of the course/severity of disease during the acute phase. Nonetheless, these findings support the consideration of home health care as an effective approach to support patients who are continuing to recover from COVID-19.

Click here to read the study in Annals of Internal Medicine

Relevant Reading: Considerations for Postacute Rehabilitation for Survivors of COVID-19

In-Depth [retrospective cohort]: This retrospective cohort study involved 1409 patients admitted to a single New York City home health care (HHC) agency between 1 April and 15 June 2020 after hospitalization for COVID-19. At the time of admission, the average age was 67 years (SD, 15). 69% of patients had hypertension, 41% had diabetes, and 16% had chronic pulmonary disease; 84% reported dyspnea with any exertion, 47-50% reported confusion or anxiety, and 42% reported persistent pain. According to the OASIS assessment, 94% had at least 1 risk factor for hospitalization, the most common being concurrent use of 5 or more medications, exhaustion, difficulty with adherence to medical instruction, and a recent decline in mental, emotional, or behavioral status. Similarly, functional deficits were highly prevalent, with the majority (55%) of patients having 7 or more dependencies. Over an average of 32 days of care (SD, 25.7), patients received an average of 11.1 visits (marginal means 95% CI, 10.8 to 11.4 visits), over three-quarters of which were provided in person and by either a registered nurse or physical therapist. Among the 1302 patients who had been discharged by the time of analysis, the percentage reporting constant or daily pain was reduced by 35 percentage points (CI, 32 to 38 percentage points), the percentage reporting no dyspnea increased by 57 percentage points (CI, 54 to 61 percentage points), the percentage reporting no anxiety increased by 32 percentage points (CI, 28 to 35 percentage points). Clinically and statistically significant improvements were also seen in functional status between admission and discharge, with the average number of dependencies falling from 6 to 1.2. Notable ADL categories were ambulation (difference, -66 percentage points (CI, -63 to -69 percentage points), transferring (difference, -67 percentage points), and bathing (difference, -68 percentage points; CI, -65 to -71 percentage points).

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