Key Points Question What are the mortality and readmission rates in patients with COVID-19 pneumonia discharged according to an expected practice approach with supplemental home oxygen? Findings In this cohort study of 621 patients with COVID-19 discharged with supplemental home oxygen from emergency department and inpatient encounters at 2 large urban medical centers, the all-cause mortality rate was 1.3% and the all-cause 30-day return hospital admission rate was 8.5%. No patients died in the ambulatory setting or in transit when returning to acute care setting. Meaning In this study, a careful and systematic expected practice approach to treatment of patients with COVID-19 using home oxygen was associated with low all-cause mortality and low 30-day return admission rates. Importance To optimize patient outcomes and preserve critical acute care access during the COVID-19 pandemic, the Los Angeles County Department of Health Services developed the SAFE @ HOME O 2 Expected Practice (expected practice), enabling ambulatory oxygen management for COVID-19. Objective To assess outcomes of patients with COVID-19 pneumonia discharged via the expected practice approach to home or quarantine housing with supplemental home oxygen. Design, Setting, and Participants This retrospective cohort study included 621 adult patients with COVID-19 pneumonia who were discharged from 2 large urban public hospitals caring primarily for patients receiving Medicaid from March 20 to August 19, 2020. Patients were included in the analysis cohort if they received emergency or inpatient care for COVID-19 and were discharged with home oxygen. Interventions Patients receiving at least 3 L per minute of oxygen, stable without other indication for inpatient care, were discharged from either emergency or inpatient encounters with home oxygen equipment, educational resources, and nursing telephone follow-up within 12 to 18 hours of discharge. Nurses provided continued telephone follow up as indicated, always with physician back-up. Main Outcomes and Measures All-cause mortality and all-cause 30-day return admission. Results A total of 621 patients with COVID-19 pneumonia (404 male [65.1%] and 217 female [34.9%]) were discharged with home oxygen. Median age of these patients was 51 years (interquartile range, 45-61 years), with 149 (24.0%) discharged from the emergency department and 472 (76%) discharged from inpatient encounters. The all-cause mortality rate was 1.3% (95% CI, 0.6%-2.5%) and the 30-day return hospital admission rate was 8.5% (95% CI, 6.2%-10.7%) with a median follow-up time of 26 days (interquartile range, 15-55 days). No deaths occurred in the ambulatory setting. Conclusions and Relevance In this cohort study, patients with COVID-19 pneumonia discharged on home oxygen had low rates of mortality and return admission within 30 days of discharge. Ambulatory management of COVID-19 with home oxygen has an acceptable safety profile, and the expected practice approach may help optimize outcomes, by ensuring right care in the right place at the right time and preserving access to acute care during the COVID-19 pandemic. This cohort study assesses mortality and readmission rates of adult patients with COVID-19 pneumonia discharged from 2 centers in Los Angeles County, California, via an expected practice approach to home or quarantine housing with supplemental home oxygen.
【초록키워드】 COVID-19, Treatment, Mortality, Pneumonia, quarantine, equipment, COVID-19 pandemic, oxygen, outcome, discharge, cohort study, outcomes, Cohort, management, Practice, male, female, Patient, death, age, Hospital admission, Follow-up, ambulatory, Admission, Care, Critical, safety profile, readmission, Analysis, Nurse, retrospective cohort study, interquartile range, Medicaid, 95% CI, all-cause mortality, help, measure, participant, follow-up time, finding, Department, service, resources, Public Hospital, approach, objective, setting, all-cause mortality rate, Result, occurred, indicated, provided, receiving, median, expected, discharged, Importance, Los Angele, patients died, patients with COVID-19, Point, Relevance, 【제목키워드】 COVID-19, setting, Rate,