1
|
Ioannou GN, Baraff A, Fox A, Shahoumian T, Hickok A, O’Hare AM, Bohnert ASB, Boyko EJ, Maciejewski ML, Bowling CB, Viglianti E, Iwashyna TJ, Hynes DM. Rates and Factors Associated With Documentation of Diagnostic Codes for Long COVID in the National Veterans Affairs Health Care System. JAMA Netw Open 2022; 5:e2224359. [PMID: 35904783 PMCID: PMC9338411 DOI: 10.1001/jamanetworkopen.2022.24359] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Some persons infected with SARS-CoV-2 experience symptoms or impairments many months after acute infection. OBJECTIVES To determine the rates, clinical setting, and factors associated with documented receipt of COVID-19-related care 3 or more months after acute infection. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the US Department of Veterans Affairs health care system. Participants included persons with a positive SARS-CoV-2 test between February 1, 2020, and April 30, 2021, who were still alive 3 months after infection and did not have evidence of reinfection. Data analysis was performed from February 2020 to December 2021. EXPOSURES Positive SARS-CoV-2 test. MAIN OUTCOMES AND MEASURES Rates and factors associated with documentation of COVID-19-related International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes (U07.1, Z86.16, U09.9, and J12.82) 3 or more months after acute infection (hereafter, long-COVID care), with follow-up extending to December 31, 2021. RESULTS Among 198 601 SARS-CoV-2-positive persons included in the study, the mean (SD) age was 60.4 (17.7) years, 176 942 individuals (89.1%) were male, 133 924 (67.4%) were White, 44 733 (22.5%) were Black, and 19 735 (9.9%) were Hispanic. During a mean (SD) follow-up of 13.5 (3.6) months, long-COVID care was documented in a wide variety of clinics, most commonly primary care and general internal medicine (18 634 of 56 310 encounters [33.1%]), pulmonary (7360 of 56 310 encounters [13.1%]), and geriatrics (5454 of 56 310 encounters [9.7%]). Long-COVID care was documented in 26 745 cohort members (13.5%), with great variability across geographical regions (range, 10.8%-18.1%) and medical centers (range, 3.0%-41.0%). Factors significantly associated with documented long-COVID care included older age, Black or American Indian/Alaska Native race, Hispanic ethnicity, geographical region, high Charlson Comorbidity Index score, having documented symptoms at the time of acute infection (adjusted odds ratio [AOR], 1.71; 95% CI, 1.65-1.78) and requiring hospitalization (AOR, 2.60; 95% CI, 2.51-2.69) or mechanical ventilation (AOR, 2.46; 95% CI, 2.26-2.69). Patients who were fully vaccinated at the time of infection were less likely to receive long-COVID care (AOR, 0.78; 95% CI, 0.68-0.90). CONCLUSIONS AND RELEVANCE Long-COVID care was documented in a variety of clinical settings, with great variability across regions and medical centers and was documented more commonly in older persons, those with higher comorbidity burden, those with more severe acute COVID-19 presentation and those who were unvaccinated at the time of infection. These findings provide support and guidance for health care systems to develop systematic approaches to the evaluation and management of patients who may be experiencing long COVID.
Collapse
Affiliation(s)
- George N. Ioannou
- Health Services Research and Development, Center of Innovation, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle
| | - Aaron Baraff
- Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Alexandra Fox
- Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Troy Shahoumian
- Department of Veterans Affairs, Population Health, Palo Alto Healthcare System, Palo Alto, California
| | - Alex Hickok
- Center of Innovation to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon
| | - Ann M. O’Hare
- Nephrology Section, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
- Division of Nephrology, University of Washington, Seattle
| | - Amy S. B. Bohnert
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Edward J. Boyko
- General Internal Medicine, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
- Division of General Internal Medicine, University of Washington, Seattle
| | - Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Duke University School of Medicine, Durham, North Carolina
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | - C. Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - Elizabeth Viglianti
- Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Theodore J. Iwashyna
- Health Management and Policy, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Corvallis, Oregon
- Health Data and Informatics Program, Center for Genome Research and Biocomputing, Oregon State University, Corvallis
| | - Denise M. Hynes
- Center of Innovation to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon
- Health Management and Policy, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Corvallis, Oregon
- Health Data and Informatics Program, Center for Genome Research and Biocomputing, Oregon State University, Corvallis
| |
Collapse
|
2
|
McPeake J, Shaw M, MacTavish P, Blyth KG, Devine H, Fleming G, Griffin J, Gemmell L, Grose P, Henderson M, Henderson P, Hogg L, King K, McInnes I, O'Brien P, Puxty K, Rainey C, Sharma V, Sim M, Strachan L, Siebert S, Quasim T. Long-term outcomes following severe COVID-19 infection: a propensity matched cohort study. BMJ Open Respir Res 2021; 8:e001080. [PMID: 34887318 PMCID: PMC8663070 DOI: 10.1136/bmjresp-2021-001080] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There are limited data describing the long-term outcomes of severe COVID-19. We aimed to evaluate the long-term psychosocial and physical consequences of severe COVID-19 for patients. METHODS We conducted a multicentre observational cohort study; between 3 and 7 months posthospital discharge, patients who had been admitted to critical care due to severe COVID-19 were invited to an established recovery service. Standardised questionnaires concerning emotional, physical and social recovery, including information on employment, were completed by patients. Using propensity score matching, we explored outcomes between patients admitted to critical care with and without COVID-19, using data from the same recovery programme. RESULTS Between July 2020 and December 2020, 93 patients who had been admitted to critical with COVID-19 participated. Emotional dysfunction was common: 46.2% of patients had symptoms of anxiety and 34.4% symptoms of depression. At follow-up 53.7% of previously employed patients had returned to employment; there was a significant difference in return to employment across the socio-economic gradient, with lower numbers of patients from the most deprived areas returning to employment (p=0.03). 91 (97.8%) COVID-19 patients were matched with 91 non-COVID-19 patients. There were no significant differences in any measured outcomes between the two cohorts. INTERPRETATION Emotional and social problems are common in survivors of severe COVID-19 infection. Coordinated rehabilitation is required to ensure patients make an optimal recovery.
Collapse
Affiliation(s)
- Joanne McPeake
- NHS Greater Glasgow and Clyde, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Martin Shaw
- NHS Greater Glasgow and Clyde, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | - Kevin G Blyth
- NHS Greater Glasgow and Clyde, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | | | | | | | | | | | - Philip Henderson
- NHS Greater Glasgow and Clyde, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | | | - Iain McInnes
- University of Glasgow, College of Medical, Veterinary and Life Science, Glasgow, UK
| | | | - Kathryn Puxty
- NHS Greater Glasgow and Clyde, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | | | - Malcolm Sim
- NHS Greater Glasgow and Clyde, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Tara Quasim
- NHS Greater Glasgow and Clyde, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| |
Collapse
|