Mortality and transitions-of-care after COVID-19 hospitalization among US Medicare patients: a retrospective claims analysis.

BACKGROUND

The patient burden from COVID-19 extends beyond acute hospitalization, especially for older adults. The objective of this study was to describe post-discharge care settings and mortality rates after a COVID-19 hospitalization among adults aged ≥ 65 years in the United States.

METHODS

This retrospective observational study used the Medicare fee-for-service dataset. We identified Medicare patients hospitalized with COVID-19 from September 2023-February 2024. The date of discharge was the index date. Patients were followed until death, end of enrollment, or six months post-index. Pre- and post- hospitalization care settings, all-cause mortality, and readmission rates were analyzed. Patients were stratified by COVID-19 severity (general ward, intensive care unit [ICU], invasive mechanical ventilation [IMV]) and age (65-74, ≥ 75 years old).

RESULTS

A total of 67,358 patients were included; most were female (55.6%), white (84.9%), and on average 80.8 years (standard deviation: 8.1). The majority (96.4%) had ≥ 1 high-risk condition as defined by the Centers for Disease Control and Prevention (CDC). The median (interquartile range) length of stay was 5.0 (3.0-7.0) days. During index hospitalization, 4.4% of patients were admitted to the ICU and 5.1% required IMV. Post-discharge, 50.5% of patients who resided at home pre-hospitalization (self-care or under care) required increased care. Less than half (47.8%) of patients who were home (self-care) pre-hospitalization returned home (self-care) upon discharge. A total of 11,658 (17.4%) patients died within 6-months of hospital discharge. Mortality rates increased for patients requiring higher levels of care: 7.1% of patients discharged home (self-care), 13.0% of patients discharged home (under care), and 31.8% discharged to any healthcare facility died within six months. Mortality was higher in those with more severe COVID-19 and those aged ≥ 75 years. The COVID-19-related readmission rate was 4.5% within six months of discharge, and 3.2% occurred within 30 days.

CONCLUSION

The proportion of older adults who lost independence and required care (under care at home or at a healthcare facility) more than doubled after COVID-19 hospitalization, making the post-discharge period a particularly vulnerable time for patients, who are at risk for death and hospital readmission.