Background: Patients who survived hospitalization for COVID-19
experienced varying durations of illness but the factors associated with
prompt recovery are unknown. This study identifies factors
differentiating hospitalized patients who recovered promptly vs.
survived a prolonged course of illness due to COVID-19. Methods: This
was a retrospective study from March-August 2020 of hospitalized adults
with COVID-19 which were grouped based on time to recovery: short (≤ 3
days), intermediate (4-10 days), and prolonged (>10 days).
Recovery was defined as resolution of fever, tachypnea, hypotension,
extubation and return of mental status at baseline. Multivariate
analysis was used to evaluate factors associated with prompt recovery.
Results: Among 508 patients hospitalized for COVID-19, 401 (79%)
survived. Of those, prompt recovery (within 3 days) was achieved in 43%
(174/401) whereas 23% (92/401) recovered after a prolonged period of
> 10 days. Overall, median age was 64 y with 73% admitted
from home and 25% from a skilled nursing facility. Predictors for
prompt recovery upon admission included female sex (OR, 1.8; 95% CI,
1.1-2.7; p = 0.01), no fever (OR, 1.6; 95% CI, 1.1-2.6; p = 0.03),
longer time from symptom onset to hospitalization (OR, 1.1; 95% CI,
1.0-1.1; p = 0.001), no supplemental oxygen (OR, 1.9; 95% CI, 1.2-3.0;
p = 0.004), no direct ICU admission (OR, 41.7; 95% CI, 2.4-740.4; p =
0.01) and absence of bacterial co-infections (OR, 2.5; 95% CI, 1.5-4.0,
p = 0.0003). Conclusions: Our study provides relevant data that could
help clinicians triage competing resources in health systems that are
challenged by the ebb and flow of COVID-19 cases by identifying clinical
features of COVID-19 patients who may require less intensive management
including avoidance of unnecessary antibacterial therapy.
Skilled Nursing Facility Participation in Medicare’s Bundled Payments for Care Improvement Initiative: A Retrospective Study
