scholarly journals Severity of COVID-19 and adverse long-term outcomes: a retrospective cohort study based on a US electronic health record database

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e056284
Author(s):  
Nick Jovanoski ◽  
Xin Chen ◽  
Ursula Becker ◽  
Kelly Zalocusky ◽  
Devika Chawla ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Hospital Discharge ◽  
Retrospective Cohort ◽  
Treatment Setting ◽  
Health Record ◽  
Long Term Outcomes ◽  
Increased Risk ◽  
Clinical Conditions

ObjectiveTo identify potential risk factors for adverse long-term outcomes (LTOs) associated with COVID-19, using a large electronic health record (EHR) database.DesignRetrospective cohort study. Patients with COVID-19 were assigned into subcohorts according to most intensive treatment setting experienced. Newly diagnosed conditions were classified as respiratory, cardiovascular or mental health LTOs at >30–≤90 or >90–≤180 days after COVID-19 diagnosis or hospital discharge. Multivariate regression analysis was performed to identify any association of treatment setting (as a proxy for disease severity) with LTO incidence.SettingOptum deidentified COVID-19 EHR dataset drawn from hospitals and clinics across the USA.ParticipantsIndividuals diagnosed with COVID-19 (N=57 748) from 20 February to 4 July 2020.Main outcomesIncidence of new clinical conditions after COVID-19 diagnosis or hospital discharge and the association of treatment setting (as a proxy for disease severity) with their risk of occurrence.ResultsPatients were assigned into one of six subcohorts: outpatient (n=22 788), emergency room (ER) with same-day COVID-19 diagnosis (n=11 633), ER with COVID-19 diagnosis≤21 days before ER visit (n=2877), hospitalisation without intensive care unit (ICU; n=16 653), ICU without ventilation (n=1837) and ICU with ventilation (n=1960). Respiratory LTOs were more common than cardiovascular or mental health LTOs across subcohorts and LTO incidence was higher in hospitalised versus non-hospitalised subcohorts. Patients with the most severe disease were at increased risk of respiratory (risk ratio (RR) 1.86, 95% CI 1.56 to 2.21), cardiovascular (RR 2.65, 95% CI 1.49 to 4.43) and mental health outcomes (RR 1.52, 95% CI 1.20 to 1.91) up to 6 months after hospital discharge compared with outpatients.ConclusionsPatients with severe COVID-19 had increased risk of new clinical conditions up to 6 months after hospital discharge. The extent that treatment setting (eg, ICU) contributed to these conditions is unknown, but strategies to prevent COVID-19 progression may nonetheless minimise their occurrence.

Association between acute psychiatric bed availability in the Veterans Health Administration and veteran suicide risk: a retrospective cohort study

2021 ◽  
pp. bmjqs-2020-012975
Author(s):  
Peter J Kaboli ◽  
Matthew R Augustine ◽  
Bjarni Haraldsson ◽  
Nicholas M Mohr ◽  
M Bryant Howren ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Suicide Risk ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Bed Occupancy ◽  
Increased Risk

BackgroundVeteran suicides have increased despite mental health investments by the Veterans Health Administration (VHA).ObjectiveTo examine relationships between suicide and acute inpatient psychiatric bed occupancy and other community, hospital and patient factors.MethodsRetrospective cohort study using administrative and publicly available data for contextual community factors. The study sample included all veterans enrolled in VHA primary care in 2011–2016 associated with 111 VHA hospitals with acute inpatient psychiatric units. Acute psychiatric bed occupancy, as a measure of access to care, was the main exposure of interest and was categorised by quarter as per cent occupied using thresholds of ≤85%, 85.1%–90%, 90.1%–95% and >95%. Hospital-level analyses were conducted using generalised linear mixed models with random intercepts for hospital, modelling number of suicides by quarter with a negative binomial distribution.ResultsFrom 2011 to 2016, the national incidence of suicide among enrolled veterans increased from 39.7 to 41.6 per 100 000 person-years. VHA psychiatric bed occupancy decreased from a mean of 68.2% (IQR 56.5%–82.2%) to 65.4% (IQR 53.9%–79.9%). VHA hospitals with the highest occupancy (>95%) in a quarter compared with ≤85% had an adjusted incident rate ratio (IRR) for suicide of 1.10 (95% CI 1.01 to 1.19); no increased risk was observed for 85.1%–90% (IRR 0.96; 95% CI 0.89 to 1.03) or 90.1%–95% (IRR 0.96; 95% CI 0.89 to 1.04) compared with ≤85% occupancy. Of hospital and community variables, suicide risk was not associated with number of VHA or non-VHA psychiatric beds or amount spent on community mental health. Suicide risk increased by age categories, seasons, geographic regions and over time.ConclusionsHigh VHA hospital occupancy (>95%) was associated with a 10% increased suicide risk for veterans whereas absolute number of beds was not, suggesting occupancy is an important access measure. Future work should clarify optimal bed occupancy to meet acute psychiatric needs and ensure adequate bed distribution.

scholarly journals Long-term Outcomes After Elective Sterilization Procedures—A Comparative Retrospective Cohort Study of Medicaid Patients

2018 ◽  
Vol 73 (11) ◽  
pp. 638-640
Author(s):  
Rachel Steward ◽  
Patricia Carney ◽  
Amy Law ◽  
Lin Xie ◽  
Yuexi Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Long Term Outcomes

scholarly journals Unintended discontinuation of medication following hospitalisation: a retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e024747 ◽  
Author(s):  
Patrick Redmond ◽  
Ronald McDowell ◽  
Tamasine C Grimes ◽  
Fiona Boland ◽  
Ronan McDonnell ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Discharge ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Discharge Summary ◽  
Lipid Lowering ◽  
Evidence Based ◽  
Hospitalised Patients ◽  
Hospital Discharge Summary

ObjectivesWhether unintended discontinuation of common, evidence-based, long-term medication occurs after hospitalisation; what factors are associated with unintended discontinuation; and whether the presence of documentation of medication at hospital discharge is associated with continuity of medication in general practice.DesignRetrospective cohort study between 2012 and 2015.SettingElectronic records and hospital supplied discharge notifications in 44 Irish general practices.Participants20 488 patients aged 65 years or more prescribed long-term medication for chronic conditions.Primary and secondary outcomesDiscontinuity of four evidence-based medication drug classes: antithrombotic, lipid-lowering, thyroid replacement drugs and respiratory inhalers in hospitalised versus non-hospitalised patients; patient and health system factors associated with discontinuity; impact of the presence of medication in the hospital discharge summary on continuity of medication in a patient’s general practitioner (GP) prescribing record at 6 months follow-up.ResultsIn patients admitted to hospital, medication discontinuity ranged from 6%–11% in the 6 months posthospitalisation. Discontinuity of medication is significantly lower for hospitalised patients taking respiratory inhalers (adjusted OR (AOR) 0.63, 95% CI (0.49 to 0.80), p<0.001) and thyroid medications (AOR 0.62, 95% CI (0.40 to 0.96), p=0.03). There is no association between discontinuity of medication and hospitalisation for antithrombotics (AOR 0.95, 95% CI (0.81 to 1.11), p=0.49) or lipid lowering medications (AOR 0.92, 95% CI (0.78 to 1.08), p=0.29). Older patients and those who paid to see their GP were more likely to experience increased odds of discontinuity in all four medicine groups. Less than half (39% to 47.4%) of patients had medication listed on their hospital discharge summary. Presence of medication on hospital discharge summary is significantly associated with continuity of medication in the GP prescribing record for lipid lowering medications (AOR 1.64, 95% CI (1.15 to 2.36), p=0.01) and respiratory inhalers (AOR 2.97, 95% CI (1.68 to 5.25), p<0.01).ConclusionDiscontinuity of evidence-based long-term medication is common. Increasing age and private medical care are independently associated with a higher risk of medication discontinuity. Hospitalisation is not associated with discontinuity but less than half of hospitalised patients have medication recorded on their hospital discharge summary.

scholarly journals Erratum to: Impact of Obesity on Postoperative and Long-term Outcomes in a General Surgery Population: A Retrospective Cohort Study

2013 ◽  
Vol 37 (11) ◽  
pp. 2560-2560
Author(s):  
Tabita M. Valentijn ◽  
Wael Galal ◽  
Sanne E. Hoeks ◽  
Yvette R. van Gestel ◽  
Hence J. Verhagen ◽  
...  
Keyword(s):  
Cohort Study ◽  
General Surgery ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Long Term Outcomes
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