Home oxygen for patients with COVID-19 pneumonia conferred low mortality, readmission
Patients with COVID-19 pneumonia who were discharged from the hospital on home oxygen had low rates of mortality and readmission within 30 days, according to new data published in JAMA Network Open.
“In preparation for the COVID-19 surges this past year, we sought to develop a formal home oxygen program that would enhance patient safety and improve flow through the hospital, to prevent the hospital from being overwhelmed by COVID patients,” Brad Spellberg, MD, chief medical officer at the Los Angeles County-University of Southern California Medical Center, told Healio. “Being in the hospital when one does not need to be is unsafe; hospitals are dangerous places. If we can provide the care the patient needs at home, that is always preferred.”
The retrospective cohort study enrolled 621 adults (median age, 51 years; 34.9% women) with COVID-19 pneumonia who received emergency or inpatient care for COVID-19 infection and were discharged on home oxygen from two hospitals in Los Angeles from March to August 2020. Stable patients receiving at least 3 L per minute of oxygen without other indications for inpatient care were discharged with home oxygen equipment, educational resources and nursing follow-up by telephone within 12 to 18 hours of discharge and continued, if indicated.
The main outcomes were all-cause mortality and all-cause 30-day readmissions.
Twenty-four percent of patients were discharged from the ED and 76% were discharged from inpatient encounters.
During a median follow-up of 26 days, the rate of all-cause mortality was 1.3% (95% CI, 0.6-2.5) and the rate of all-cause 30-day readmissions was 8.5% (95% CI, 6.2-10.7) among patients discharged receiving home oxygen.
No deaths occurred during follow-up.
The observed 30-day readmission rate fell below the nationally reported rates for Medicaid (13.7%) but were consistent with privately insured patients (8.6%), according to the researchers. Also, the 30-day readmission rates in this study were lower than the overall post-acute care 30-day readmission rate (15.2%) for patients in the LA County Department of Health Services, according to 2020 data reported to the California Department of Health Care Services.
“We were not surprised, but happy to provide that oxygen can be delivered very safely at home to patients with COVID_19, with excellent outcomes,” Spellberg told Healio.
According to the researchers, these findings underscore the safety of a carefully implemented home oxygen program for discharged patients with COVID-19 pneumonia.
“This [expected practice] may be considered part of a strategy to ensure right care, right place and right time for patients with COVID-19 pneumonia, and to preserve acute care access during the pandemic,” the researchers wrote.