Background: The number of survivors of an initial COVID-19 disease hospitalization is growing and further data describing clinical and sociodemographic risk factors for hospital readmissions is needed. The CROSS (COVID-19 Characteristics of Readmissions and Outcomes and Social Determinants of Health Study) Collaborative was developed in July 2020 and is a multidisciplinary, multi-hospital group dedicated to examining reasons for COVID-19 hospital readmissions, associated clinical outcomes, and exploration of social determinants of health that place patients at risk for readmission. Our objective is to determine clinical characteristics, clinical outcomes, and social determinants of health of COVID-19 readmitted patients in order to identify predictors of readmissions.
Methods: In this retrospective/prospective study. data extraction via the clinical data warehouse and manual chart reviews was used to gather patient demographics, clinical characteristics and clinical outcomes of readmitted COVID-19 patients to four Emory Healthcare hospitals.(Patient-level zip code data will be used in future analyses to explore the effects of social determinants of health on 30-day readmissions). Participants included PCR-confirmed COVID-19 positive adults (>18 years old) with all-cause hospital readmissions within 30 days of index admission to four Emory Healthcare hospitals from March 1 to November 14, 2020. Demographics and clinical characteristics including sex, race/ethnicity, and comorbidities (obesity, hypertension, diabetes mellitus, hyperlipidemia, congestive heart failure, chronic kidney disease, end stage renal disease, malignancy, chronic lung disease, HIV, dementia, and mental health diagnoses) were extracted from the charts of readmitted COVID-19 patients. The primary endpoint was 30-day all-cause readmission.
Results: 2399 PCR-positive COVID-19 patients were hospitalized. 153 were readmitted within 30 days. 72% of the readmitted patients were Black or Hispanic. 30-day readmission rates varied from 1.9% to 4.7 % across the four hospitals. Diabetes (P-value: 0.03) and end stage renal disease (P-value: 0.004) reached statistical significance for 30-day readmission (Table 1).
Conclusions: Black and Hispanic patients comprised the majority (72%) of readmitted COVID-19 patients. Diabetes and end stage renal disease were associated with increased risk for 30-day readmission in COVID-19 patients.