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A typology of healthcare pathways after hospital discharge for adults with COVID-19.pdf (771.25 kB)

A typology of healthcare pathways after hospital discharge for adults with COVID-19: the evolution of UK services during pandemic conditions.

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posted on 2023-09-14, 09:53 authored by Linzy Houchen-Wolloff, Charlotte Overton, Andrew Ibbetson, Archie Walters, Claire Hastie, Rhyan Gill, Natalie Armstrong, Sally Singh, Paul Little, Kirby Evans, John Pimm, Michael Marks, Krisnah Poinasamy, Sam Walker, Andrew Briggs, Rachael A Evans

Introduction Over half of post-COVID-hospitalisation adults have persistent symptoms 2 years after discharge, providing a challenge for individuals and healthcare systems. We therefore aimed to describe a typology of UK healthcare pathways post-hospital discharge as a first step towards understanding clinical effectiveness and cost-effectiveness of different healthcare pathways.


Methods In 2021, we surveyed hospital sites taking part in the UK Post-hospital COVID-19 (PHOSP-COVID) study. The online survey explored the availability of proactive follow-up, patient selection, involvement of multidisciplinary teams, investigations, assessment and access to mental health and rehabilitation interventions. The typology was defined by a three-stage process: 1) using the survey results to develop a bespoke algorithm to inform a draft classification, 2) a stakeholder event for refinement and 3) finalisation between the Project Advisory Group and research team. The bespoke algorithm was used to map each site onto the classification with further mapping by level of mental health and rehabilitation provision.


Results 70% of hospital sites (45 out of 64) responded to the survey. 82% (37 out of 45) reported delivering a follow-up service after hospital discharge during the first few months of the pandemic. Only 13 out of 37 services (35%) were delivered by permanent staff. The final typology of five categories included no proactive follow-up, and a matrix of four groups based on patient selection (prespecified subgroup/all patients) and complexity of assessment (low/high). The complexity of assessment, rehabilitation and mental health interventions was variable within sites.


Discussion We describe the first typology of post-hospitalisation COVID-19 healthcare pathways to enable modelling of clinical effectiveness and cost-effectiveness to inform future policy. Our results highlight the heterogeneity and vulnerability of healthcare services after COVID-19 hospitalisation.

Funding

National Institute for Health Research policy research programme (NIHR reference: 202708)

History

Author affiliation

Department of Population Health Sciences, University of Leicester

Version

  • VoR (Version of Record)

Published in

ERJ open research

Volume

9

Issue

4

Publisher

European Respiratory Society (ERS)

issn

2312-0541

eissn

2312-0541

Copyright date

2023

Available date

2023-09-14

Spatial coverage

England

Language

eng

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