Comparison of Outcomes and Process of Care for Patients Treated at Hospitals Dedicated for COVID-19 Care vs Other Hospitals
Authors: Zachary R. Bergman, Michael Usher, Andrew Olson, Jeffrey G. Chipman, Melissa E. Brunsvold, Greg Beilman, Christopher Tignanelli, Elizabeth R. Lusczek
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Early in the SARS-CoV-2 pandemic, the M Health Fairview Hospital System established dedicated hospitals for establishing cohorts and caring for patients with COVID-19, yet the association between treatment at COVID-19–dedicated hospitals and mortality and complications is not known. <h3>Objective</h3> To analyze the mortality rate and complications associated with treatment at the COVID-19–dedicated hospitals. <h3>Design, Setting, and Participants</h3> This retrospective cohort study evaluated data prospectively collected from March 1, 2020, through June 30, 2021, from 11 hospitals in Minnesota, including 2 hospitals created solely to care for patients with COVID-19. Data obtained included demographic characteristics, treatments, and outcomes of interest for all patients with a confirmed COVID-19 infection admitted to this hospital system during the study period. <h3>Exposures</h3> Patients were grouped based on whether they received treatment from 1 of the 2 COVID-19–dedicated hospitals compared with the remainder of the hospitals within the hospital system. <h3>Main Outcomes and Measures</h3> Multivariate analyses, including risk-adjusted logistic regression and propensity score matching, were performed to evaluate the primary outcome of in-hospital mortality and secondary outcomes, including complications and use of COVID-specific therapeutics. <h3>Results</h3> There were 5504 patients with COVID-19 admitted during the study period (median age, 62.5 [IQR, 45.0-75.6] years; 2854 women [51.9%]). Of these, 2077 patients (37.7%) (median age, 63.4 [IQR, 50.7-76.1] years; 1080 men [52.0%]) were treated at 1 of the 2 COVID-19–dedicated hospitals compared with 3427 (62.3%; median age, 62.0 [40.0-75.1] years; 1857 women (54.2%) treated at other hospitals. The mortality rate was 11.6% (n = 241) at the dedicated hospitals compared with 8.0% (n = 274) at the other hospitals (<i>P</i> &lt; .001). However, risk-adjusted in-hospital mortality was significantly lower for patients in the COVID-19–dedicated hospitals in both the unmatched group (n = 2077; odds ratio [OR], 0.75; 95% CI, 0.59-0.95) and the propensity score–matched group (n = 1317; OR, 0.78; 95% CI, 0.58-0.99). The rate of overall complications in the propensity score–matched group was significantly lower (OR, 0.81; 95% CI, 0.66-0.99) and the use of COVID-19–specific therapeutics including deep vein thrombosis prophylaxis (83.9% vs 56.9%;<i>P</i> &lt; .001), high-dose corticosteroids (56.1% vs 22.2%;<i>P</i> &lt; .001), remdesivir (61.5% vs 44.5%;<i>P</i> &lt; .001), and tocilizumab (7.9% vs 2.0;<i>P</i> &lt; .001) was significantly higher. <h3>Conclusions and Relevance</h3> In this cohort study, COVID-19–dedicated hospitals had multiple benefits, including providing high-volume repetitive treatment and isolating patients with the infection. This experience suggests improved in-hospital mortality for patients treated at dedicated hospitals owing to improved processes of care and supports the use of establishing cohorts for future pandemics.