Estimated excess acute-care length of stay and extra cost of testing-based versus symptom-based isolation strategies among veterans hospitalized with coronavirus disease 2019 (COVID-19) discharging to a congregate setting

• Published in: Infection Control & Hospital Epidemiology 2021-03, Vol.42 (3), p.356-358
• Main Authors: Wu, Chenwei, Glass, Susan, Demars, Sandra, Tulloch-Palomino, Luis G, Wander, Pandora L
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Asymptomatic; Coronaviruses; Cost control; Cost-Benefit Analysis; COVID-19; COVID-19 - diagnosis; COVID-19 - economics; COVID-19 - therapy; Disease control; Disease transmission; Health care expenditures; Health care policy; Homeless people; Homelessness; Hospital Costs - statistics & numerical data; Hospitalization; Humans; Illnesses; Length of stay; Length of Stay - economics; Length of Stay - statistics & numerical data; Long term health care; Long-term care; Male; Nursing; Oxygen; Pandemics; Patient Discharge; Patients; Prevention; Quarantine; Rehabilitation; Research Brief; SARS-CoV-2 - isolation & purification; Severe acute respiratory syndrome coronavirus 2; Veterans; Washington
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2020.1295

During the coronavirus disease 2019 (COVID-19) pandemic, hospitals worldwide have experienced capacity shortfalls because of high case volumes compounded by prolonged length of stay (LOS).1 Although illness severity plays a major role in prolonging hospitalization, asymptomatic or recovered patients could potentially recuperate in congregate settings but may be prevented from discharging due to persistent yet clinically inconsequential viral shedding.1-7 Because COVID-19 transmission is unlikely >10 days after symptom onset,3-5 the US Centers for Disease Control and Prevention (CDC) in August 2020 recommended symptom-based rather than testing-based isolation measures.7 Implications of these recommendations for hospital operations remain unclear. Individual-Level Characteristics, Acute-Care LOS, and Cost Parameters for VA Puget Sound Health Care System Veterans Hospitalized With COVID-19 Between March 2 and June 2, 2020, Needing Discharge to a Congregate Settinga Case Age, y Severe Illnessb Immuno-compromisec Total LOS, dd Acute-Care LOS, dd Total Acute-Care Cost, USDd Daily Acute- Care Cost, USDe Excess LOS, df Excess Cost, USDg Prehospital Habitation Disposition Principal Diagnosis, ICD-10-CM 1 96 No No 22 22 $76,368 $3,471 21 $72,897 Long-term care Rehabilitation (VHA) U07.1 2 89 Yes No 32 32 $106,911 $3,341 13 $43,433 Long-term care Rehabilitation (VHA) U07.1 3 71 Yes No 35 35 $148,011 $4,229 8 $33,831 Long-term care Rehabilitation (Non-VHA) A41.9 4 76 No No 45 45 $185,841 $4,130 27 $111,505 Long-term care Rehabilitation (VHA) I99.8 5 76 Yes No 19 17 $60,961 $3,586 2 $7,172 Homeless Shelter U07.1 6 74 Yes No 46 8 $42,676 $5,335 1 $5,335 Private residence Rehabilitation (VHA) U07.1 7 71 Yes No 44 5 $14,991 $2,998 0 $0 Private residence Rehabilitation (VHA) A41.89 8 73 Yes No 29 29 $104,620 $3,608 20 $72,152 Long-term care Rehabilitation (VHA) U07.1 9 74 Yes No 33 33 $121,513 $3,682 20 $73,644 Homeless Quarantine (VHA)8 I13.0 10 100 Yes No 28 28 Missing Missing 3 Missing Long-term care Long-term care Missing 11 68 Yes Yes 38 21 $91,091 $4,338 8 $34,701 Private residence Rehabilitation (VHA) U07.1 Total 371 275 $952,983 N/A 123 $454,669 Median 33 28 $97,856 $3,645 8 $39,067 Note. COVID-19, coronavirus disease 2019; LOS, length of stay; VHA, Veterans Health Administration; CDC, US Centers for Disease Control and Prevention; ICD-10-CM, diagnostic codes per the International Classification of Diseases, 10th Edition, Clinical Modification. a Refers to rehabili