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Minnesota Patients Fared Better at Dedicated COVID-19 Hospitals

NEW YORK (Reuters Health) – Patients treated at COVID-19-dedicated hospitals in Minnesota were less likely to die than those cared for at other hospitals, a new study shows.

An analysis of data from more than 5,500 patients in the M Health Fairview Hospital System found that mortality rates among COVID-19 patients at dedicated hospitals were 25% lower, researchers report in JAMA Network Open.

“Dedicated COVID-19 hospitals in Minnesota are associated with improved in-hospital mortality, reduced complications and rapid implementation of new care processes, while caring for the sickest patients,” said Dr. Elizabeth Lusczek and Dr. Zachery Bergman of the University of Minnesota, in Minneapolis, who worked on the study.

The improvements were mostly due to greater experience, they told Reuters Health in a joint email.

“We know that high-volume specialty healthcare centers that treat many patients with the same conditions, like cancer centers and trauma centers, have improved outcomes,” the two authors said. “This is likely due to the high level of specialized expertise of the healthcare workers at these centers. We believe that our COVID cohort hospitals benefited from the same phenomenon.”

“This model of care has likely run its course for COVID-19, but our hope is that our work can serve as a framework for possible future pandemics so we don’t have to start from scratch again during a stressful and uncertain time,” they added.

To determine whether COVID-19-specialized hospitals had better outcomes than those that were not specialized in treating the disease, the two researchers and their colleagues performed a cohort study on data collected from patients within the M Health Fairview Hospital System of 11 hospitals from March 1, 2020 through June 30, 2021.

They included consecutive patients 18 and older with SARS-CoV-2 who were admitted to the hospitals. Patients were excluded if they had opted out of research in their electronic records. A total of 5,504 patients (2,854 women and 2,650 men) whose median age was 63 years were included in the analysis; 2,077 were treated at one of two COVID-19 dedicated hospitals and 3,427 at other hospitals.

While the raw mortality rate was higher in the dedicated hospitals, risk-adjusted in-hospital mortality was significantly lower for patients in the dedicated hospitals in both the unmatched group (odds ratio, 0.75) and the propensity-score-matched group (OR, 0.78).

The overall rate of complications in the propensity-score-matched group was also significantly lower (OR, 0.81), and the use of COVID-19-specific therapeutics including deep-vein-thrombosis prophylaxis, high-dose corticosteroids, remdesivir and tocilizumab, was significantly higher.

The study is “interesting,” said Dr. Thomas Russo, professor and chief of the division of infectious diseases at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo, New York. And the findings make sense since there is always a learning curve with a new disease, he added.

Another advantage to having the dedicated hospitals is that the other hospitals in the system could continue to treat non-COVID-19 patients, Dr. Russo told Reuters Health by phone.

“In a pandemic you suddenly have an overwhelming number of patients,” he said. “These hospitals could act as a buffer to prevent the healthcare system from being overwhelmed.”

It’s also worth mentioning that for critically ill patients it’s not just the use of targeted therapies that counts, Dr. Russo said. “There are other non-pharmaceutical interventions, such as nursing staff.”

SOURCE: JAMA Network Open, online March 3, 2022.

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