Association of unmet discharge needs on readmission or mortality among acute respiratory failure survivors during the COVID-19 pandemic: The Addressing Post-Intensive Care Syndrome (APICS-COVID) multicenter prospective cohort study

BACKGROUND: Survivors of acute respiratory failure (ARF) often face long-term impairments known as Post-Intensive Care Syndrome. These impairments, coupled with fragmented healthcare, contribute to high rates of readmission and mortality. The COVID-19 pandemic challenged healthcare systems, providing an important opportunity to evaluate healthcare fragmentation before and during the pandemic. METHODS: From December 2020 to July 2022, this prospective multicenter study (APICS-COVID) enrolled ARF survivors discharged home from acute care hospitalization. The primary exposure was unmet healthcare needs within 1-4 weeks post-discharge and the primary composite outcome was 3-month readmission and mortality. We additionally compared unmet healthcare needs in this study versus a predominately pre-pandemic cohort from an identical study protocol (APICS-01). RESULTS: Of 201 patients enrolled, 94% had at least one unmet healthcare need. The median (IQR) number of healthcare needs upon discharge was 18 (11-25) and the median proportion of unmet healthcare needs was 26% (17-36%). Follow-up appointments were the most frequent unmet need. Higher vs. lower unmet healthcare needs were not significantly associated with 3-month readmission or mortality (aRR 0.61, p = 0.22). Compared to the APICS-01 cohort, the frequency of 3-month readmission/mortality was lower (14% vs. 29%, p = 0.26), despite higher unmet needs in the APICS-COVID cohort (26% vs. 16%, p < 0.001). CONCLUSIONS: Across six US academic hospitals during the COVID-19 pandemic, we did not detect a significant association between higher and lower unmet healthcare needs and 3-month readmission or mortality. Compared to APICS-01, unmet follow-up appointments increased but readmission and mortality decreased. Home health services, durable medical equipment, and medications remained robust during pandemic conditions.