{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:51:19Z","timestamp":1785239479593,"version":"3.55.0"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100002558","name":"Warren Alpert Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002558","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Medicare beneficiaries face significant health risks and care disruptions during public health emergencies, but little is known about how care patterns evolved throughout the COVID-19 pandemic or differed between traditional Medicare (TM) and Medicare Advantage (MA).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using Medicare claims data for over 20 million hospital discharges during 2018-2022, we examined trends in hospital length of stay, discharge disposition, and mortality among beneficiaries with 5 major comorbidities (dementia, diabetes, congestive heart failure, hip fracture, and stroke), stratified by COVID status and payer type.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We found that COVID patients initially experienced substantially longer hospital stays (8.3 vs 4.6 days) and higher 30-day mortality (34% vs 5%) compared to patients without COVID. MA beneficiaries showed consistently higher home health utilization but similar mortality patterns to TM enrollees. By mid-2022, most outcome differences had converged between COVID and non-COVID patients, suggesting health system adaptation to the pandemic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our findings highlight how the pandemic was associated with shifts toward home-based post-acute care, emphasizing the need for policies supporting home-based care infrastructure and flexible care delivery models that could help health systems better adapt during future public health emergencies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/haschl\/qxaf056","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T10:04:03Z","timestamp":1742292243000},"source":"Crossref","is-referenced-by-count":2,"title":["Trends in hospital discharge outcomes among high-risk Medicare beneficiaries before and during the COVID-19 pandemic"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2165-1246","authenticated-orcid":false,"given":"Anthony I","family":"Roberts","sequence":"first","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health , Providence, RI 02903 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M","family":"Santostefano","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health , Providence, RI 02903 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health , Providence, RI 02903 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5342-6548","authenticated-orcid":false,"given":"Brian E","family":"McGarry","sequence":"additional","affiliation":[{"name":"Division of Geriatrics and Aging, Department of Medicine, University of Rochester , Rochester, NY 14642, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth M","family":"White","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health , Providence, RI 02903 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0168-6759","authenticated-orcid":false,"given":"Linda J","family":"Resnik","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health , Providence, RI 02903 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7399-8612","authenticated-orcid":false,"given":"Fangli","family":"Geng","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health , Providence, RI 02903 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2915-5770","authenticated-orcid":false,"given":"David C","family":"Grabowski","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School , Boston, MA 02115, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8592-3511","authenticated-orcid":false,"given":"Momotazur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health , Providence, RI 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