{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T01:57:43Z","timestamp":1775786263695,"version":"3.50.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T00:00:00Z","timestamp":1670457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K24AI141036"],"award-info":[{"award-number":["K24AI141036"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Weissman Family MGH Scholar Award","award":["R01 AI042006-24S1"],"award-info":[{"award-number":["R01 AI042006-24S1"]}]},{"name":"Winickoff Scholars Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>During the initial surge of coronavirus disease 2019 (COVID-19), health-care utilization fluctuated dramatically, straining acute hospital capacity across the USA and potentially contributing to excess mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was an observational retrospective study of patients with COVID-19 admitted to a large US urban academic medical center during a 12-week COVID-19 surge in the Spring of 2020. We describe patterns in length of stay (LOS) over time. Our outcome of interest was prolonged LOS (PLOS), which we defined as 7 or more days. We performed univariate analyses of patient characteristics, clinical outcomes and discharge disposition to evaluate the association of each variable with PLOS and developed a final multivariate model via backward elimination, wherein all variables with a P-value above 0.05 were eliminated in a stepwise fashion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cohort included 1366 patients, of whom 13% died and 29% were readmitted within 30\u2009days. The LOS (mean: 12.6) fell over time (P\u2009&amp;lt;\u20090.0001). Predictors of PLOS included discharge to a post\u2013acute care (PAC) facility (odds ratio [OR]: 11.9, 95% confidence interval [CI] 2.6\u201354.0), uninsured status (OR 3.2, CI 1.1\u20139.1) and requiring intensive care and intubation (OR 18.4, CI 11.5\u201329.6). Patients had a higher readmission rate if discharged to PAC facilities (40%) or home with home health agency (HHA) services (38%) as compared to patients discharged home without HHA services (26%) (P\u2009&amp;lt;\u20090.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients hospitalized with COVID-19 during a US COVID-19 surge had a PLOS and high readmission rate. Lack of insurance, an intensive care unit stay and a decision to discharge to a PAC facility were associated with a PLOS. Efforts to decrease LOS and optimize hospital capacity during COVID-19 surges may benefit from focusing on increasing PAC and HHA capacity and resources.<\/jats:p><\/jats:sec>","DOI":"10.1093\/intqhc\/mzac098","type":"journal-article","created":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T23:41:13Z","timestamp":1670456473000},"source":"Crossref","is-referenced-by-count":2,"title":["Discharge to post\u2013acute care and other predictors of prolonged length of stay during the initial COVID-19 surge: a single site analysis"],"prefix":"10.1093","volume":"35","author":[{"given":"Jessica C","family":"O\u2019neil","sequence":"first","affiliation":[{"name":"Department of Medicine, Massachusetts General Hospital , 55 Fruit Street, Boston, MA 02114, USA"},{"name":"Harvard Medical School , 25 Shattuck Street, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin P","family":"Geisler","sequence":"additional","affiliation":[{"name":"Department of Medicine, Massachusetts General Hospital , 55 Fruit Street, Boston, MA 02114, USA"},{"name":"Harvard Medical School , 25 Shattuck Street, Boston, MA 02115, USA"},{"name":"Institute for Medical Information Processing, Biometry and Epidemiology, Marchioninistr , 15, M\u00fcnchen 81377, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donna","family":"Rusinak","sequence":"additional","affiliation":[{"name":"Performance Analysis and Improvement, Massachusetts General Hospital , 125 Nashua Street, Boston, MA 02114, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingrid V","family":"Bassett","sequence":"additional","affiliation":[{"name":"Department of Medicine, Massachusetts General Hospital , 55 Fruit Street, Boston, MA 02114, USA"},{"name":"Harvard Medical School , 25 Shattuck Street, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginia A","family":"Triant","sequence":"additional","affiliation":[{"name":"Department of Medicine, Massachusetts General Hospital , 55 Fruit Street, Boston, MA 02114, USA"},{"name":"Harvard Medical School , 25 Shattuck Street, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachael","family":"Mckenzie","sequence":"additional","affiliation":[{"name":"Department of Case Management, Massachusetts General Hospital , 55 Fruit Street, Boston, MA 02114, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa L","family":"Mattison","sequence":"additional","affiliation":[{"name":"Department of Medicine, Massachusetts General Hospital , 55 Fruit Street, Boston, MA 02114, USA"},{"name":"Harvard Medical School , 25 Shattuck Street, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1275-3769","authenticated-orcid":false,"given":"Amy 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