{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T16:35:14Z","timestamp":1772210114072,"version":"3.50.1"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T00:00:00Z","timestamp":1627516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000738","name":"u.s. department of veterans affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"u.s. department of veterans affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"u.s. department of veterans affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We explored longitudinal trends in sociodemographic characteristics, reported symptoms, laboratory findings, pharmacological and non-pharmacological treatment, comorbidities, and 30-day in-hospital mortality among hospitalized patients with coronavirus disease 2019 (COVID-19).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included patients diagnosed with COVID-19 in the United States Veterans Health Administration between 03\/01\/20 and 08\/31\/20 and followed until 09\/30\/20. We focused our analysis on patients that were subsequently hospitalized, and categorized them into groups based on the month of hospitalization. We summarized our findings through descriptive statistics. We used Cuzick\u2019s Trend Test to examine any differences in the distribution of our study variables across the six months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During our study period, we identified 43,267 patients with COVID-19. A total of 8,240 patients were hospitalized, and 13.1% (N = 1,081) died within 30 days of admission. Hospitalizations increased over time, but the proportion of patients that died consistently declined from 24.8% (N = 221\/890) in March to 8.0% (N = 111\/1,396) in August. Patients hospitalized in March compared to August were younger on average, mostly black, urban-dwelling, febrile and dyspneic. They also had a higher frequency of baseline comorbidities, including hypertension and diabetes, and were more likely to present with abnormal laboratory findings including low lymphocyte counts and elevated creatinine. Lastly, there was a decline from March to August in receipt of mechanical ventilation (31.4% to 13.1%) and hydroxychloroquine (55.3% to &lt;1.0%), while treatment with dexamethasone (3.7% to 52.4%) and remdesivir (1.1% to 38.9%) increased.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among hospitalized patients with COVID-19, we observed a trend towards decreased disease severity and mortality over time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0246217","type":"journal-article","created":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T14:37:31Z","timestamp":1627569451000},"page":"e0246217","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Trends in COVID-19 cases and clinical management in Veterans Health Administration medical facilities: A national cohort study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6140-4250","authenticated-orcid":true,"given":"Maya","family":"Aboumrad","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Shiner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Riblet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugh","family":"Huizenga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nabin","family":"Neupane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yinong","family":"Young-Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,7,29]]},"reference":[{"issue":"3","key":"pone.0246217.ref001","doi-asserted-by":"crossref","first-page":"105924","DOI":"10.1016\/j.ijantimicag.2020.105924","article-title":"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and corona virus disease-2019 (COVID-19): the epidemic and the challenges","volume":"55","author":"CC Lai","year":"2020","journal-title":"Int J antimicrob Agents"},{"key":"pone.0246217.ref002","unstructured":"Centers for Disease Control and Prevention. Coronavirus Disease 2019 (Covid-19): Cases, Data, & Surveillance. February 28, 2021. Available at: https:\/\/covid.cdc.gov\/covid-data-tracker. Accessed February 28, 2021."},{"key":"pone.0246217.ref003","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.ijid.2020.03.017","article-title":"Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis","volume":"94","author":"J Yang","year":"2020","journal-title":"Int J Infect Dis"},{"issue":"9","key":"pone.0246217.ref004","doi-asserted-by":"crossref","first-page":"e1003379","DOI":"10.1371\/journal.pmed.1003379","article-title":"Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: A nationwide cohort study","volume":"17","author":"CT Rentsch","year":"2020","journal-title":"PLoS Med"},{"issue":"26","key":"pone.0246217.ref005","doi-asserted-by":"crossref","first-page":"2534","DOI":"10.1056\/NEJMsa2011686","article-title":"Hospitalization and mortality among black patients and white patients with Covid-19","volume":"382","author":"EG Price-Haywood","year":"2020","journal-title":"N Engl J Med"},{"issue":"8","key":"pone.0246217.ref006","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1038\/s41591-020-0952-y","article-title":"Disease and healthcare burden of COVID-19 in the United States","volume":"26","author":"IF Miller","year":"2020","journal-title":"Nat Med"},{"issue":"3","key":"pone.0246217.ref007","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1093\/pubmed\/fdaa070","article-title":"Racial demographics and COVID-19 confirmed cases and deaths: a correlational analysis of 2886 US counties","volume":"42","author":"UV Mahajan","year":"2020","journal-title":"J Public Health"},{"issue":"1","key":"pone.0246217.ref008","first-page":"114","article-title":"Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19","volume":"1","author":"J Magagnoli","year":"2020","journal-title":"Med (N Y)"},{"issue":"9","key":"pone.0246217.ref009","doi-asserted-by":"crossref","first-page":"e2022310","DOI":"10.1001\/jamanetworkopen.2020.22310","article-title":"Risk factors for hospitalization, mechanical ventilation, or death among 10 131 US veterans with SARS-CoV-2 infection","volume":"3","author":"GN Ioannou","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"7","key":"pone.0246217.ref010","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1515\/cclm-2020-0369","article-title":"Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis","volume":"58","author":"BM Henry","year":"2020","journal-title":"Clin Chem Lab Med"},{"issue":"9","key":"pone.0246217.ref011","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1016\/S1473-3099(20)30371-6","article-title":"Risk factors for SARS-CoV-2 among patients in the Oxford Royal College of General Practitioners Research and Surveillance Centre primary care network: a cross-sectional study","volume":"20","author":"S de Lusignan","year":"2020","journal-title":"Lancet Infect Dis"},{"issue":"5","key":"pone.0246217.ref012","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.cell.2020.04.021","article-title":"Coast-to-coast spread of SARS-CoV-2 during the early epidemic in the United States","volume":"181","author":"JR Fauver","year":"2020","journal-title":"Cell"},{"key":"pone.0246217.ref013","unstructured":"Veterans Health Administration Office of Emergency Management. COVID-19 Response Plan. March 23, 2020. Available at: https:\/\/www.va.gov\/opa\/docs\/VHA_COVID_19_03232020_vF_1.pdf. Accessed June 1, 2020."},{"issue":"4","key":"pone.0246217.ref014","article-title":"Expanding access through virtual care: The VA\u2019s early experience with Covid-19","volume":"1","author":"L Heyworth","year":"2020","journal-title":"NEJM Catalyst."},{"key":"pone.0246217.ref015","article-title":"Review of Veterans Health Administration\u2019s COVID-19 Response and Continued Pandemic Readiness","author":"Department of Veterans Affairs Office of Inspector General","year":"2020"},{"key":"pone.0246217.ref016","first-page":"8802162","article-title":"Pandemic politics: Timing state-level social distancing responses to COVID-19","author":"C Adolph","year":"2020","journal-title":"J Health Polit Policy Law"},{"issue":"4","key":"pone.0246217.ref017","first-page":"13","article-title":"Current and projected characteristics and unique health care needs of the patient population served by the Department of Veterans Affairs","volume":"5","author":"C Eibner","year":"2016","journal-title":"Rand Health Q"},{"key":"pone.0246217.ref018","author":"Centers for Disease Control and Prevention","year":"2020","journal-title":"Coronavirus Disease 2019 (COVID-19) 2020 Interim Case Definition"},{"issue":"5","key":"pone.0246217.ref019","doi-asserted-by":"crossref","first-page":"469","DOI":"10.7205\/MILMED-D-15-00094","article-title":"Veterans Affairs health system enrollment and health care utilization after the Affordable Care Act: Initial insights","volume":"181","author":"A Silva","year":"2016","journal-title":"Mil Med"},{"issue":"8","key":"pone.0246217.ref020","doi-asserted-by":"crossref","first-page":"1962","DOI":"10.1093\/cid\/ciaa674","article-title":"Predictors for Severe COVID-19 Infection","volume":"71","author":"A Bhargava","year":"2020","journal-title":"Clin Infect Dis"},{"key":"pone.0246217.ref021","article-title":"Coronavirus disease 2019 (COVID-19) treatment guidelines","author":"National Institutes of Health","year":"2020"},{"key":"pone.0246217.ref022","article-title":"Infectious Diseases Society of America guidelines on the treatment and management of patients with COVID-19 infection","author":"A Bhimraj","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"3","key":"pone.0246217.ref023","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S0895-4356(02)00585-1","article-title":"How to measure comorbidity: a critical review of available methods","volume":"56","author":"V De Groot","year":"2003","journal-title":"J Clin Epidemiol"},{"issue":"2","key":"pone.0246217.ref024","doi-asserted-by":"crossref","first-page":"e88","DOI":"10.1016\/S2665-9913(21)00008-4","article-title":"Changing COVID-19 outcomes in patients with rheumatic disease\u2013are we really getting better at this?","volume":"3","author":"M Gianfrancesco","year":"2021","journal-title":"Lancet Rheumatol"},{"issue":"8","key":"pone.0246217.ref025","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1056\/NEJMoa2021436","article-title":"Dexamethasone in Hospitalized Patients with Covid-19-Preliminary Report","volume":"384","author":"P Horby","year":"2021","journal-title":"N Engl J Med"},{"issue":"24","key":"pone.0246217.ref026","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.1056\/NEJMoa2007016","article-title":"Compassionate use of remdesivir for patients with severe Covid-19","volume":"382","author":"J Grein","year":"2020","journal-title":"N Engl J Med"},{"issue":"7","key":"pone.0246217.ref027","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1080\/1744666X.2020.1792778","article-title":"Swinging the pendulum: lessons learned from public discourse concerning hydroxychloroquine and COVID-19","volume":"16","author":"S Sattui","year":"2020","journal-title":"Expert Rev Clin Immunol"},{"key":"pone.0246217.ref028","author":"United States Census Bureau","year":"2020.","journal-title":"Facts for Features: Veterans Day 2018"},{"issue":"3","key":"pone.0246217.ref029","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.2105\/AJPH.2017.304246","article-title":"Mortality disparities in racial\/ethnic minority groups in the Veterans Health Administration: an evidence review and map","volume":"108","author":"K Peterson","year":"2018","journal-title":"Am J Public Health"},{"issue":"5","key":"pone.0246217.ref030","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.amepre.2012.07.029","article-title":"Health and health behavior differences: US Military, veteran, and civilian men","volume":"43","author":"KD Hoerster","year":"2012","journal-title":"Am J Prev Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0246217","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T14:38:13Z","timestamp":1627569493000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0246217"}},"subtitle":[],"editor":[{"given":"Muhammed","family":"Elhadi","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,7,29]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0246217","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.01.18.427092","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,29]]}}}