Outcomes of COVID-19 adults managed in an outpatient versus hospital setting.

Abstract

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic continues to spread globally and as of February 4, 2021, there are more than 26 million confirmed cases and more than 440,000 deaths in the United States (US). A top priority of the Centers for Disease Control and Prevention (CDC) is to identify risk factors for severe COVID-19 illness. The objective of this study was to analyze the characteristics and outcomes of COVID-19 adults who were managed in an outpatient setting compared to patients who required hospitalization at US academic centers.MethodsUsing the Vizient clinical database, Discharge records of adults with a diagnosis of COVID-19 between March 1, 2020 and January 31, 2021 were reviewed. Outcome measures included demographics, characteristics, rate of hospitalization, and mortality, and data were analyzed based on inpatient versus outpatient management.ResultsAmong COVID-19 adults, 1,360,078 patients were managed in an outpatient setting while 545,635 patients required hospitalization. Compared to hospitalized COVID-19 adults, COVID-19 adults who were managed in an outpatient setting were more likely to be female (56.1% vs 47.5%, p <0.001), white (57.7% vs 54.8%, p <0.001), within younger age group of 18–50 years (p<0.001) and have lower rate of comorbidities. Mortality was significantly lower in outpatient group compared to hospitalized group (0.2% vs 12.2%, respectively, p <0.01%). For outpatient group, mortality increased with increasing age group: 0.02% (52 of 295,112) for patients 18–30 years and 1.2% (1,373 of 117,866) for patients >75 years. The rate of hospitalization was lowest for age group 18–30 years at 10.6% (35,607 of 330,719) and highest for age group >75 years at 56.1% (150,381 of 268,247).ConclusionThis analysis of US academic centers showed that 28.6% of COVID-19 adults who sought care at one of the hospitals reporting data to the Vizient clinical database required in-patient treatment. The rate of hospitalization in our study was lowest for the youngest age group of 18–30 years and highest for age group >75 years. Beside older age, other factors associated with outpatient management included female gender, white race, and having commercial insurance.