COVID-19 Wave 1 Colorado SEPTEMBER 11, 2020 Health System - - PowerPoint PPT Presentation

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COVID-19 Wave 1 Colorado SEPTEMBER 11, 2020 Health System - - PowerPoint PPT Presentation

Apr 13, 2023 403 likes •647 views

COVID-19 Wave 1 Colorado SEPTEMBER 11, 2020 Health System Collaborative Participants Darlene Tad-y, MD Ben Keidan, MD Kathryn Perkins, MD Shauna Gulley, MD Vice President Clinical Affairs Chief Medical Officer Chief Medical Officer, Chief

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SLIDE 1

COVID-19 Wave 1 Colorado

SEPTEMBER 11, 2020

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SLIDE 2

Health System Collaborative Participants

Ben Keidan, MD Chief Medical Officer Boulder Community Health Shauna Gulley, MD Chief Clinical Officer Centura Health William Neff, MD Chief Medical Officer – Northern Colorado UCHealth J.P. Valin, MD Chief Clinical Officer SCL Health Gary Winfield, MD Division Chief Medical Officer HCA Healthcare/HealthONE Kathryn Perkins, MD Chief Medical Officer, Western Region Banner Health Darlene Tad-y, MD Vice President Clinical Affairs Colorado Hospital Association Connie Savor Price, MD Chief Medical Officer Denver Health

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About the Data

 Includes 6,329 COVID-19 confirmed admissions

 98% of statewide admissions (6,441 admissions per CDPHE)  60,252 patient days  17,431 ventilator days

 All patients had a positive COVID-19 PCR test  Admitted between March 1, 2020 and July 31, 2020

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About the Patients

 67.2% (4,250) patients discharged to home  18.4% (1,162) patients discharged to another facility

(Skilled Nursing Facility, Acute Rehab, Long Term Acute Care Hospital, another Acute Care Hospital or Hospice)

 Overall in-hospital mortality 13.5% (855)

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SLIDE 5

About the Data: Caveats

 The data is not risk adjusted or case-mix adjusted  The data was aggregated and de-identified at a health

system level, and then aggregated centrally

 COVID-19 positive patient readmissions and transfers may

be included in the datasets – a single patient may be counted more than once in the data

 62 patients in the dataset remained hospitalized at the

time the data was compiled, which could slightly skew mortality and length of stay in July

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SLIDE 6

Number of Hospitalizations

52 263 278 701 154 580 431 1291 121 303 244 535 68 129 95 186 102 210 174 412 200 400 600 800 1,000 1,200 1,400 Age <30 Age 30-49 Age 50-59 Age 60+

Number of Hospitalizations

March (1,294) April (2,456) May (1,153) June (478) July (898)

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SLIDE 7

Distribution of Admissions Across Systems

Banner 5% Boulder 1% Centura 15% Denver Health 10% HealthOne 24% SCL Health 15% UCHealth 30%

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SLIDE 8

Daily Reported Inpatient Census

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SLIDE 9

Daily System Inpatient Census

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SLIDE 10

Daily System Inpatient Census

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SLIDE 11

Disposition: All COVID-19 Patients

* “Another Facility” includes SNF, LTAC, Rehab, Another Acute Hospital, or Hospice

Deceased 14% Home 67% Another Facility 18% Remain Inpatient 1%

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SLIDE 12

COVID -19 Patient Disposition by Age Group

Deceased 1% Home 93% Another Facility 6%

Disposition: Age <30

Deceased 3% Home 88% Another Facility 9%

Disposition: Age 30-49

Deceased 8% Home 76% Another Facility 13% Remain Inpatient 3%

Disposition: Age 50-59

Deceased 22% Home 50% Another Facility 27% Remain Inpatient 1%

Disposition: Age 60+

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SLIDE 13

Overall COVID-19 Mortality Rate

1.9% 2.6% 0.0% 1.5% 0.0% 3.4% 3.6% 3.6% 3.1% 1.0% 7.6% 6.7% 11.1% 6.3% 6.9% 23.4% 25.6% 20.9% 19.4% 15.8% 15.1% 15.6% 12.5% 9.8% 8.8%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

March April May June July

Overall COVID-19 Hospital Mortality Rate

Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

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Mortality Rates

Patients Ventilated vs. No Time on Ventilator

10.0% 17.4% 0.0% 20.0% 0.0% 10.1% 18.4% 18.4% 15.4% 6.3% 22.1% 21.2% 45.8% 27.3% 38.5% 39.6% 46.7% 49.4% 58.1% 49.1% 29.3% 34.0% 39.4% 38.0% 37.3%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

March April May June July

COVID-19 Mortality Rate - Any Time on Ventilator

Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations 0.0% 0.0% 0.0% 0.0% 0.0% 1.0% 1.0% 1.5% 1.7% 0.5% 1.0% 2.1% 2.6% 0.0% 1.4% 16.6% 20.7% 15.6% 11.6% 10.6% 9.3% 11.5% 7.7% 4.9% 5.2%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

March April May June July

COVID-19 Mortality - No Time on Ventilator

Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

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SLIDE 15

Decreased Use of Mechanical Ventilation

19% 15% 7% 7% 5% 26% 15% 13% 10% 8% 31% 24% 20% 23% 15% 30% 19% 16% 17% 13% 29% 19% 15% 15% 11%

0% 5% 10% 15% 20% 25% 30% 35%

March April May June July

% of COVID-19 Hospitalized Patients Requiring Ventilation

Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

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SLIDE 16

Improved Average Length of Stay (ALOS)

6.46 6.79 4.21 4.57 3.89 9.40 8.35 8.04 6.30 5.49 13.21 10.85 10.13 10.80 7.44 12.50 10.62 9.36 9.61 8.58 11.78 9.88 8.67 8.24 7.10

2 4 6 8 10 12 14

March April May June July

Days

ALOS - All COVID-19 Hospitalizations

Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

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SLIDE 17

Improved Average Length Of Stay (ALOS)

Patients Ventilated vs. No Time on Ventilator

16.00 21.34 14.03 19.34 12.28 19.93 21.37 27.52 22.11 14.41 26.40 22.88 26.25 27.52 20.01 22.13 21.29 23.34 20.66 17.38 22.54 21.67 24.53 22.96 17.34

5 10 15 20 25 30

March April May June July

Days

ALOS - COVID-19 Patients - Any Time on Ventilator

Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

4.19 4.23 3.42 3.39 3.46 5.65 6.05 5.25 4.53 4.76 7.30 7.02 6.18 5.76 5.23 8.47 8.15 6.72 7.40 7.23 7.44 7.19 5.87 5.67 5.79

1 2 3 4 5 6 7 8 9

March April May June July

Days

ALOS - COVID-19 Patients - No Time on Ventilator

Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

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SLIDE 18

Average Time on Ventilator

9.23 15.65 6.97 12.00 6.94 12.74 16.19 17.08 14.47 12.23 16.85 15.30 19.73 17.05 12.16 13.83 15.11 14.59 12.92 12.03 14.20 15.38 16.10 14.42 11.84

5 10 15 20 25

March April May June July

Days

COVID-19 Patients: Average Time on Vent

Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

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Discharge to Home: All Patients

90.4% 90.3% 94.2% 95.6% 95.1% 88.6% 88.4% 88.8% 69.0% 93.8% 79.9% 72.2% 72.1% 78.9% 85.6% 56.1% 42.6% 47.3% 52.7% 63.1% 69.2% 61.6% 67.5% 68.4% 78.3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

March April May June July

% of All COVID-19 Patients Discharged Home

Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

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SLIDE 20

Patients Discharged to Home:

Ventilated vs. No Time on Ventilator

80% 57% 89% 60% 60% 67% 52% 53% 69% 69% 44% 42% 29% 32% 23% 27% 19% 26% 13% 18% 40% 32% 36% 32% 29%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% March April May June July

% Discharged Home - COVID-19 - Anytime on Vent

Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations 93% 96% 95% 98% 97% 96% 95% 94% 69% 96% 96% 82% 83% 93% 97% 68% 48% 51% 61% 70% 81% 68% 73% 75% 85% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% March April May June July

% Discharge Home - COVID-19 - No Time on Vent

Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

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Summary

 This dataset provides a comprehensive view of Wave 1

  • f COVID-19 in Colorado

 Length of stay, mortality rates and ventilator use rates

were observed to be higher in older age groups

 Patients requiring mechanical ventilation were observed

to have:

 Higher mortality  Longer lengths of stay  Lower rates of discharge to home

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SLIDE 22

Summary

 Ventilator utilization decreased between March and July  Study was not designed to evaluate the cause of improved

  • utcomes, but could be related to:

 Improved patient management and treatment algorithms  Rapid sharing and dissemination of knowledge and best practices  New therapies including antivirals and convalescent plasma  Baseline patient characteristics and comorbidities

 Rates of ventilator use and length of stay data can help with

future surge planning for potential future waves of COVID-19 in Colorado

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SLIDE 23

Thank You to the Real Heroes!