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

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 Clinical Officer Colorado Hospital Western Region Boulder Community Health Centura Health Association Banner Health J.P. Valin, MD William Neff, MD Connie Savor Price, MD Gary Winfield, MD Chief Clinical Officer Chief Medical Officer – Chief Medical Officer Division Chief Medical Officer SCL Health Northern Colorado Denver Health HCA Healthcare/HealthONE UCHealth

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

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)

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

Number of Hospitalizations Number of Hospitalizations 1,400 1291 1,200 1,000 800 701 580 600 535 431 412 400 303 278 263 244 210 186 174 200 154 129 121 102 95 68 52 0 Age <30 Age 30-49 Age 50-59 Age 60+ March (1,294) April (2,456) May (1,153) June (478) July (898)

Distribution of Admissions Across Systems Banner Boulder 5% 1% Centura 15% UCHealth 30% Denver Health 10% SCL Health 15% HealthOne 24%

Daily Reported Inpatient Census

Daily System Inpatient Census

Daily System Inpatient Census

Disposition: All COVID-19 Patients Remain Inpatient 1% Deceased 14% Another Facility 18% Home 67% * “Another Facility” includes SNF, LTAC, Rehab, Another Acute Hospital, or Hospice

COVID -19 Patient Disposition by Age Group Disposition: Age <30 Disposition: Age 30-49 Another Another Deceased Facility Facility 3% 6% Deceased 9% 1% Home Home 88% 93% Disposition: Age 50-59 Disposition: Age 60+ Remain Inpatient Remain Inpatient Deceased 3% 1% 8% Deceased 22% Another Facility Another 27% Facility 13% Home Home 50% 76%

Overall COVID-19 Mortality Rate Overall COVID-19 Hospital Mortality Rate 30.0% 25.6% 25.0% 23.4% 20.9% 20.0% 19.4% 15.8% 15.6% 15.0% 15.1% 12.5% 11.1% 10.0% 9.8% 8.8% 7.6% 6.9% 6.7% 6.3% 5.0% 3.6% 3.6% 3.4% 3.1% 2.6% 1.9% 1.5% 1.0% 0.0% 0.0% 0.0% March April May June July Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

Mortality Rates Patients Ventilated vs. No Time on Ventilator COVID-19 Mortality Rate - Any Time on Ventilator COVID-19 Mortality - No Time on Ventilator 60.0% 25.0% 58.1% 50.0% 49.4% 49.1% 20.7% 20.0% 46.7% 45.8% 40.0% 39.6% 39.4% 16.6% 38.5% 38.0% 37.3% 15.6% 15.0% 34.0% 30.0% 29.3% 27.3% 11.6% 11.5% 10.6% 10.0% 22.1% 9.3% 21.2% 20.0% 20.0% 18.4% 18.4% 7.7% 17.4% 15.4% 5.0% 5.2% 4.9% 10.0% 10.0% 10.1% 6.3% 2.6% 2.1% 1.7% 1.5% 1.4% 1.0% 1.0% 1.0% 0.5% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% March April May June July March April May June July Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

Decreased Use of Mechanical Ventilation % of COVID-19 Hospitalized Patients Requiring Ventilation 35% 31% 30% 30% 29% 26% 25% 24% 23% 20% 20% 19% 19% 19% 17% 16% 15% 15% 15% 15% 15% 15% 13% 13% 11% 10% 10% 8% 7% 7% 5% 5% 0% March April May June July Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

Improved Average Length of Stay (ALOS) ALOS - All COVID-19 Hospitalizations 14 13.21 12.50 12 11.78 10.85 10.80 10.62 10.13 10 9.88 9.61 9.40 9.36 8.67 8.58 8.35 8.24 8 8.04 7.44 Days 7.10 6.79 6.46 6.30 6 5.49 4.57 4.21 4 3.89 2 0 March April May June July Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

Improved Average Length Of Stay (ALOS) Patients Ventilated vs. No Time on Ventilator ALOS - COVID-19 Patients - Any Time on Ventilator ALOS - COVID-19 Patients - No Time on Ventilator 30 9 8.47 27.52 27.52 8.15 8 26.40 26.25 25 7.44 7.40 24.53 7.30 7.23 7.19 7 23.34 7.02 22.96 22.88 22.54 6.72 22.13 22.11 21.67 21.29 21.37 21.34 20.66 6.18 20 6 6.05 19.93 20.01 5.87 19.34 5.79 5.76 5.65 5.67 17.38 5.25 17.34 5.23 5 Days 16.00 Days 4.76 15 4.53 14.41 14.03 4.23 4.19 4 12.28 3.46 3.42 3.39 10 3 2 5 1 0 0 March April May June July March April May June July Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

Average Time on Ventilator COVID-19 Patients: Average Time on Vent 25 20 19.73 17.08 17.05 16.85 16.19 16.10 15.65 15.38 15 15.30 15.11 14.59 14.47 14.42 14.20 13.83 Days 12.92 12.74 12.23 12.16 12.03 12.00 11.84 10 9.23 6.97 6.94 5 0 March April May June July Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

Discharge to Home: All Patients % of All COVID-19 Patients Discharged Home 100% 95.6% 95.1% 94.2% 93.8% 90% 90.4% 90.3% 88.6% 88.4% 88.8% 85.6% 80% 79.9% 78.9% 78.3% 72.2% 72.1% 70% 69.2% 69.0% 68.4% 67.5% 63.1% 61.6% 60% 56.1% 52.7% 50% 47.3% 42.6% 40% 30% 20% 10% 0% March April May June July Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

Patients Discharged to Home: Ventilated vs. No Time on Ventilator % Discharged Home - COVID-19 - Anytime on Vent % Discharge Home - COVID-19 - No Time on Vent 100% 100% 98% 97% 96% 97% 96% 96% 96% 95% 95% 94% 93% 93% 90% 90% 89% 85% 83% 82% 81% 80% 80% 80% 75% 73% 70% 70% 69% 70% 69% 69% 68% 68% 67% 61% 60% 60% 60% 60% 57% 53% 52% 51% 50% 50% 48% 44% 42% 40% 40% 40% 36% 32% 32% 32% 30% 30% 29% 29% 27% 26% 23% 20% 20% 19% 18% 13% 10% 10% 0% 0% March April May June July March April May June July Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations Age <30 Age 30-49 Age 50-59 Age 60+ ALL Hospitalizations

Summary  This dataset provides a comprehensive view of Wave 1 of 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

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

Thank You to the Real Heroes!