Comparative use of homecare and health services following hospitalization with COVID-19, sepsis, and influenza: Population-based cohort study

Background — People hospitalized with infectious illnesses are at elevated risk of long-term morbidity and disability.

Objective — Our objectives were to explore potential care gaps by characterizing and comparing home- and healthcare service use for up to 1 year amongst adults discharged alive following a COVID-19 hospitalization relative to adults who survived a hospitalization with sepsis or influenza.

Design and participants — We conducted a propensity-based overlap-weighted cohort study using linked health administrative data of all community-dwelling adults in Ontario discharged alive following hospitalization with COVID-19 or sepsis between April/2020 and December/2022. Historical comparators were hospitalized with influenza and sepsis between January/2014 and December/2019. Poisson regression was used to measure the association of hospitalization from COVID-19, sepsis, or influenza with home- and healthcare use in 1 year following discharge.

Main measures — The primary outcome was homecare service use up to 1 year post-hospitalization.

Key results — Among 204,008 included adults, 53,895 survived hospitalizations with COVID-19, 93,271 with sepsis (contemporary), 46,246 with sepsis (historical), and 10,596 with influenza. The rates of homecare use in the weighted cohorts were higher among those with COVID-19 than with influenza (rate ratio 1.25, 95% CI 1.13–1.38), lower than with contemporary sepsis (RR 0.81, 95% CI 0.78–0.85), and similar to those with historical sepsis (RR 1.02, 95% CI 0.96–1.07). Those with sepsis had a higher number of homecare visits up to 29 days following discharge than those with COVID-19, but an equal number at 30 days and beyond. Hospitalization with COVID-19 was associated with significantly higher rates of post-acute inpatient rehabilitation compared to all other groups.

Conclusion — The additional burden of homecare use following hospitalization for multiple circulating severe infectious illnesses in the post-pandemic era necessitates adequate health system resource planning to meet the care needs of an aging and multimorbid population.