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COVID-19 Follow-up care paths and Long-term Outcomes Within the Dutch health care system: a combined rehabilitation, pulmonary, and intensive care perspective (CO-FLOW study)

After hospital discharge, patients with COVID-19 follow different aftercare trajectories, such as in a medical rehabilitation center, skilled nursing facility or community-based rehabilitation center. At the beginning of the pandemic, these trajectories had to be developed in a short time period, without much knowledge about the disease. To further develop the aftercare it is important to have knowledge about the recovery of patients with COVID-19 after hospital discharge and about the quality of the aftercare.

Goal

Aim of the CO-FLOW study was to evaluate the long-term consequences of COVID-19 in patients who had been hospitalized. Besides, we explored the predictors of recovery. Finally, we evaluated the quality of the aftercare process.

Approach

For 3 years we followed 650 patients with COVID-19 who had been hospitalized in the Rotterdam-Rijnmond and Delft region. We collected data on their physical recovery, recovery of problems with memory and concentration, and on psychosocial recovery. Besides, we asked participants how satisfied they were with the received aftercare, and whether they had suggestions for improvement. We also asked health care professionals about potential improvements regarding aftercare. Data on recovery were collected at 3, 6, 12, 24, and 36 months after hospital discharge.
 

Afbeelding
3, 6, 12, 24, en 36 maanden na ziekenhuisontslag

Collaboration partners

The study was performed by the departments of rehabilitation medicine, respiratory medicine, and intensive care of Erasmus MC in Rotterdam, The Netherlands. We intensively collaborated with Rijndam Rehabilitation, Laurens and Aafje, and the following hospitals: Albert Schweitzer, Franciscus Gasthuis & Vlietland, IJsselland, Ikazia, Maasstad and Reinier de Graaf Gasthuis. Without this collaboration it would not have been possible to include a large and diverse group of patients. The first measurements were performed in the hospitals where patients had been hospitalized, later measurements were performed at Erasmus MC or at home.

Results

Over 70% of patients experienced long-lasting problems, even until 3 years after hospital discharge. These long-lasting problems were more often experienced by women and by patients with pre-existing pulmonary disease. Aftercare seemed effective in physical recovery. However, to improve the recovery of other problems, such as problems with memory and concentration and fatigue, aftercare needs to be improved. To be able to do that, more knowledge is necessary about the causes of long-term health problems after COVID-19 and effective treatment. We started several projects for this purpose.

Products

Title: Podcast over lange termijn gevolgen
Link: https://www.nporadio1.nl/podcasts/long-covid-de-schaduwpandemie
Title: Long COVID blijft een mysterie
Title: CO-FLOW: onderwijs fysiotherapie studenten Haagse Hoge School
Title: Interview Radio 1 Journaal augustus 2022 over aanhoudende klachten op 1 jaar na ziekenhuisontslag
Link: https://www.nporadio1.nl/fragmenten/nos-radio-1-journaal/c6a735f0-3401-4706-936a-d72dd92d0e52/2022-08-25-9-op-10-opgenomen-coronapatienten-jaar-later-nog-klachten
Title: CO-FLOW onderzoek en patientparticipatie
Title: (H)erken langdurige symptomen na COVID-19.
Link: https://www.doq.nl/herken-langdurige-symptomen-na-covid-19
Title: (H)erken langdurige symptomen na COVID-19. DOQ, Arts aan het woord.
Link: https://www.doq.nl/herken-langdurige-symptomen-na-covid-19/?hash=c151e57162f490550b743e688a9abe1
Title: Interview Op1
Link: https://op1npo.nl/tag/merel-hellemons/
Title: Interview NPO 1 Journaal (radio): Langdurige klachten na COVID-19
Title: Langdurige klachten na COVID-19
Title: nieuwsfragment NPO 1 Journaal (TV): langdurige klachten na COVID-19
Title: Diverse kranten melden nieuws over aanhoudende klachten op 1 jaar na ziekenhuisontslag
Link: https://www.trouw.nl/wetenschap/jaar-na-opname-om-corona-hebben-negen-op-de-tien-patienten-nog-steeds-klachten~b7ad2005/
Title: Interview in Trouw (Februari 2022): Hoe is het om long covid te hebben? ‘Er is weinig perspectief voor mij. Dat is heftig’
Link: https://www.nd.nl/nieuws/nederland/1083149/drie-mensen-met-long-covid-over-hun-ziekte-ik-heb-geen-keuze-ik
Title: The Shadow Pandemic
Title: Diverse kranten/media: 9 op de 10 patienten houden langdurige klachten na ziekenhuisopname voor COVID-19
Title: Position Paper Tweede Kamer der Staten Generaal
Link: https://www.tweedekamer.nl/kamerstukken/detail?id=2022Z00039&did=2022D00073
Title: Onderwijs Minor Rehabilitation & Sports (Bachelor Geneeskunde, Erasmus Universiteit / Universiteit Leiden; Bachelor Klinische Technologie, Technische Universiteit Delft Universiteit Leiden University/Erasmus Universiteit)
Link: http://nvt
Title: Wetenschappers ontdekken steeds meer over long covid
Title: Interview CO-FLOW TV Rijnmond in kader van Science Hotel
Link: http://rijnmond.nl/nieuws/amp/1408594/
Title: Bericht Amazing Erasmus MC over aanhoudende klachten op 1 jaar na ziekenhuisontslag
Link: https://amazingerasmusmc.nl/infectie/9-op-de-10-patienten-houden-langdurige-klachten-na-ziekenhuisopname-voor-covid-19/
Title: 9 op de 10 patienten ervaart op 1 jaar nog klachten na ziekenhuisopname
Title: Presentatie vervolgonderzoeken van CO-FLOW tijdens bezoek demissionair minister Pia Dijkstra in Erasmus MC (juni 2024).
Link: http://nvt
Title: Onderwijs: COVID-19 in de kliniek en het herstel daarna. Bachelor geneeskunde, Erasmus Universiteit
Title: Onderwijs: COVID-19 in de kliniek en het herstel daarna. Bachelor geneeskunde, Erasmus Universiteit,
Link: http://nvt
Title: Diverse presentaties bij regionale refereeravonden revalidatiegeneeskunde en longgeneeskunde, internationale visitatie Erasmus MC, Regionaal Overleg Acute Zorg Rotterdam-Rijnmond, European Scientific Working group on Influenza congres (ESWI), EU project
Link: https://youtu.be/I4ac0gfOo9U
Title: CO-FLOW: onderwijs bachelor studenten Geneeskunde Erasmus Universiteit, Leiden Universiteit, Technische Universiteit Delft
Title: Onderwijs 3e jaars fysiotherapie studenten Haagse Hoge School
Link: http://nvt
Title: Berichtgeving NOS journaal TV over aanhoudende klachten op 1 jaar na ziekenhuisontslag
Link: https://www.npostart.nl/nos-journaal/25-08-2022/POW_05158743
Title: Genezen maar toch ziek
Title: Bericht op Amazing Erasmus MC: CO-FLOW studie volgt alle COVID-19 patiënten uit Rijnmond na ontslag uit ziekenhuis (oktober 2020).
Link: https://amazingerasmusmc.nl/biomedisch/co-flow-studie-volgt-alle-covid-19-patienten-uit-rijnmond-na-ontslag-ziekenhuis
Title: Mogelijk honderdduizenden met long covid
Title: CO-FLOW: Onderwijs Bachelor Geneeskunde Erasmus universiteit, Leiden universiteit, Technische Universiteit Delft
Title: Uitzending NTR focus ‘Ziek na Corona’, uitzending 24-06-2023
Link: https://ntr.nl/Focus/287/detail/Ziek-na-corona-12/VPWON_1344838
Title: Veel leraren hebben long covid
Title: Bij mensen met long covid vertoont het immuunsysteem tal van afwijkingen
Title: A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021.
Author: Wulf Hanson S and collaborators.
Magazine: JAMA
Start- and endpage: 1604-1615
Link: https://jamanetwork.com/journals/jama/fullarticle/2797443
Title: Nutritional status of patients with COVID-19 1-y post-ICU stay: a prospective observational study.
Author: Lakenman PLM, Joosten KFM, van Bommel J, Bek LM, van den Berg-Emons RJG, Olieman J.
Magazine: Nutrition
Start- and endpage: 1-10
Link: https://doi.org/10.1016/j.nut.2023.112025
Title: Symptoms persisting after hospitalization for COVID-19: 12 months interim results of the CO-FLOW study.
Author: Bek LM, Berentschot JC, Heijenbrok-Kal, Huijts S, van Genderen ME, Vlake JH, van Bommel J, Aerts JGJV, Ribbers GM, van den Berg-Emons HJG, Hellemons M.
Magazine: ERJ Open Research
Start- and endpage: 1-10
Title: Nazorg en langetermijngevolgen van COVID-19; interim-analyses tot 12 maanden na ziekenhuisontslag in het CO-FLOW cohort.
Author: Bek LM, Berentschot JC, Heijenbrok-Kal MH, Hellemons ME, Aerts JGJV, Ribbers GM, van den Berg-Emons HJG.
Magazine: Nederlands Tijdschrift voor Revalidatiegeneeskunde
Start- and endpage: 1-10
Link: https://www.revalidatie.nl/ntr/nazorg-en-langetermijngevolgen-van-covid-19-interim-analyses-tot-12-maanden-na-ziekenhuisontslag-in-het-co-flow-cohort/
Title: Persistent health problems beyond pulmonary recovery up to 6 months after hospitalization for SARS-CoV-2
Author: Hellemons ME, Huijts S, Bek L, Berentschot J, Nakshbandi G, Schurink CAM, Vlake J, van Genderen ME, van Bommel J, Gommers D, Odink A, Ciet P, Shamier MC, GeurtsvanKessel C, Baart SJ, Ribbers GM, van den Berg-Emons HG, Heijenbrok-Kal MH, Aerts JGJV.
Magazine: Annals of American Thoracic Society
Start- and endpage: 1-34
Link: https://pubmed.ncbi.nlm.nih.gov/34582728/
Title: Immunological profiling in long COVID: overall low grade inflammation and T-lymphocyte senescence and increased monocyte activation correlating with increasing fatigue severity.
Author: Berentschot, J. C., Drexhage, H. A., Aynekulu Mersha, D. G., Wijkhuijs, A. J. M., GeurtsvanKessel, C. H., Koopmans, M. P. G., Voermans, J. J. C., Hendriks, R. W., Nagtzaam, N. M. A., de Bie, M., Heijenbrok-Kal, M. H., Bek, L. M., Ribbers, G. M., van den Berg-Emons, R. J. G., Aerts, J. G. J. V., Dik, W. A., & Hellemons, M. E.
Magazine: Frontiers in immunology
Start- and endpage: 1-10
Link: https://doi.org/10.3389/fimmu.2023.1254899
Title: Symptoms persisting after hospitalization for COVID-19: 12 months interim results of the CO-FLOW study.
Author: Bek LM, Berentschot JC, Heijenbrok-Kal, Huijts S, van Genderen ME, Vlake JH, van Bommel J, Aerts JGJV, Ribbers GM, van den Berg-Emons HJG, Hellemons M.
Magazine: European Respiratory Journal
Start- and endpage: 1-32
Link: http://10.1183/2312.00355-2022
Title: CO-FLOW: COvid-19 Follow-up care paths and Long-term Outcomes Within the Dutch health care system: study protocol of a multicenter prospective cohort study following patients 2 years after hospital discharge
Author: LM Bek, JC Berentschot, ME Hellemons, SM Huijts, JGJV Aerts, J van Bommel, ME van Genderen, DAMPJ Gommers, GM Ribbers, MH Heijenbrok-Kal, RJG van den Berg-Emons, and the CO-FLOW Collaboration Group
Magazine: BMC Health Services Research
Start- and endpage: 1-10
Link: http://rdcu.be/cvRVg
Title: Severe fatigue as symptom of long COVID and clinical and immunological profile
Author: Berentschot JC, Drexhage HA, Aynekulu Mersha DA, Wijkhuijs AJM, Geurts van Kessel CH, Koopmans MPG, Voermans J, Heijenbrok-Kal MH, Bek LM, Ribbers GM, van den Berg-Emons RJG, Aerts JGJV, Dik WA, Hellemons ME.
Magazine: medrxiv.org
Start- and endpage: 1-32
Link: http://www.medrxiv.org/content/10.1101/2022.09.15.22279970v1
Title: Physical recovery across care pathways up to 12 months after hospitalization for COVID-19: a multicenter prospective cohort study (CO-FLOW).
Author: Berentschot JC, Heijenbrok-Kal MH, Bek LM, Huijts SM, van Bommel J, van Genderen ME, Aerts JGJV, Ribbers GM, Hellemons ME, van den Berg-Emons RJG, on behalf of the CO-FLOW Collaboration Group.
Magazine: Lancet Regional Health
Start- and endpage: 1-14
Link: https://doi.org/10.1016/j.lanepe.2022.100485
Title: CO-FLOW: COvid-19 Follow-up care paths and Long-term Outcomes Within the Dutch health care system: study protocol of a multicenter prospective cohort study following patients 2 years after hospital discharge.
Author: Bek LM, Berentschot JC, Hellemons ME, Huijts SM, Aerts JGJV, van Bommel J, van Genderen ME, Gommers DAMPJ, Ribbers GM, Heijenbrok-Kal MH, van den Berg-Emons RJG, and the CO-FLOW Collaboration Group
Magazine: BMC Health Services
Start- and endpage: 1-10
Link: https://pubmed.ncbi.nlm.nih.gov/34419032/
Title: Estimated global proportions of individuals with persistent fatigue, cognitive and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021
Author: Wulf Hanson S, et al.
Magazine: JAMA
Start- and endpage: 1-10
Link: https://jamanetwork.com/journals/jama/fullarticle/2797443
Title: Physical recovery across care pathways up to 12 months after hospitalization for COVID-19: a multicenter prospective cohort study (CO-FLOW).
Author: Berentschot JC, Heijenbrok-Kal MH, Bek LM, Huijts SM, van Bommel J, van Genderen ME, Aerts JGJV, Ribbers GM, Hellemons ME, van den Berg-Emons RJG, on behalf of the CO-FLOW Collaboration Group
Magazine: The Lancet Regional Health – Europe 2022
Start- and endpage: 1-10
Link: https://authors.elsevier.com/sd/article/S2666-7762(22)00181-8
Title: Return to work and health-related quality of life up to 1 year in patients hospitalized for COVID-19: the CO-FLOW study.
Author: Bek, L. M., Berentschot, J. C., Hellemons, M. E., Remerie, S. C., van Bommel, J., Aerts, J. G. J. V., Ribbers, G. M., van den Berg-Emons, H. J. G., Heijenbrok-Kal, M. H., & CO-FLOW collaboration group
Magazine: BMC medicine
Start- and endpage: 1-10
Link: https://doi.org/10.1186/s12916-023-03083-3
Title: Persistent health problems beyond pulmonary recovery up to 6 months after hospitalization for SARS-CoV-2; A longitudinal study of respiratory, physical and psychological outcomes.
Author: Hellemons ME, Huijts S, Bek L, Berentschot J, Nakshbandi G, Schurink CAM, Vlake J, van Genderen ME, van Bommel J, Gommers D, Odink A, Ciet P, Shamier MC, GeurtsvanKessel C, Baart SJ, Ribbers GM, van den Berg-Emons HG, Heijenbrok-Kal MH, Aerts JGJV
Magazine: Ann Am Thorac Soc.
Start- and endpage: 1-34
Link: https://pubmed.ncbi.nlm.nih.gov/34582728/
Title: Cognitive and psychological recovery patterns across different care pathways 12 months after hospitalization for COVID-19: a multicenter cohort study (CO-FLOW)
Author: Bek LM, Hellemons ME, Berentschot JC, Visser MM, Huijts SM, van Bommel J, van Genderen ME, Aerts JGJV, Ribbers GM, van den Berg-Emons RJG, Heijenbrok-Kal MH, on behalf of the CO-FLOW collaboration group.
Magazine: Annals of Physical and Rehabilitation Medicine
Start- and endpage: 1-10
Link: https://doi.org/10.1016/j.rehab.2023.101737
Title: Symptoms persisting after hospitalization for COVID-19
Author: Bek LM, Berentschot JC, Heijenbrok-Kal, Huijts S, van Genderen ME, Vlake JH, van Bommel J, Aerts JGJV, Ribbers GM, van den Berg-Emons HJG, Hellemons M.
Magazine: medrxiv.org
Start- and endpage: 1-10
Link: https://www.medrxiv.org/content/10.1101/2021.12.11.21267652v1
Title: A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021.
Author: Sarah Wulf Hanson, Cristiana Abbafati, Joachim G Aerts, Ziyad Al-Aly, Charlie Ashbaugh, Tala Ballouz, Oleg Blyuss, Polina Bobkova, Gouke Bonsel, Svetlana Borzakova, Danilo Buonsenso, Denis Butnaru, Austin Carter, Helen Chu, Cristina De Rose, Mohamed Mustafa Diab, Emil Ekbom, Maha El Tantawi, Victor Fomin, Robert Frithiof, Aysylu Gamirova, Petr V Glybochko, Juanita A. Haagsma, Shaghayegh Haghjooy Javanmard, Erin B Hamilton, Gabrielle Harris, Majanka H Heijenbrok-Kal, Raimund Helbok, Merel E H
Magazine: medrxiv.org
Start- and endpage: 1-52
Link: https://doi.org/10.1101/2022.05.26.22275532
Title: Cognitive and psychological 1-year recovery patterns across care pathways in COVID-19 survivors: a multicenter cohort study (CO-FLOW).
Author: Bek LM, Hellemons ME, Berentschot JC, Visser MM, Huijts SM, van Bommel J, van Genderen ME, Aerts JGJV, Ribbers GM, van den Berg-Emons RJG, Heijenbrok-Kal MH, CO-FLOW Collaboration group.
Magazine: Annals of Physical and Rehabilitation Medicine
Start- and endpage: 1-10
Link: https://doi.org/10.1016/j.rehab.2023.101737
Title: Patients' evaluation of aftercare following hospitalization for COVID-19: satisfaction and unmet needs.
Author: Berentschot, J. C., de Ridder, W. A., Bek, L. M., Heijenbrok-Kal, M. H., Braunstahl, G. J., Remerie, S. C., Stuip, Y., Ribbers, G. M., Aerts, J. G. J. V., Ista, E., Hellemons, M. E., van den Berg-Emons, R. J. G., & CO-FLOW Collaboration Group
Magazine: Respiratory research
Start- and endpage: 1-10
Link: https://doi.org/10.1186/s12931-024-02748-8
Title: CO-FLOW, eerste tussentijdse resultaten
Author: HJG van den Berg-Emons
Title: Ronde Tafelgesprek; Tweede Kamer der Staten Generaal
Author: HJG van den Berg-Emons
Link: https://debatgemist.tweedekamer.nl/node/27207
Title: CO-FLOW
Author: L Bek, J Berentschot
Title: Trajectory of patient-reported outcomes (PROMS) up to 6 months after hospitalization for SARS-CoV-2.
Author: J. Berentschot
Title: Long COVID
Author: M Hellemons
Title: Long COVID
Author: M Hellemons
Title: CO-FLOW
Author: M Heijenbrok-Kal
Title: De rol van de POH bij Long COVID
Author: M. Hellemons
Link: https://healthinvestment.nl/cursus/nationaal-poh-congres-2022,
Title: CO-FLOW onderzoek, design
Author: M Bek
Title: CO-FLOW onderzoek
Author: L Bek
Link: https://youtu.be/I4ac0gfOo9U
Title: Rondetafelgesprek Long COVID van de vaste commissie voor Volksgezondheid, Welzijn en Sport van de Tweede Kamer der Staten-Generaal
Author: HJG van den Berg-Emons
Link: https://debatgemist.tweedekamer.nl/node/27207
Title: Fatigue, psychological and cognitive outcomes up to 12 months after hospitalization for COVID-19
Author: L Bek et al.
Title: Workshop Long COVID
Author: M Hellemons
Title: CO-FLOW, onderzoeksdesign
Author: L Bek
Title: Workshop Long-Covid
Author: M. Hellemons
Link: https://healthinvestment.nl/cursus/tweedaagse-huisartsen-nascholingen-2022
Title: Betreft data-set van het CO-FLOW onderzoek.
Link: https://doi.org/10.34894/V11HKV
Title: Medische scholing voor zorgprofessionals
Link: https://medischescholing.nl/cursus/43025
Title: The CO-FLOW long covid study at Erasmus MC, Rotterdam, Netherlands
Author: Hellemons, Berentschot, Bek
Title: Its time for action: we have a lot of work ahead of us
Author: WHO, Hellemons, Berentschot, Bek
Title: Position Paper Rondetafelgesprek Long COVID van de vaste commissie voor VWS van de Tweede Kamer der Staten-Generaal.
Author: HJG van den Berg-Emons
Link: https://debatgemist.tweedekamer.nl/node/27207

Features

Project number:
10430022010026
Duration: 100%
Duration: 100 %
2020
2024
Part of programme:
Related funding round:
Project lead and secretary:
Dr. Rita van den Berg-Emons
Responsible organisation:
Erasmus Medisch Centrum