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.
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.
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