Length of postpartum hospital stays during COVID-19: Findings from a convergent parallel mixed-methods study.

OBJECTIVE: We examined length of postpartum hospitalization for live births during the COVID-19 pandemic and explored how pandemic circumstances influenced postpartum hospital experiences. METHODS: We conducted a cross-provincial, convergent parallel mixed-methods study in Ontario (ON) and British Columbia (BC), Canada. We included birthing persons (BPs) with an in-hospital birth in ON from 1 January to 31 March 2019, 2021, and 2022 (quantitative), and BPs (≥18 years) in ON or BC from 1 May 2020 to 1 December 2021 (qualitative). We linked multiple health administrative datasets at ICES and developed multivariable linear regression models to examine length of hospital stay (quantitative). We conducted semi-structured interviews using qualitative descriptive to understand experiences of postpartum hospitalization (qualitative). Data integration occurred during design and interpretation. RESULTS: Relative to 2019, postpartum hospital stays decreased significantly by 3.29 hours (95% CI: -3.58 to -2.99; 9.2% reduction) in 2021 and 3.89 hours (95% CI: -4.17 to -3.60; 9.0% reduction) in 2022. After adjustment, factors associated with shortened stays included: giving birth during COVID-19, social deprivation (more ethnocultural diversity), midwifery care, multiparity, and lower newborn birth weight. Postpartum hospital experiences were impacted by risk perception of COVID-19 infection, clinical care and hospital services/amenities, visitor policies, and duration of stay. CONCLUSION: Length of postpartum hospital stays decreased during COVID-19, and qualitative findings described unmet needs for postpartum services. The integration of large administrative and interview data expanded our understanding of observed differences. Future research should investigate the impacts of shortened stays on health services outcomes and personal experiences. OBJECTIF: Nous avons examiné la durée d'hospitalisation post-partum pour les cas de naissance vivante pendant la pandémie de COVID-19 et exploré comment les circonstances de la pandémie ont influencé l'expérience post-partum à l'hôpital. MéTHODES: Nous avons mené une étude interprovinciale selon un modèle mixte parallèle et convergent en Ontario (Ont.) et en Colombie-Britannique (C.-B.), au Canada. Nous avons inclus les personnes ayant accouché à l'hôpital en Ont. entre le 1 janvier et le 31 mars 2019, 2021 et 2022 (quantitatif), et celles ayant accouché (≥ 18 ans) entre le 1 mai 2020 et le 1 décembre 2021 en Ont. ou en C.-B. (qualitatif). Nous avons relié plusieurs ensembles de données de santé administratives à l'ICES et développé des modèles de régression linéaire multivariable pour examiner la durée d'hospitalisation (quantitative). Nous avons mené des entretiens semi-structurés en utilisant une méthode qualitative descriptive pour comprendre les expériences d'hospitalisation post-partum (qualitative). L'intégration des données a eu lieu pendant la conception de l'étude et l'interprétation. RéSULTATS: Par rapport à 2019, la durée de l'hospitalisation post-partum a significativement diminué de 3,29 heures (IC à 95 % : -3,58 à -2,99; réduction de 9,2 %) en 2021 et de 3,89 heures (IC à 95 % : -4,17 à -3,60; réduction de 9,0 %) en 2022. Après ajustement, les facteurs associés à la réduction de la durée d'hospitalisation étaient les suivants : accouchement pendant la pandémie de COVID-19, manque de socialisation (plus grande diversité ethnoculturelle), prise en charge en pratique sage-femme, multiparité et poids plus faible du nouveau-né à la naissance. L'expérience d'hospitalisation post-partum était influencée par la perception du risque de contracter la COVID-19, les soins cliniques et les services et commodités à l'hôpital, les politiques relatives aux visiteurs et la durée de l'hospitalisation. CONCLUSION: La durée d'hospitalisation post-partum a diminué pendant la pandémie de COVID-19, et les résultats qualitatifs ont décrit des besoins non satisfaits en matière de services post-partum. L'intégration de grands ensembles de données administratives et d'entretiens a permis de mieux comprendre les différences observées. Les recherches futures devront se pencher sur l'impact de la réduction de la durée d'hospitalisation sur les résultats des services de santé et les expériences personnelles.

Evaluating the Association between the Implementation of the PoET (Prevention of Error-Based Transfers) Southwest Spread Project and Palliative Care Provision: A Quasi-Experimental Matched Cohort Study Using Population-Level Health Administrative Data.

OBJECTIVES: The PoET (Prevention of Error-based Transfers) project seeks to align long-term care (LTC) home informed consent practices to existing legislation, thereby reducing consent-related error-based transfers to acute care. We sought to measure changes in resident-level palliative care provision after participating in the PoET Southwest Spread Project (PSSP), and to identify patient and LTC home characteristics associated with palliative care provision. DESIGN: Quasi-experimental matched (1:1 ratio) cohort study design using linked population-based health administrative data. SETTING: Sixty LTC homes (PSSP = 30; Control = 30) in Ontario, Canada, from November 2019 to December 2021. METHODS: We matched 30 PSSP to 30 control homes and described incidence rates for resident-level palliative care provision (ie, physician palliative care encounters and palliative medication prescriptions) during the 7-month postimplementation period. We used generalized linear mixed models to evaluate the association between PSSP implementation and palliative care provision during the postimplementation period. We adjusted for resident-level characteristics (ie, age, sex, comorbidity status) and home-level characteristics (ie, rurality status, profit model, COVID-19 impact). We identified a decedent subcohort to measure palliative care provision patterns during the last 2 months of life. RESULTS: We captured a matched cohort of 8894 residents (PSSP = 4103; Control = 4791). Incidence rates of palliative care encounters increased during the postimplementation period for PSSP (82.6 to 85.4 per 100 person-months) but not for control residents (68.8 to 65.3 per 100 person-months). After adjusting for key covariates, PSSP exposure was associated increased palliative care provision (incidence rate ratio 2.47, 95% CI 2.31-2.64) and palliative care medication prescription (1.16, 95% CI 1.12-1.20). Larger home size, certain health regions, and higher number of comorbidities were associated with increased physician palliative care encounters. CONCLUSIONS AND IMPLICATIONS: By promoting correct informed consent practices in LTC, PSSP participation increased palliative care provision for PSSP LTC residents across all settings.

Pomalidomide Use and Kidney Outcomes in Patients With Relapsed/Refractory Multiple Myeloma and Chronic Kidney Disease: A Real-World, Population-Based Cohort Study.

BACKGROUND: Pomalidomide-based regimens are the cornerstone of treatment for relapsed/refractory MM (RRMM). Despite the high incidence of chronic kidney disease (CKD) in RRMM, individuals with advanced CKD have been excluded from phase II/III RCTs, creating a gap in our understanding of the effects of pomalidomide use in patients with RRMM complicated with advanced CKD. We undertook a cohort to study to understand the efficacy safety of pomalidomide-based regimens among patients with CKD using real-world data. METHODS: Population-based, cohort study of patients ≥ 18 years with RRMM treated with pomalidomide in Ontario, Canada. Primary outcome was all-cause mortality. Secondary outcomes were time-to-major adverse kidney events (MAKE), time-to-next treatment, kidney response and safety. RESULTS: Total 748 patients with RRMM utilizing pomalidomide were included; 440 had preserved kidney function, 210 had moderate CKD (eGFR 30-59 mL/min/1.73m2), and 98 had advanced CKD (eGFR < 30 mL/min/1.73m2). Mean age was 70.2 years, 43.3% were women. Patients with advanced CKD had a higher risk of all-cause mortality compared to the preserved kidney function group (aHR 1.37, 95% CI 1.06, 1.78). MAKE was higher in advanced CKD (aHR 1.70, 95% CI 1.03, 2.35). Kidney response was similar between moderate and severe CKD groups (aOR 1.04, 95%, CI 0.56-1.90). Safety outcomes were similar between groups. CONCLUSIONS: Patients with advanced CKD and RRMM on pomalidomide-based regimens exhibited reduced survival and a higher risk for MAKE. However, the probability of experiencing some degree of kidney recovery is 50% in both moderate and severe CKD, with comparable safety outcomes.