Cleveland Clinic study highlights how standardizing care leads to equitable COVID-19 outcomes in the ICU

Wednesday, February 9, 2022, CLEVELAND: A Cleveland Clinic study has shown there were no significant differences in rates of mortality or length of ICU stay between racial or ethnic groups hospitalized for COVID-19 at Cleveland Clinic facilities, during the first three waves of the pandemic. Findings from the study were published in the Journal of Racial and Ethnic Disparities.

Abhijit Duggal, M.D., vice-chair of the Department of Critical Care at Cleveland Clinic, led a multidisciplinary team of medical students, ICU physicians and an expert in health disparities, to investigate disparities among racial and ethnic minority groups hospitalized for COVID-19 at Cleveland Clinic hospitals.

For the study, Dr. Duggal and the research team used clinical data from Cleveland Clinic’s COVID-19 ICU registry, and reviewed detailed information from 2,215 patients admitted to a Cleveland Clinic ICU in Northeast Ohio between March and December 2020. Of the study cohort, 60% were White, 33% were Black and 4.3% were Hispanic patients.

Analysis of the data revealed:

• Mortality was comparable between Black and White patients (30.5% vs. 37.5%).
• The average length of stay in the ICU was similar between Black (3.4 days), Hispanic (3.9 days) and White patients (4.4 days).
• A similar percentage of Black and White patients being treated for COVID-19 required ventilation during their ICU stay (41.9% vs. 42.7%).
• There were no major differences in utilization of COVID-19 pharmacological interventions, such as dexamethasone, remdesivir, hydroxychloroquine, and tocilizumab.

Despite the similarity in outcomes of patients critically ill with COVID-19, Dr. Duggal, says its findings sheds light on long-standing health disparities that exist in communities of color, which could lead to a higher prevalence of severe COVID-19 cases in these communities.

“Nationally, Black and Hispanic patients are at a higher risk of COVID-19 infection and death from the virus because of inequalities in chronic disease prevention and management,” said Dr. Duggal. “In our study, Black patients had a higher prevalence of asthma, diabetes, chronic kidney disease and hypertension, while Hispanic patients had a greater incidence of liver disease. These conditions are risk factors for more severe cases of COVID-19. However, by  standardizing COVID-19 care, we were able to mitigate disparities and improve outcomes.”

According to recent data from the U.S. Centers for Disease Control and Prevention, Black patients make up approximately 12.5% of COVID-19 cases, and account for over 13.7% of COVID-19 deaths. While Hispanics make up over 24.4% of COVID-19 cases, and represent 16.7% of COVID-19 deaths, . All despite Black/African Americans and Hispanics comprising roughly 13.6% and 18.5% of the U.S. population, respectively.

Early in the pandemic, Cleveland Clinic implemented several strategies to care for patients with COVID-19:

• Having the ability to care for critically ill, COVID-19 patients in six medical intensive care units on its main campus plus 16 more at its regional hospitals. 
• Using an ICU operations team with representatives from every ICU to improve communication, standardize best practices and share resources.
• Offering COVID-19 educational training modules for all ICU providers.
• Collaborating of multidisciplinary teams, including critical care, infectious disease, nephrology and palliative care.

“Our proactive, system-wide strategies were helpful in improving outcomes in the ICU” said Dr. Duggal. “Ultimately, if we can better manage health disparities on the front end, we can make a bigger impact on outcomes.”

About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 70,800 employees worldwide are more than 4,660 salaried physicians and researchers, and 18,500 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,500-bed health system that includes a 173-acre main campus near downtown Cleveland, 19 hospitals, more than 220 outpatient facilities, and locations in southeast Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2020, there were 8.7 million total outpatient visits, 273,000 hospital admissions and observations, and 217,000 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.

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