{
  "abstract": "Background: Survivors of acute respiratory failure (ARF) often face long-term impairments known as Post-Intensive Care Syndrome. These impairments, coupled with fragmented healthcare, contribute to high rates of readmission and mortality. The COVID-19 pandemic challenged healthcare systems, providing an important opportunity to evaluate healthcare fragmentation before and during the pandemic. Methods: From December 2020 to July 2022, this prospective multicenter study (APICS-COVID) enrolled ARF survivors discharged home from acute care hospitalization. The primary exposure was unmet healthcare needs within 1−4 weeks post-discharge and the primary composite outcome was 3-month readmission and mortality. We additionally compared unmet healthcare needs in this study versus a predominately pre-pandemic cohort from an identical study protocol (APICS-01). Results: Of 201 patients enrolled, 94% had at least one unmet healthcare need. The median (IQR) number of healthcare needs upon discharge was 18 (11–25) and the median proportion of unmet healthcare needs was 26% (17−36%). Follow-up appointments were the most frequent unmet need. Higher vs. lower unmet healthcare needs were not significantly associated with 3-month readmission or mortality (aRR 0.61, p = 0.22). Compared to the APICS-01 cohort, the frequency of 3-month readmission/mortality was lower (14% vs. 29%, p = 0.26), despite higher unmet needs in the APICS-COVID cohort (26% vs. 16%, p < 0.001). Conclusions: Across six US academic hospitals during the COVID-19 pandemic, we did not detect a significant association between higher and lower unmet healthcare needs and 3-month readmission or mortality. Compared to APICS-01, unmet follow-up appointments increased but readmission and mortality decreased. Home health services, durable medical equipment, and medications remained robust during pandemic conditions.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Hospital Medicine, Intermountain Medical Center, Murray, Utah, United States of America",
    "Department of Medicine, University of Utah, Salt Lake City, Utah, United States of America",
    "Department of Critical Care Medicine, Intermountain Medical Center, Murray, Utah, United States of America",
    "Outcomes After Critical Illness and Surgery (OACIS) Group, and Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America",
    "Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America",
    "Center for Anesthesia Research Excellence, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America",
    "Division of Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States of America",
    "Section of Pulmonary and Critical Care Medicine, George E Wahlen VA Medical Center, Salt Lake City, Utah, United States of America",
    "Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Harris L. Carmichael"
    },
    {
      "affs": [
        1
      ],
      "name": "Danielle Groat"
    },
    {
      "affs": [
        2
      ],
      "name": "Victor D. Dinglas"
    },
    {
      "affs": [
        3
      ],
      "name": "Somnath Bose"
    },
    {
      "affs": [
        4
      ],
      "name": "Mustafa Mir Kasimov"
    },
    {
      "affs": [
        5
      ],
      "name": "James C. Jackson"
    },
    {
      "affs": [
        6
      ],
      "name": "Naga Preethi Kadiri"
    },
    {
      "affs": [
        7
      ],
      "name": "Maria Isabel Trejo-Zambrano"
    },
    {
      "affs": [
        8
      ],
      "name": "Carla M. Sevin"
    },
    {
      "name": "Tom Greene"
    },
    {
      "name": "Dale M. Needham"
    },
    {
      "name": "Samuel M. Brown"
    },
    {
      "name": "for the APICS-COVID Study Team"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/08t1ttjpt3egg.bib",
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  "doi": "10.1371/journal.pone.0361770",
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  "issns": [
    "1932-6203"
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  "landing_url": "https://doi.org/10.1371/journal.pone.0361770",
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  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
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  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
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  "published": "2026-11-06",
  "publisher": "Public Library of Science",
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      "first_seen": "2026-11-07T12:20:24Z",
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  "title": "Association of unmet discharge needs on readmission or mortality among acute respiratory failure survivors during the COVID-19 pandemic: The Addressing Post-Intensive Care Syndrome (APICS-COVID) multicenter prospective cohort study",
  "title_text": "Association of unmet discharge needs on readmission or mortality among acute respiratory failure survivors during the COVID-19 pandemic: The Addressing Post-Intensive Care Syndrome (APICS-COVID) multicenter prospective cohort study",
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