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OBJECTIVES:. Hispanic individuals comprise one-fifth of the U.S. population and Hispanic patients with acute hypoxemic respiratory failure (AHRF) experience higher odds of death compared with non-Hispanic White patients. Representation of Hispanic patients in clinical trials for respiratory failure is critical to address this inequity. We conducted a systematic review to examine the inclusion of Hispanic patients in randomized controlled trials for AHRF and assessed language as a potential barrier to enrollment. DATA SOURCES:. National Library of Medicine PubMed, Elsevier Embase, and Cochrane Central Register of Controlled Trials databases through January 2024. STUDY SELECTION:. Randomized controlled trials assessing AHRF interventions enrolling U.S. patients receiving mechanical ventilation, noninvasive mechanical ventilation, or high-flow nasal cannula were included. The systematic review was registered prospectively through PROSPERO (CRD42023437828). DATA EXTRACTION:. Two authors independently screened studies and extracted data for each included study. DATA SYNTHESIS:. Ninety-four trials published from 1975 to 2023 were included; 33.0% (n = 31) of studies reported ethnicity, and 11.2% of participants in studies reporting race or ethnicity (1,320/11,780) were identified as Hispanic. The proportion of Hispanic-identified participants was significantly lower than the U.S. Hispanic population from 1996 to 2019 (p < 0.01). Starting in 2020, the proportion of Hispanic-identified participants was significantly higher than the U.S. population (27.8% vs. 19.1%; p < 0.01). Two studies (4.9%) reporting race or ethnicity excluded non-English speaking participants; the remainder did not specify language requirements for enrollment. CONCLUSIONS:. Hispanic-identified individuals were underrepresented in trials for AHRF until 2020 when Hispanic patient representation increased during COVID-19. Exclusion of participants who do not speak English may represent a barrier to trial enrollment.

Background: To address unknown risk for readmission among patients with COVID-19 and persistent capacity strain, hospital systems used postdischarge contact and monitoring to facilitate safe discharge and recovery. However, little work has systematically documented how hospitals implemented changes to hospitalization postdischarge contact practices during COVID-19. Research Question: How did hospitals’ innovate and adapt postdischarge telephone follow-up and remote monitoring strategies to assess discharged patients with COVID-19 for risk of readmission and recovery progress? Study Design and Methods: Semistructured interviews were conducted (January 2022 to March 2023) with 70 inpatient and outpatient providers and administrators (5-12 per site) in nine health systems that varied by size, region, rurality, proportion of Medicaid patients, and estimated scale of post-COVID-19 care organization. Participants described innovation in and implementation of discharge and postdischarge care processes used to assess patients with COVID-19 for readmission risk and recovery progress. The primary analysis was site-level case comparative analysis. Results: Respondents described hospital systems’ motivations for adapting preexisting resources and innovating new postdischarge programs, including postdischarge telephone follow-up and remote monitoring programs, to facilitate safe hospital discharge and transitions to ambulatory care for patients with COVID-19. Respondents also explained various factors that influenced the implementation and use of postdischarge contact practices. Participants perceived that these practices mitigated postdischarge risks and alleviated capacity strain. Respondents described retiring or adapting remote monitoring programs for other conditions as COVID-19 demands declined. Interpretation: Our results show that hospitals implemented and adapted postdischarge practices to help facilitate recovery and address unknown risk for readmission during the pandemic. Some efforts may present opportunities to manage readmission concerns and capacity strain more generally.