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Qureshi N, Huilgol SS, Berdahl CT, Cohen CC, Mendel P, Fischer SH. Understanding uptake of information about innovations among emergency department clinicians during the COVID-19 pandemic. J Am Coll Emerg Physicians Open 2024; 5:e13243. [PMID: 39035811 PMCID: PMC11259543 DOI: 10.1002/emp2.13243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/21/2024] [Accepted: 07/01/2024] [Indexed: 07/23/2024] Open
Abstract
Objectives Early in the COVID-19 pandemic, little was known about managing sick patients, but emergency department (ED) clinicians had to decide which treatments and care processes to adopt. Our objective was to describe how ED clinicians learned about innovations and how they assessed them for credibility during the pandemic. Methods We purposively sampled clinicians from hospital-based EDs to conduct focus groups with ED clinicians and staff. We used both inductive and deductive approaches to conduct thematic analysis of transcripts. Results We conducted focus groups with clinicians from eight EDs across the United States. We found that ED clinicians in our sample relied on friends and colleagues or departmental and institutional leadership for information on innovations. They used social media sources when they came from credible accounts but did not directly seek information from professional societies. Clinicians reported a range of challenges to obtain credible information during the pandemic, including a fractured and changing information environment, policies misaligned across clinical sites or that conflicted with clinical knowledge, high patient volume, fear of harming patients, and untimely information. Facilitators included access to experienced and trusted colleagues and leaders and practicing at multiple EDs. Conclusion Participants cited anecdotal evidence, institutional practice, and word-of-mouth-rather than peer-reviewed evidence and professional society communications-as their primary sources of information about care innovations during the early phases of the pandemic. These results underscore the importance of developing trusted local mechanisms and wider networks to identify and vet information for frontline clinicians during rapidly emerging public health emergencies.
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Affiliation(s)
- Nabeel Qureshi
- RAND HealthRAND CorporationSanta MonicaCaliforniaUSA
- Department of General Internal MedicineCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Shreya S. Huilgol
- RAND HealthRAND CorporationSanta MonicaCaliforniaUSA
- RAND HealthRAND CorporationBostonMassachusettsUSA
| | - Carl T. Berdahl
- RAND HealthRAND CorporationSanta MonicaCaliforniaUSA
- Department of General Internal MedicineCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | | | - Peter Mendel
- RAND HealthRAND CorporationSanta MonicaCaliforniaUSA
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Sudri S, Pharayra M, Ghantous Y, Abu El-Naaj I, Laviv A. Pediatric Maxillofacial Infections During COVID-19: What Have We Learned? J Oral Maxillofac Surg 2024; 82:976-983. [PMID: 38744420 DOI: 10.1016/j.joms.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The coronavirus (COVID-19) pandemic significantly affected health care systems worldwide, and the field of dentistry is no exception. Odontogenic infections in pediatric patients pose unique challenges to treatment and diagnosis. PURPOSE The purpose of this study was to evaluate the incidence, characteristics, and treatment of pediatric maxillofacial odontogenic infections during COVID-19 compared to pre-COVID-19. STUDY DESIGN, SETTING, SAMPLE This retrospective cohort study included all pediatric patients (0-18 years old) who visited the emergency department (ED) at Tzafon Medical Center, Israel, between March 2020 and February 2021 (COVID-19), or between March 2018 and February 2020 (pre-COVID-19), and were diagnosed with maxillofacial odontogenic infections. Patients with missing demographic data and patients who did not complete the medical examination were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The exposure variable was the date of presentation, categorized as COVID-19 or pre-COVID-19. MAIN OUTCOME VARIABLE(S) The main outcome variables were the proportion of patients diagnosed with odontogenic infections, hospitalization rate, treatment methods, and length of hospital stay. COVARIATES Covariates included patient demographics, involved dentition and associated spaces, and the administration of antibiotics before ED arrival. ANALYSES The Fisher exact test and Pearson's χ2 test were applied to assess differences in categorical variables. The Wilcoxon rank-sum test was used for independent variables. A logistic regression model was used to predict outcome variables. P values were two-tailed, and statistical significance was defined as P < .05. RESULTS The study sample comprised 471 patients: 357 (76%) in the pre-COVID-19 period and 114 (24%) during COVID-19. The relative risk of visits to the ED out of total oral and maxillofacial ED visits was lower during COVID-19 (relative risk = 0.65, P = .0001). The hospitalization rate increased from 72% (257 patients) pre-COVID-19 to 86.8% (99 patients) during the COVID-19 period (P = .001). Length of hospital stay during COVID-19 was significantly shorter than pre-COVID-19 (P < .001). CONCLUSION AND RELEVANCE The findings of this study reveal a significant reduction in odontogenic infection incidents referred to the ED during the pandemic. This implies that many of these incidents can be successfully treated in community health care settings without referral to the ED.
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Affiliation(s)
- Shiran Sudri
- Department of Oral and Maxillofacial Surgery, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel.
| | - Maisa Pharayra
- Dental Student, Department of Oral and Maxillofacial Surgery, The Maurice & Gabriela Goldschlager School of Dental Medicine, Tel Aviv University, Tel Aviv
| | - Yasmin Ghantous
- Department of Oral and Maxillofacial Surgery, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel; Post Doctoral at Johns Hopkins Medicine (2017), Maxillofacial Surgeon, Tzafon Medical Center, Poria, Israel
| | - Imad Abu El-Naaj
- Department of Oral and Maxillofacial Surgery, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel; Head Department of Oral and Maxillofacial Surgery, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amir Laviv
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, The Maurice & Gabriela Goldschlager School of Dental Medicine, Tel Aviv University, Tel Aviv
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Hamshari S, Hamadneh S, Ghneem M, Khalaf R, Daqqa S, Alwafa RA, Ktaifan M. Barriers faced by primary healthcare providers in addressing emergencies in the Northern region of Palestine before and during the Gaza war. BMC PRIMARY CARE 2024; 25:261. [PMID: 39020303 PMCID: PMC11253419 DOI: 10.1186/s12875-024-02512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Physicians working in primary health care (PHC) centers are the first contact for patients and expected to deal with emergencies. Emergency care training in PHC settings has been neglected globally, especially in low to middle income countries. Adequate preparation becomes especially important during periods of conflict. The study objectives are to identify the barriers facing PHC physicians when dealing with emergency cases in the northern region of Palestine during the current conflict. METHODS A cross-sectional study was conducted with 179 physicians working in the 10 PHC centers distributed among 5 northern governances in Palestine. The study period was from July through December 2023. Data were collected electronically using a self-administered questionnaire, which was adapted from a comprehensive literature review. The questionnaire's internal validity was confirmed by a Cronbach's alpha coefficient of [0.85], indicating high reliability. RESULTS The ages of the physicians ranged from 25 to 60 years, with a mean ± SD of 35.3 ± 8.15 years. A significant majority (91.6%) were not boarded in any specialty. Most physicians (85.5%) had attended Basic Life Support (BLS) courses, whereas 45.2% and 72% had never attended Advanced Cardiovascular Life Support (ACLS) or Advanced Trauma Life Support (ATLS) courses, respectively. Physicians with emergency department experience (P = 0.002) and those who had attended ACLS courses (P < 0.001) reported significantly higher perceived competence in managing emergency cases. CONCLUSION Emergency services at PHC centers in northern Palestine are operational but require significant enhancements. There is a critical need for increased availability of essential equipment, supplies, and medications. Additionally, implementing comprehensive training programs in emergency management, particularly ACLS, is essential to improve the competence and performance of PHC physicians in emergency situations.
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Affiliation(s)
- Suha Hamshari
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Department of Family Medicine and Community Medicine, An-Najah National University, Nablus, 44839, Palestine.
| | - Sondos Hamadneh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Family Medicine and Community Medicine, An-Najah National University, Nablus, 44839, Palestine
| | - Mukaram Ghneem
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Raghad Khalaf
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Sara Daqqa
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Rola Abu Alwafa
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of General Surgery, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Mahfouz Ktaifan
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
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Alias R, Neo YL, Wang L, Sie LZ, Goh HJ, Mohamed Hussein MY, Abdullah H, Wong YP. Fulfilling last wishes: improving the compassionate discharge process. BMJ Open Qual 2024; 13:e002666. [PMID: 39009462 PMCID: PMC11253726 DOI: 10.1136/bmjoq-2023-002666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 06/29/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Compassionate discharges (ComD), commonly known as rapid discharges, are urgent one-way discharges for critically ill hospitalised patients with death expected within hours or less than 7 days, to die at their place of choice-usually in their own home. Challenges abound in this time-sensitive setting when multiple parties must work together to prepare medically unstable patients for discharge, yet healthcare staff are largely unaware of the process, resulting in delays. METHODS Process mapping, an Ishikawa diagram and a Pareto chart were used to identify barriers, which included timely acquisition of home equipment and medication and poor communication among stakeholders. In May 2020, the Quality Improvement (QI) team embarked on a pilot project to reduce family caregiver anxiety and delays in the ComD process while maintaining a success rate above 90% over a 12-month period. INTERVENTIONS Three Plan-Do-Study-Act (PDSA) cycles were used to refine a ComD resource package that was developed; this consisted of a checklist, a kit and caregiver resources. This was to support nurses, doctors and families during this difficult and emotional transition. Items in the ComD resource package were revised iteratively based on user feedback, with further data collected to measure its usefulness. RESULTS The 12-month ComD success rate over 3 PDSA cycles were 88.9%, 94.2% and 96.7%, respectively, after each cycle. There was a consistent reduction in the level of family anxiety before and after caregiver training and resources. Reasons for failed ComD included acute clinical deterioration or delays in obtaining home oxygen support. CONCLUSION The ComD resource package allowed collaborative work across different disciplines, strengthening the safety and utility of ComD and allowing patients to die in their place of choice. These are ubiquitous across settings; this QI problem is thus relevant beyond our local institution.
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Affiliation(s)
- Rasidah Alias
- Specialty Nursing, Changi General Hospital, Singapore
| | - Yi Ling Neo
- Specialty Nursing, Changi General Hospital, Singapore
| | - Liyun Wang
- Advanced Practice Nurse Development, Changi General Hospital, Singapore
| | - Long Zhen Sie
- Specialty Nursing, Changi General Hospital, Singapore
| | - Hwee Jin Goh
- Specialty Nursing, Changi General Hospital, Singapore
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Vandenberg AE, Hwang U, Das S, Genes N, Nyamu S, Richardson L, Ezenkwele U, Legome E, Richardson C, Belachew A, Leong T, Kegler M, Vaughan CP. Scaling the EQUIPPED medication safety program: Traditional and hub-and-spoke implementation models. J Am Geriatr Soc 2024; 72:2184-2194. [PMID: 38259070 DOI: 10.1111/jgs.18746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/09/2023] [Accepted: 12/09/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) medication safety program is an evidence-informed quality improvement initiative to reduce potentially inappropriate medications (PIMs) prescribed by Emergency Department (ED) providers to adults aged 65 and older at discharge. We aimed to scale-up this successful program using (1) a traditional implementation model at an ED with a novel electronic medical record and (2) a new hub-and-spoke implementation model at three new EDs within a health system that had previously implemented EQUIPPED (hub). We hypothesized that implementation speed would increase under the hub-and-spoke model without cost to PIM reduction or site engagement. METHODS We evaluated the effect of the EQUIPPED program on PIMs for each ED, comparing their 12-month baseline to 12-month post-implementation period prescribing data, number of months to implement EQUIPPED, and facilitators and barriers to implementation. RESULTS The proportion of PIMs at all four sites declined significantly from pre- to post-EQUIPPED: at traditional site 1 from 8.9% (8.1-9.6) to 3.6% (3.6-9.6) (p < 0.001); at spread site 1 from 12.2% (11.2-13.2) to 7.1% (6.1-8.1) (p < 0.001); at spread site 2 from 11.3% (10.1-12.6) to 7.9% (6.4-8.8) (p = 0.045); and at spread site 3 from 16.2% (14.9-17.4) to 11.7% (10.3-13.0) (p < 0.001). Time to implement was equivalent at all sites across both models. Interview data, reflecting a wide scope of responsibilities for the champion at the traditional site and a narrow scope at the spoke sites, indicated disproportionate barriers to engagement at the spoke sites. CONCLUSIONS EQUIPPED was successfully implemented under both implementation models at four new sites during the COVID-19 pandemic, indicating the feasibility of adapting EQUIPPED to complex, real-world conditions. The hub-and-spoke model offers an effective way to scale-up EQUIPPED though a speed or quality advantage could not be shown.
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Affiliation(s)
- Ann E Vandenberg
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ula Hwang
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
- James J. Peters VA Medical Center GRECC, Bronx, New York, USA
| | - Shamie Das
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nicholas Genes
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Sylviah Nyamu
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lynne Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ugo Ezenkwele
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric Legome
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam Belachew
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Michelle Kegler
- Department of Behavioural, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Camille P Vaughan
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Birmingham/Atlanta VA GRECC, Atlanta, Georgia, USA
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Hamdollahzadeh A, Nabilou B, Yusefzadeh H. Efficiency of hospitals in COVID-19 era: a case study of an affected country. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:50. [PMID: 38863012 PMCID: PMC11165788 DOI: 10.1186/s12962-024-00549-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/22/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected all aspects of human life and society and has damaged the global economy. Health systems and hospitals were not exempted from this situation. The performance of hospitals during the COVID-19 pandemic was affected by policies related to the pandemic and other factors. This study aimed to investigate hospital performance indicators such as admissions and revenue. METHODS The medical records of patients with selected orthopedic and general surgical diseases were studied in two government hospitals in the capital city of Urmia in the second quarter of 2019, with the same period in 2020. Data were extracted based on the number of medical records, including length of stay, hospitalization type, sex, age, insurance, number of deaths, and readmissions from the medical records department. Payment amounts were collected from the revenue department and Hospital Information System. Two performance indicators, two result indicators, and two control indicators were used. Mean disease-specific revenue, total revenue, length of stay, and bed occupancy rate were calculated for both periods. Data were analyzed using SPSS (version 16) and the Mann-Whitney statistical test. RESULTS 2140 cases were studied in the two disease groups. An increase was observed in the number of hospitalizations and average length of stay during the pandemic. The mean disease-specific revenue in the quarter of 2020 was higher than in 2019. However, total revenue decreased, and the difference in the mean of total revenue was significant for the two years (P = 0.00) in teaching center. The number of readmissions remained unchanged throughout in the pandemic. The number of deaths due to general surgery diseases in 2020 compared to the same period in 2019 was associated with a relative increase. CONCLUSIONS The COVID-19 pandemic increased the slope of health care costs. The analysis of the studied variables as performance, result, and control indicators showed that hospitalization rate, bed occupancy rate, and total revenue followed a similar and decreasing pattern in the selected hospitals during the COVID-19 pandemic. Hospitals should adopt appropriate strategies so that, in conditions identical to the COVID-19 pandemic, their performance is accompanied by proper management of resources, efficiency, and minimal reduction in revenue.
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Affiliation(s)
- Anita Hamdollahzadeh
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Bahram Nabilou
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
- Social Determinants of Health Research Center, Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Nazloo Paradise, Sero Road, Urmia, West Azerbaijan, 5756116111, Iran
| | - Hasan Yusefzadeh
- Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran.
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Booij-Tromp FM, van Groningen NJ, Vervuurt S, Haagsma JA, de Groot B, Lameijer H, Gaakeer MI, Alsma J, Rood PPM, Verdonschot RJCG, Bouwhuis MG. Association between stringency of lockdown measures and emergency department visits during the COVID-19 pandemic: A Dutch multicentre study. PLoS One 2024; 19:e0303859. [PMID: 38771835 PMCID: PMC11108187 DOI: 10.1371/journal.pone.0303859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/02/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION The COVID-19 outbreak disrupted regular health care, including the Emergency Department (ED), and resulted in insufficient ICU capacity. Lockdown measures were taken to prevent disease spread and hospital overcrowding. Little is known about the relationship of stringency of lockdown measures on ED utilization. OBJECTIVE This study aimed to compare the frequency and characteristics of ED visits during the COVID-19 outbreak in 2020 to 2019, and their relation to stringency of lockdown measures. MATERIAL AND METHODS A retrospective multicentre study among five Dutch hospitals was performed. The primary outcome was the absolute number of ED visits (year 2018 and 2019 compared to 2020). Secondary outcomes were age, sex, triage category, way of transportation, referral, disposition, and treating medical specialty. The relation between stringency of lockdown measures, measured with the Oxford Stringency Index (OSI) and number and characteristics of ED visits was analysed. RESULTS The total number of ED visits in the five hospitals in 2019 was 165,894, whereas the total number of visits in 2020 was 135,762, which was a decrease of 18.2% (range per hospital: 10.5%-30.7%). The reduction in ED visits was greater during periods of high stringency lockdown measures, as indicated by OSI. CONCLUSION The number of ED visits in the Netherlands has significantly dropped during the first year of the COVID-19 pandemic, with a clear association between decreasing ED visits and increasing lockdown measures. The OSI could be used as an indicator in the management of ED visits during a future pandemic.
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Affiliation(s)
- F. Marlijn Booij-Tromp
- Emergency Department, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | - Juanita A. Haagsma
- Emergency Department, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bas de Groot
- Emergency Department, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heleen Lameijer
- Emergency Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Menno I. Gaakeer
- Emergency Department, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Jelmer Alsma
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Pleunie P. M. Rood
- Emergency Department, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rob J. C. G. Verdonschot
- Emergency Department, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marna G. Bouwhuis
- Emergency Department, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Meyer D, Lowensen K, Perrin N, Moore A, Mehta SH, Himmelfarb CR, Inglesby TV, Jennings JM, Mueller AK, LaRicci JN, Gallo W, Bocek AP, Farley JE. An evaluation of the impact of social and structural determinants of health on forgone care during the COVID-19 pandemic in Baltimore, Maryland. PLoS One 2024; 19:e0302064. [PMID: 38739666 PMCID: PMC11090349 DOI: 10.1371/journal.pone.0302064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024] Open
Abstract
Evidence suggests that reductions in healthcare utilization, including forgone care, during the COVID-19 pandemic may be contributing towards excess morbidity and mortality. The objective of this study was to describe individual and community-level correlates of forgone care during the COVID-19 pandemic. We conducted a cross-sectional, secondary data analysis of participants (n = 2,003) who reported needing healthcare in two population-representative surveys conducted in Baltimore, MD in 2021 and 2021-2022. Abstracted data included the experience of forgone care, socio-demographic data, comorbidities, financial strain, and community of residence. Participant's community of residence were linked with data acquired from the Baltimore Neighborhood Indicators Alliance relevant to healthcare access and utilization, including walkability and internet access, among others. The data were analyzed using weighted random effects logistic regression. Individual-level factors found to be associated with increased odds for forgone care included individuals age 35-49 (compared to 18-34), female sex, experiencing housing insecurity during the pandemic, and the presence of functional limitations and mental illness. Black/African American individuals were found to have reduced odds of forgone care, compared to any other race. No community-level factors were significant in the multilevel analyses. Moving forward, it will be critical that health systems identify ways to address any barriers to care that populations might be experiencing, such as the use of mobile health services or telemedicine platforms. Additionally, public health emergency preparedness planning efforts must account for the unique needs of communities during future crises, to ensure that their health needs can continue to be met. Finally, additional research is needed to better understand how healthcare access and utilization practices have changed during versus before the pandemic.
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Affiliation(s)
- Diane Meyer
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
- Center for Health Security, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Kelly Lowensen
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Nancy Perrin
- Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Ayana Moore
- FHI 360, Durham, NC, United States of America
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Cheryl R. Himmelfarb
- Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Thomas V. Inglesby
- Center for Health Security, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jacky M. Jennings
- Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, MD, United States of America
| | - Alexandra K. Mueller
- Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, MD, United States of America
| | - Jessica N. LaRicci
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Woudase Gallo
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Adam P. Bocek
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Jason E. Farley
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
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Sudri S, Shitrit S, Ben Amy DP, Dahoud WA, Laviv A, El-Naaj IA. Pediatric Trauma During COVID-19: What Have We Learned? J Oral Maxillofac Surg 2024; 82:546-553. [PMID: 38403270 DOI: 10.1016/j.joms.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND In December 2019, an outbreak of a novel pneumonia-like illness, COVID-19 (C-19), emerged in Wuhan, China. In March 2020, as the incidence of C-19 rose, the Israeli government, like that of other nations, declared a national state of emergency, and a full, general lockdown was announced. PURPOSE The purpose of this study is to determine the incidence and characteristics of pediatric maxillofacial trauma presentation during the 2020 C-19 lockdown restrictions and compare them to periods outside lockdown between 2019 and 2020 (pre-C-19). STUDY DESIGN, SETTING, SAMPLE A retrospective cohort study was conducted and included all pediatric patients (0-18 years) referred to the emergency department (ED) at Tzafon Medical Center, Israel, and diagnosed with maxillofacial injuries. Patients with missing demographic data and patients who did not complete the medical examination were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The exposure variable is the date of injury-2020 C-19 lockdown period compared to the previous year (pre-C-19). MAIN OUTCOME VARIABLE(S) The main outcome variable was the number of pediatric maxillofacial trauma ED arrivals out of total pediatric ED arrivals and out of total maxillofacial ED arrivals. COVARIATES Covariates included patient demographics, etiology, and place of injury. ANALYSES The association between categorical variables was tested using the Fisher exact test or χ2 test for binary variables with relative risk when appropriate, logistic regression model used to predict outcome variable. P values were 2-tailed and statistical significance was defined as P < .05. RESULTS The study sample comprised 1174 patients. Relative risk of presenting with oral and maxillofacial trauma out of all pediatric ED patients was 1.85 comparing C-19 period to pre-C-19 period (confidence interval [1.65; 2.073], P < .0001). Most of the injuries recorded during the C-19 restrictions occurred in the domestic environment (56.1% compared to 47.5% in pre-C-19, P < .001). Incidences necessitating treatment increased from 45.8 to 55% during C-19 (P = .002). CONCLUSION AND RELEVANCE During C-19, there was a higher rate of pediatric injuries compared to pre-C-19. The incidence of domestic oral and maxillofacial injuries increased despite the considered home safety.
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Affiliation(s)
- Shiran Sudri
- Resident, Department of Oral and Maxillofacial Surgery, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel.
| | - Shany Shitrit
- Dental Student at the Maurice & Gabriela Goldschlager School of Dental Medicine, Department of Oral and Maxillofacial Surgery, The Maurice & Gabriela Goldschlager School of Dental Medicine, Tel Aviv University, Tel Aviv; Senior Lecturer, Department of Oral and Maxillofacial Surgery, The Maurice & Gabriela Goldschlager School of Dental Medicine, Tel Aviv University, Tel Aviv
| | - Dalit Porat Ben Amy
- Head of Oral Medicine Unit, Oral Medicine Unit, Tzafon Medical Center, Affiliated with Azrieli Faculty of medicine, Bar Ilan University, Israel
| | - Wadie Abu Dahoud
- Head Department of Oral and Maxillofacial Surgery, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Statical Analysist, Research Institute, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel
| | - Amir Laviv
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, The Maurice & Gabriela Goldschlager School of Dental Medicine, Tel Aviv University, Tel Aviv
| | - Imad Abu El-Naaj
- Resident, Department of Oral and Maxillofacial Surgery, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel; Head Department of Oral and Maxillofacial Surgery, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Israel
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10
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Muscogiuri G, Kohler L, Parra O, Soltani L, Spegman D, Coletta D, Mandarino LJ. Longitudinal study of the impact of the COVID-19 pandemic on diet and physical activity among Latinos of Mexican ancestry. J Transl Med 2024; 22:342. [PMID: 38594708 PMCID: PMC11005240 DOI: 10.1186/s12967-024-05007-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/18/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic caused societal disruption in the United States and most of the world, affecting many aspects of life, including healthcare and health-related behaviors such as diet, food security, and physical activity. Communities with economic and health disparities may have been particularly affected. This study was undertaken to determine how conditions in the early pandemic (January, 2021-February, 2022) affected Latino patients of Mexican Ancestry at high risk of type 2 diabetes mellitus who participated in El Banco por Salud biobank project in Tucson, Arizona. METHODS Baseline, prepandemic measurements were available in 17, 21, and 60 patients with normal hemoglobin A1c (HbA1c), prediabetes, and type 2 diabetes, respectively. RESULTS People with healthy HbA1c were significantly younger, less obese, and had higher HDL cholesterol. HbA1c was unaffected by the pandemic in any group. Triglycerides, total and HDL cholesterol levels fell in all groups during the pandemic. Physical activity levels in all groups were remarkably low, with most reporting no engagement in any voluntary physical activity. Engagement in physical activity or its enjoyment was lower in patients with diabetes and prediabetes than in younger, less obese patients. Major diet differences were between men and women and were present before the pandemic. Women consumed significantly more vegetables, fruit, and salad than men. The only pandemic-related change in diet was a drop in egg consumption, possibly explaining the fall in total cholesterol. CONCLUSION Societal disruption during the COVID-19 pandemic had minimal effects on adverse health-related behaviors, cardiometabolic risk, or changes in glycemic control in a Latino community with diabetes and healthcare disparities in the Southwest US.
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Affiliation(s)
- Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi Di Napoli Federico II, Naples, Italy
- Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
- Division of Endocrinology, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Lindsay Kohler
- Department of Health Promotion Sciences, College of Public Health, University of Arizona, Tucson, AZ, USA
- Center for Disparities in Diabetes, Obesity, and Metabolism, University of Arizona Health Sciences, University of Arizona, Tucson, AZ, USA
- Pima County Department of Public Health, Tucson, AZ, USA
| | - Oscar Parra
- Center for Disparities in Diabetes, Obesity, and Metabolism, University of Arizona Health Sciences, University of Arizona, Tucson, AZ, USA
| | | | | | - Dawn Coletta
- Division of Endocrinology, Department of Medicine, University of Arizona, Tucson, AZ, USA
- Center for Disparities in Diabetes, Obesity, and Metabolism, University of Arizona Health Sciences, University of Arizona, Tucson, AZ, USA
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | - Lawrence J Mandarino
- Division of Endocrinology, Department of Medicine, University of Arizona, Tucson, AZ, USA.
- Center for Disparities in Diabetes, Obesity, and Metabolism, University of Arizona Health Sciences, University of Arizona, Tucson, AZ, USA.
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11
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Ibeziako P, Kaufman K, Campbell E, Zou B, Samsel C, Qayyum Z, Caracansi A, Ray A. Reducing Pediatric Mental Health Boarding and Increasing Acute Care Access. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00044-2. [PMID: 38583523 DOI: 10.1016/j.jaclp.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/17/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND There have been notable increases in pediatric mental health boarding in the United States in recent years, with youth remaining in emergency departments or admitted to inpatient medical/surgical units, awaiting placement in psychiatric treatment programs. OBJECTIVES We aimed to evaluate the outcomes of interventions to reduce boarding and improve access to acute psychiatric services at a large tertiary pediatric hospital during a national pediatric mental health crisis. METHODS Boarding interventions included expanding inpatient psychiatric beds and hiring additional staff for enhanced crisis stabilization services and treatment initiation in the emergency department and on inpatient medical/surgical units for boarding patients awaiting placement. Post-hoc assessment was conducted via retrospective review of patients presenting with mental health emergencies during the beginning of intervention implementation in October-December 2021 and one year later (October-December 2022). Inclusion criteria were patients ≤17 years who presented with mental health-related emergencies during the study period. Exclusion criteria were patients ≥18 years and/or patients with >100 days of admission awaiting long-term placement. Primary outcome was mean length of boarding (LOB). Secondary outcome was mean length of stay (LOS) at the hospital's acute psychiatry units. RESULTS One year after full intervention implementation (October-December 2022), mean LOB decreased by 53% (4.3 vs 9.1 days, P < 0.0001) for boarding patients discharged to high (e.g., inpatient, acute residential) and intermediate (e.g., partial hospital, in-home crisis stabilization programs) levels of care, compared to October-December 2021. Additionally, mean LOS at all the 24-hour acute psychiatry treatment programs was reduced by 27% (20.0 vs 14.6 days, P = 0.0002), and more patients were able to access such programs (265/54.2% vs 221/41.9%, P < 0.0001). Across both years, youth with aggressive behaviors had 193% longer LOB (2.93 ± 1.15, 95% CI [2.23, 3.87]) than those without aggression, and youth with previous psychiatric admissions had 88% longer LOB than those without (1.88 ± 1.11, 95% CI [1.54, 2.30]). CONCLUSIONS The current study shows decreased LOB and improved access for youth requiring acute psychiatric treatment after comprehensive interventions and highlights challenges with placement for youth with aggressive behaviors. We recommend a call-to-action for pediatric hospitals to commit sufficient investment in acute psychiatric resources to address pediatric mental health boarding.
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Affiliation(s)
- Patricia Ibeziako
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA.
| | - Katy Kaufman
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA
| | - Emily Campbell
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA
| | - Billy Zou
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA
| | - Chase Samsel
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA
| | - Zheala Qayyum
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA
| | - Annmarie Caracansi
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA; Harvard Medical School, Boston, MA
| | - Aliza Ray
- Boston Children's Hospital, Department of Psychiatry and Behavioral Sciences, Boston, MA
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12
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Kim S, Sung HK, Lee J, Ko E, Kim SJ. Trends in emergency department visits for emergency care-sensitive conditions before and during the COVID-19 pandemic: a nationwide study in Korea, 2019-2021. Clin Exp Emerg Med 2024; 11:88-93. [PMID: 38204160 PMCID: PMC11009707 DOI: 10.15441/ceem.23.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/09/2023] [Accepted: 09/09/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE Emergency care systems worldwide have been significantly affected by the COVID-19 pandemic. This study investigated the trend of emergency department (ED) visits for emergency care-sensitive conditions (ECSCs) in Korea before and during the pandemic. METHODS We performed a longitudinal study using the national ED database in Korea from January 2019 to December 2021. We calculated the number and incidence rate of visits for ECSCs per 100,000 ED visits, and the incidence rate ratio of 2021 relative to the value in 2019. The selected ECSCs were intracranial injury, ischemic heart disease, stroke, and cardiac arrest. RESULTS The number of ED visits for all causes decreased by about 23% during the pandemic. The number of ED visits for intracranial injuries decreased from 166,695 in 2019 to 133,226 in 2020 and then increased to 145,165 in 2021. The number of ED visits for ischemic heart disease and stroke decreased in 2020 but increased to 2019 levels in 2021. In contrast, the number of ED visits for cardiac arrest increased from 23,903 in 2019 to 24,344 in 2020 and to 27,027 in 2021. The incidence rate and incidence rate ratio of these four ECSCs increased from 2019 to 2021, suggesting increasing relative proportions of ECSCs in total ED visits. CONCLUSION During the COVID-19 pandemic, the number of cardiac arrests seen in the EDs increased, but that of other ECSCs decreased. The decrease in ED visits for ECSCs was not as pronounced as the decrease in ED visits for all causes during the pandemic. Further studies are needed to determine clinical outcomes in patients with ECSC during the pandemic.
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Affiliation(s)
- Seonji Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Kyung Sung
- Public Health Research Institute, National Medical Center, Seoul, Korea
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Jeehye Lee
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Eunsil Ko
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Seong Jung Kim
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Chosun University College of Medicine, Gwangju, Korea
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13
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Stowell JR, Henry MB, Pugsley P, Edwards J, Burton H, Norquist C, Katz ED, Koenig BW, Indermuhle S, Subbian V, Ghaderi H, Akhter M. Impact of the COVID-19 Pandemic on Emergency Department Encounters in a Major Metropolitan Area. J Emerg Med 2024; 66:e383-e390. [PMID: 38278682 DOI: 10.1016/j.jemermed.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/21/2023] [Accepted: 10/01/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND The end of 2019 marked the emergence of the COVID-19 pandemic. Public avoidance of health care facilities, including the emergency department (ED), has been noted during prior pandemics. OBJECTIVE This study described pandemic-related changes in adult and pediatric ED presentations, acuity, and hospitalization rates during the pandemic in a major metropolitan area. METHODS The study was a cross-sectional analysis of ED visits occurring before and during the pandemic. Sites collected daily ED patient census; monthly ED patient acuity, as the Emergency Severity Index (ESI) score; and disposition. Prepandemic ED visits occurring from January 1, 2019 through December 31, 2019 were compared with ED visits occurring during the pandemic from January 1, 2020 through March 31, 2021. The change in prepandemic and pandemic ED volume was found using 7-day moving average of proportions. RESULTS The study enrolled 83.8% of the total ED encounters. Pandemic adult and pediatric visit volume decreased to as low as 44.7% (95% CI 43.1-46.3%; p < 0.001) and 22.1% (95% CI 19.3-26.0%; p < 0.001), respectively, of prepandemic volumes. There was also a relative increase in adult and pediatric acuity (ESI level 1-3) and the admission percentage for adult (20.3% vs. 22.9%; p < 0.01) and pediatric (5.1% vs. 5.6%; p < 0.01) populations. CONCLUSIONS Total adult and pediatric encounters were reduced significantly across a major metropolitan area. Patient acuity and hospitalization rates were relatively increased. The development of strategies for predicting ED avoidance will be important in future pandemics.
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Affiliation(s)
- Jeffrey R Stowell
- Department of Emergency Medicine, Creighton University School of Medicine (Phoenix) Program, Phoenix, Arizona; Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona; Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona
| | - Michael B Henry
- Department of Emergency Medicine, Creighton University School of Medicine (Phoenix) Program, Phoenix, Arizona; Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona
| | - Paul Pugsley
- Department of Emergency Medicine, Creighton University School of Medicine (Phoenix) Program, Phoenix, Arizona; Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona; Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona
| | - Jennifer Edwards
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Heather Burton
- Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona
| | - Craig Norquist
- Department of Emergency Medicine, HonorHealth, Scottsdale, Arizona
| | - Eric D Katz
- Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona; Banner Medical Group, Phoenix, Arizona
| | - B Witkind Koenig
- Department of Emergency Medicine, Creighton University School of Medicine (Phoenix) Program, Phoenix, Arizona; Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona; Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona; EMPower Emergency Physicians, Scottsdale, Arizona
| | | | - Vignesh Subbian
- College of Engineering, The University of Arizona, Tucson, Arizona
| | - Hamid Ghaderi
- College of Engineering, The University of Arizona, Tucson, Arizona
| | - Murtaza Akhter
- Department of Emergency Medicine, Creighton University School of Medicine (Phoenix) Program, Phoenix, Arizona; Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona; Department of Emergency Medicine, Valleywise Health, Phoenix, Arizona; Kendall Regional Medical Center, Department of Emergency Medicine, HCA Healthcare, Miami, Florida; Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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14
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Hsu CC, Chu CC, Ng CJ, Lin CH, Lo HY, Chen SY. Machine learning models for predicting unscheduled return visits of patients with abdominal pain at emergency department and validation during COVID-19 pandemic: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e37220. [PMID: 38394532 PMCID: PMC11309716 DOI: 10.1097/md.0000000000037220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
Machine learning (ML) models for predicting 72-hour unscheduled return visits (URVs) for patients with abdominal pain in the emergency department (ED) were developed in a previous study. This study refined the data to adjust previous prediction models and evaluated the model performance in future data validation during the COVID-19 era. We aimed to evaluate the practicality of the ML models and compare the URVs before and during the COVID-19 pandemic. We used electronic health records from Chang Gung Memorial Hospital from 2018 to 2019 as a training dataset, and various machine learning models, including logistic regression (LR), random forest (RF), extreme gradient boosting (XGB), and voting classifier (VC) were developed and subsequently used to validate against the 2020 to 2021 data. The models highlighted several determinants for 72-hour URVs, including patient age, prior ER visits, specific vital signs, and medical interventions. The LR, XGB, and VC models exhibited the same AUC of 0.71 in the testing set, whereas the VC model displayed a higher F1 score (0.21). The XGB model demonstrated the highest specificity (0.99) and precision (0.64) but the lowest sensitivity (0.01). Among these models, the VC model showed the most favorable, balanced, and comprehensive performance. Despite the promising results, the study illuminated challenges in predictive modeling, such as the unforeseen influences of global events, such as the COVID-19 pandemic. These findings not only highlight the significant potential of machine learning in augmenting emergency care but also underline the importance of iterative refinement in response to changing real-world conditions.
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Affiliation(s)
- Chun-Chuan Hsu
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
| | - Cheng-C.J. Chu
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan City 333, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
| | - Ching-Heng Lin
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan City 333, Taiwan
- Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan City 333, Taiwan
| | - Hsiang-Yun Lo
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taoyuan City 333, Taiwan
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15
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Merchant RM, Becker LB, Brooks SC, Chan PS, Del Rios M, McBride ME, Neumar RW, Previdi JK, Uzendu A, Sasson C. The American Heart Association Emergency Cardiovascular Care 2030 Impact Goals and Call to Action to Improve Cardiac Arrest Outcomes: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e914-e933. [PMID: 38250800 DOI: 10.1161/cir.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Every 10 years, the American Heart Association (AHA) Emergency Cardiovascular Care Committee establishes goals to improve survival from cardiac arrest. These goals align with broader AHA Impact Goals and support the AHA's advocacy efforts and strategic investments in research, education, clinical care, and quality improvement programs. This scientific statement focuses on 2030 AHA emergency cardiovascular care priorities, with a specific focus on bystander cardiopulmonary resuscitation, early defibrillation, and neurologically intact survival. This scientific statement also includes aspirational goals, such as establishing cardiac arrest as a reportable disease and mandating reporting of standardized outcomes from different sources; advancing recognition of and knowledge about cardiac arrest; improving dispatch system response, availability, and access to resuscitation training in multiple settings and at multiple time points; improving availability, access, and affordability of defibrillators; providing a focus on early defibrillation, in-hospital programs, and establishing champions for debriefing and review of cardiac arrest events; and expanding measures to track outcomes beyond survival. The ability to track and report data from these broader aspirational targets will potentially require expansion of existing data sets, development of new data sets, and enhanced integration of technology to collect process and outcome data, as well as partnerships of the AHA with national, state, and local organizations. The COVID-19 (coronavirus disease 2019) pandemic, disparities in COVID-19 outcomes for historically excluded racial and ethnic groups, and the longstanding disparities in cardiac arrest treatment and outcomes for Black and Hispanic or Latino populations also contributed to an explicit focus and target on equity for the AHA Emergency Cardiovascular Care 2030 Impact Goals.
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Azrielant S, Levin Y, Peled A, Samuelov L, Sprecher E, Pavlovsky M. BioNTech COVID-19 (BNT162b2) Vaccination and Varicella Zoster Reactivation: A Comprehensive Cross-sectional Study. Acta Derm Venereol 2024; 104:adv18389. [PMID: 38348725 PMCID: PMC10875474 DOI: 10.2340/actadv.v104.18389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/04/2023] [Indexed: 02/15/2024] Open
Abstract
Herpes zoster (HZ) results from reactivation of latent varicella-zoster virus. Recent observations have suggested that HZ is associated with vaccination against COVID-19. To investigate the association between the vaccine and HZ severity, a single-centre, cross-sectional study of all patients diagnosed with HZ and 2 control diagnoses (cellulitis and bone fractures), between 2017 and 2021, was performed. Hospital visits and hospitalization rates were compared. All medical records of patients diagnosed with HZ in the first year after the COVID-19 vaccination campaign began were reviewed, in order to generate a retrospective cohort comparing vaccinated and unvaccinated patients with HZ. All participants had received the Pfizer-BioNTech COVID-19 (BNT162b2) vaccine. During the study period, 2,413 patients were diagnosed with HZ, and when normalized to control diagnoses the number of cases remained stable. The retrospective cohort included 365 patients. A multivariate analysis controlling for sex, age, autoimmune diseases, malignancies, and immunosuppressive therapy showed higher admission rates in vaccinated compared with unvaccinated individuals (odds ratio (OR) 2.75, 95% CI 1.27-5.96, p = 0.01). However, matching techniques and stratification by age, used to better control for confounders, invalidated these findings. No differences were observed in other variables indicative of disease severity (hospital stay length and complications). In conclusion, COVID-19 vaccination was not found to be associated with an increased risk of HZ-related admission and complications.
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Affiliation(s)
- Shir Azrielant
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yair Levin
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alon Peled
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Samuelov
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Pavlovsky
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Iwanaga M, Yamaguchi S, Hashimoto S, Hanaoka S, Kaneyuki H, Fujita K, Kishi Y, Hirata T, Fujii C, Sugiyama N. Ranking important predictors of the need for a high-acuity psychiatry unit among 2,064 inpatients admitted to psychiatric emergency hospitals: a random forest model. Front Psychiatry 2024; 15:1303189. [PMID: 38389987 PMCID: PMC10882085 DOI: 10.3389/fpsyt.2024.1303189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Aims In order to uphold and enhance the emergency psychiatric care system, a thorough comprehension of the characteristics of patients who require a high-acuity psychiatry unit is indispensable. We aimed to clarify the most important predictors of the need for a high-acuity psychiatry unit using a random forest model. Methods This cross-sectional study encompassed patients admitted to psychiatric emergency hospitals at 161 medical institutions across Japan between December 8, 2022, and January 31, 2023. Questionnaires were completed by psychiatrists, with a maximum of 30 patients assessed per medical institution. The questionnaires included psychiatrists' assessment of the patient's condition (exposure variables) and the need for a high-acuity psychiatry unit (outcome variables). The exposure variables consisted of 32 binary variables, including age, diagnoses, and clinical condition (i.e., factors on the clinical profile, emergency treatment requirements, and purpose of hospitalization). The outcome variable was the need for a high-acuity psychiatry unit, scored from 0 to 10. To identify the most important predictors of the need for a high-acuity psychiatry unit, we used a random forest model. As a sensitivity analysis, multivariate linear regression analysis was performed. Results Data on 2,164 patients from 81 medical institutions were obtained (response rate, 50.3%). After excluding participants with missing values, this analysis included 2,064 patients. Of the 32 items, the top-5 predictors of the need for a high-acuity psychiatry unit were the essentiality of inpatient treatment (otherwise, symptoms will worsen or linger), need for 24-hour professional care, symptom severity, safety ensured by specialized equipment, and medication management. These items were each significantly and positively associated with the need for a high-acuity psychiatry unit in linear regression analyses (p < 0.001 for all). Conversely, items on age and diagnosis were lower in the ranking and were not statistically significant in linear regression models. Conclusion Items related to the patient's clinical profile might hold greater importance in predicting the need for a high-acuity psychiatry unit than do items associated with age and diagnosis.
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Affiliation(s)
- Mai Iwanaga
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Sosei Yamaguchi
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Satoshi Hashimoto
- Department of Psychiatry, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | | | - Hiroshi Kaneyuki
- Yamaguchi Prefectural Mental Health Medical Center, Yamaguchi, Japan
| | - Kiyoshi Fujita
- Okehazama Hospital Fujita Kokoro Care Center, Toyoake-shi, Japan
| | - Yoshiki Kishi
- Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | | | - Chiyo Fujii
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Naoya Sugiyama
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Numazu Chuo Hospital, Numazu, Japan
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18
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Alba C, Zheng Z, Wadhera RK. Changes in Health Care Access and Preventive Health Screenings by Race and Ethnicity. JAMA HEALTH FORUM 2024; 5:e235058. [PMID: 38306093 PMCID: PMC10837752 DOI: 10.1001/jamahealthforum.2023.5058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Importance The COVID-19 pandemic led to unprecedented disruptions in health care. Little is known about whether health care access and preventive health screenings among US adults have recovered to prepandemic levels, and how patterns varied by race and ethnicity. Objective To evaluate health care access and preventive health screenings among eligible US adults in 2021 and 2022 compared with prepandemic year 2019, overall and by race and ethnicity. Design, Setting, and Participants This cross-sectional study used data from US adults aged 18 years or older who participated in the National Health Interview Survey in 2021 and 2022. Survey weights provided by the National Health Interview Survey were used to generate nationally representative estimates. Data were analyzed from May 23 to November 13, 2023. Main Outcomes and Measures Measures of health care access included the proportion of adults with a usual place for care, those with a wellness visit, and those who delayed or did not receive medical care due to cost within the past year. Preventive health screening measures included eligible adults who received blood pressure, cholesterol, or blood glucose screening within the past year (2021), as well as colorectal, cervical, breast, and prostate cancer screenings based on US Preventive Services Task Force guidelines. Results The unweighted study population included 89 130 US adults. The weighted population included 51.6% females; 16.8% Hispanic, 5.9% non-Hispanic Asian (hereafter, Asian), 11.8% non-Hispanic Black (hereafter, Black), 62.8% non-Hispanic White (hereafter, White) individuals; and 2.9% individuals of other races and ethnicities (including American Indian, Alaska Native, Native Hawaiian or other Pacific Islander, or multiracial). After adjusting for age and sex, having a usual place for health care did not differ among adults in 2021 or 2022 vs 2019 (adjusted rate ratio [ARR] for each year, 1.00; 95% CI, 0.99-1.01). However, fewer participants had wellness visits in 2022 compared with 2019 (ARR, 0.98; 95% CI, 0.97-0.99), with the most pronounced decline among Asian adults (ARR, 0.95; 95% CI, 0.92-0.98). In addition, adults were less likely to delay medical care (ARR, 0.79; 95% CI, 0.73-0.87) or to not receive care (ARR, 0.76; 95% CI, 0.69-0.83) due to cost in 2022 vs 2019. Preventive health screenings in 2021 remained below 2019 levels (blood pressure: ARR, 0.95 [95% CI, 0.94-0.96]; blood glucose: ARR, 0.95 [95% CI, 0.93-0.96]; and cholesterol: ARR, 0.93 [95% CI, 0.92-0.94]). Eligible adults were also significantly less likely to receive colorectal cancer screening (ARR, 0.88; 95% CI, 0.81-0.94), cervical cancer screening (ARR, 0.86; 95% CI, 0.83-0.89), breast cancer screening (ARR, 0.93; 95% CI, 0.90-0.97), and prostate cancer screening (ARR, 0.86 [0.78-0.94]) in 2021 vs 2019. Asian adults experienced the largest relative decreases across most preventive screenings, while Black and Hispanic adults experienced large declines in colorectal cancer screening (ARR, 0.78; 95% CI, 0.67-0.91) and breast cancer screening (ARR, 0.83; 95% CI, 0.75-0.91), respectively. Differences in preventive screening rates across years persisted after additional adjustment for socioeconomic factors (income, employment status, and insurance coverage). Conclusions and Relevance Results of this cohort study suggest that, in the US, wellness visits and preventive health screenings have not returned to prepandemic levels. These findings support the need for public health efforts to increase the use of preventive health screenings among eligible US adults.
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Affiliation(s)
- Christopher Alba
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - ZhaoNian Zheng
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Nishioki T, Sato T, Okajima A, Motomura H, Takeshige T, Watanabe J, Yae T, Koyama R, Kido K, Takahashi K. Impact of the COVID-19 pandemic on COPD exacerbations in Japanese patients: a retrospective study. Sci Rep 2024; 14:2792. [PMID: 38307984 PMCID: PMC10837154 DOI: 10.1038/s41598-024-53389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/31/2024] [Indexed: 02/04/2024] Open
Abstract
Various infection control measures implemented during the coronavirus disease (COVID-19) pandemic have reduced the number of respiratory infections, which are the most common cause of chronic obstructive pulmonary disease (COPD) exacerbations. Here, we investigated whether infectious disease prevention during the COVID-19 pandemic reduced COPD exacerbations and the characteristics of patients exhibiting exacerbations before and during the COVID-19 pandemic. We included outpatients and inpatients with moderate or severe COPD exacerbations who required systemic steroids between April 1, 2018 and March 31, 2022. Their medical records were retrospectively compared and analyzed in 2-year intervals (before and during the COVID-19 pandemic). During the 4-year observation period, 70,847 outpatients and 2,772 inpatients were enrolled; 55 COPD exacerbations were recorded. The number of COPD exacerbations decreased from 36 before to 19 during the COVID-19 pandemic. Regarding the characteristics of patients with exacerbations, the % forced expiratory volume in one second (52.3% vs. 38.6%, P = 0.0224) and body mass index (BMI) (22.5 vs. 19.3, P = 0.0127) were significantly lower during the COVID-19 pandemic than before the pandemic. The number of COPD exacerbations during the pandemic decreased. Additionally, the tendency for a reduction in COPD exacerbation was greatest in patients with preserved lung function or above-standard BMI patients.
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Affiliation(s)
- Toshihiko Nishioki
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan.
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
| | - Tadashi Sato
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Akifumi Okajima
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Hiroaki Motomura
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Tomohito Takeshige
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Junko Watanabe
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Toshifumi Yae
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Ryo Koyama
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Kenji Kido
- Department of Respiratory Medicine, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
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20
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Gala S, Alsbrooks K, Bahl A, Wimmer M. The economic burden of difficult intravenous access in the emergency department from a United States' provider perspective. J Res Nurs 2024; 29:6-18. [PMID: 38495321 PMCID: PMC10939017 DOI: 10.1177/17449871231213025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background Peripheral intravenous catheter placement is one of the most common invasive procedures that nurses will perform, especially in emergency departments. Aims This early analysis aimed to quantify the economic burden associated with intravenous therapy in patients presenting in emergency departments with difficult intravenous access, receiving traditional peripheral intravenous catheters. This may inform the opportunity for improvement for investment in nursing tools and services regarding difficult venous access burden reduction. Methods Model parameter data were obtained from published literature where possible via a targeted literature review for the terms including relative variations of 'Difficult Venous Access', 'burden', and 'costs', or elicited from expert clinical opinion. A simple decision tree model was developed in Microsoft® Excel 2016. Results included number of insertion attempts, number of patients requiring escalation, catheter failures due to complications, healthcare professional (e.g. nurse) time, and total costs (including/excluding health care professional time). Sensitivity analyses were performed. Results The model considers 64,000 individuals presenting in the emergency department annually, of which 75% (48,000) require a peripheral intravenous catheter; of these 22% (10,560) are estimated to have difficult venous access. The total cost burden of difficult venous access is estimated to be $890,095 per year/$84.29 per patient with difficult venous access, including the cost of clinician time. Key total cost drivers include the population size treated in the emergency department annually, the proportion of midlines placed by a specialist IV (intravenous access) nurse and the percentage of patients with difficult venous access. Conclusion This is the first formal analysis estimating the significant economic burden of difficult venous access in emergency departments via peripheral intravenous catheter placement, a task frequently performed by nurses. Further studies are needed to evaluate nursing-centric strategies for reducing this burden. Additionally, adoption of a concise definition is needed, as is routine use of reliable assessment tools so that future cost analyses can be better contextualised.
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Affiliation(s)
- Smeet Gala
- Associate Director, HEOR, Becton Dickinson and Co, Franklin Lakes, NJ, USA
| | - Kim Alsbrooks
- Senior Director Medical Affairs, Becton Dickinson and Co, Franklin Lakes, NJ, USA
| | - Amit Bahl
- Emergency Medicine Physician, Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Megan Wimmer
- Director, HEOR, Becton Dickinson and Co, Franklin Lakes, NJ, USA
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21
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V Carvalho AS, Broekema B, Brito Fernandes Ó, Klazinga N, Kringos D. Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review. BMC Emerg Med 2024; 24:19. [PMID: 38273229 PMCID: PMC10811879 DOI: 10.1186/s12873-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic severely impacted care for non-COVID patients. Performance indicators to monitor acute care, timely reported and internationally accepted, lacked during the pandemic in OECD countries. This study aims to summarize the performance indicators available in the literature to monitor changes in the quality of acute care in OECD countries during the first year and a half of the pandemic (2020-July 2021) and to assess their trends. METHODS Scoping review. Search in Embase and MEDLINE (07-07-2022). Acute care performance indicators and indicators related to acute general surgery were collected and collated following a care pathway approach. Indicators assessing identical clinical measures were grouped under a common indicator title. The trends from each group of indicators were collated (increase/decrease/stable). RESULTS A total of 152 studies were included. 2354 indicators regarding general acute care and 301 indicators related to acute general surgery were included. Indicators focusing on pre-hospital services reported a decreasing trend in the volume of patients: from 225 indicators, 110 (49%) reported a decrease. An increasing trend in pre-hospital treatment times was reported by most of the indicators (n = 41;70%) and a decreasing trend in survival rates of out-of-hospital cardiac arrest (n = 61;75%). Concerning care provided in the emergency department, most of the indicators (n = 752;71%) showed a decreasing trend in admissions across all levels of urgency. Concerning the mortality rate after admission, most of the indicators (n = 23;53%) reported an increasing trend. The subset of indicators assessing acute general surgery showed a decreasing trend in the volume of patients (n = 50;49%), stability in clinical severity at admission (n = 36;53%), and in the volume of surgeries (n = 14;47%). Most of the indicators (n = 28;65%) reported no change in treatment approach and stable mortality rate (n = 11,69%). CONCLUSION This review signals relevant disruptions across the acute care pathway. A subset of general surgery performance indicators showed stability in most of the phases of the care pathway. These results highlight the relevance of assessing this care pathway more regularly and systematically across different clinical entities to monitor disruptions and to improve the resilience of emergency services during a crisis.
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Affiliation(s)
- Ana Sofia V Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Bente Broekema
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Pediatrics, Dijklander Hospital, Location Hoorn, Maelsonstraat 3, Hoorn, 1624 NP, The Netherlands
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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22
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Razimoghadam M, Yaseri M, Effatpanah M, Daroudi R. Changes in emergency department visits and mortality during the COVID-19 pandemic: a retrospective analysis of 956 hospitals. Arch Public Health 2024; 82:5. [PMID: 38216989 PMCID: PMC10785366 DOI: 10.1186/s13690-023-01234-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/26/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, many non-COVID-19 emergency department (ED) visits were indirectly affected. ED visits and mortality were assessed during different pandemic time periods compared with pre-pandemic. METHODS The study used data from 41 million Iran Health Insurance Organization members. The outcomes were non-COVID-19 ED visits and associated mortality in 956 hospitals. An analysis of ED visits was conducted both for all-cause and cause-specific conditions: cardiovascular diseases (CVD), mental and substance use disorders, unintentional injuries, and self-harm. In addition, total in-hospital ED mortality was analyzed. A negative binomial regression and a Poisson regression with a log link were used to estimate the incidence rate ratio (IRR) of visits and mortality relative risk (RR). RESULTS 1,789,831 ED visits and 12,377 deaths were reported during the study. Pre-pandemic (Sep 2019 to Feb 2020), there were 2,767 non-COVID-19 visits rate per million person-month, which decreased to 1,884 during the first COVID-19 wave with a national lockdown from Feb 20 to Apr 19, 2020 (IRR 0.68, [0.56-0.84]). The non-COVID-19 ED mortality risk was 8.17 per 1,000 visit-month during the pre-pandemic period, rising to 12.80 during the first wave of COVID-19 (RR 1.57, [1.49-165]). Non-COVID-19 ED visit rates decreased during the first pandemic year from Sep 2020 to Feb 2021 (IRR 0.73, [0.63-0.86]), but increased after COVID-19 vaccination two years later from Sep 2021 to Feb 2022 (IRR 1.11, [0.96-0.17]). The total ED mortality risk for non-COVID-19 was significantly higher after the COVID-19 outbreak in the first (RR 1.66, [1.59-1.72]) and second years (RR 1.27, [1.22-1.32]) of the pandemic. The visit incidence rate for mental health and substance use disorders declined from 8.18 per million person-month to 4.57 (IRR 0.53, [0.32 to 0.90]) in the first wave. In the second year, unintentional injury visits increased significantly compared with pre-pandemic (IRR 1.63, [1.30-2.03]). As compared to before the pandemic, there was no significant change in CVD and self-harm visit rates during the pandemic. Cardiac arrest was the leading cause of death in Iran hospitals' EDs. CONCLUSION In the first year of the COVID-19 pandemic, non-COVID-19 hospital ED visits declined and mortality risk increased. Despite two years since the COVID-19 outbreak, non-COVID-19 ED mortality risk remains high.
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Affiliation(s)
- Mahya Razimoghadam
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Effatpanah
- Pediatric department, School of Medicine, Imam Khomeini hospital, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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23
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Wyer L, Guterman Y, Ewa V, Lang E, Faris P, Holroyd-Leduc J. The impact of the COVID-19 pandemic on transfers between long-term care and emergency departments across Alberta. BMC Emerg Med 2024; 24:9. [PMID: 38185672 PMCID: PMC10773029 DOI: 10.1186/s12873-023-00926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Long-term care (LTC) was overwhelmingly impacted by COVID-19 and unnecessary transfer to emergency departments (ED) can have negative health outcomes. This study aimed to explore how the COVID-19 pandemic impacted LTC to ED transfers and hospitalizations, utilization of community paramedics and facilitated conversations between LTC and ED physicians during the first four waves of the pandemic in Alberta, Canada. METHODS In this retrospective population-based study, administrative databases were linked to identify episodes of care for LTC residents who resided in facilities in Alberta, Canada. This study included data from January 1, 2018 to December 31, 2021 to capture outcomes prior to the onset of the pandemic and across the first four waves. Individuals were included if they visited an emergency department, received care from a community paramedic or whose care involved a facilitated conversation between LTC and ED physicians during this time period. RESULTS Transfers to ED and hospitalizations from LTC have been gradually declining since 2018 with a sharp decline seen during wave 1 of the pandemic that was greatest in the lowest-priority triage classification (CTAS 5). Community paramedic visits were highest during the first two waves of the pandemic before declining in subsequent waves; facilitated calls between LTC and ED physicians increased during the waves. CONCLUSIONS There was a reduction in number of transfers from LTC to EDs and in hospitalizations during the first four waves of the pandemic. This was supported by increased conversations between LTC and ED physicians, but was not associated with increased community paramedic visits. Additional work is needed to explore how programs such as community paramedics and facilitated conversations between LTC and ED providers can help to reduce unnecessary transfers to hospital.
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Affiliation(s)
- Leanna Wyer
- Alberta Health Services, Calgary, AB, Canada.
| | | | - Vivian Ewa
- Alberta Health Services, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Eddy Lang
- Alberta Health Services, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Peter Faris
- Alberta Health Services, Calgary, AB, Canada
| | - Jayna Holroyd-Leduc
- Alberta Health Services, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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24
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Odufalu FD, Sewell JL, Rudrapatna V, Somsouk M, Mahadevan U. Assessing the Impact of COVID-19 on IBD Outcomes Among Vulnerable Patient Populations in a Large Metropolitan Center. Inflamm Bowel Dis 2024; 30:29-37. [PMID: 36943305 DOI: 10.1093/ibd/izad041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND With the onset of COVID-19, there were rapid changes in healthcare delivery as remote access became the norm. The aim of this study was to determine the impact of changes in healthcare delivery during the COVID-19 pandemic on patients with inflammatory bowel disease (IBD), in both well-resourced and vulnerable populations. METHODS Using a mixed methods, observational study design, patients receiving IBD care at a university or a safety-net hospital were identified by the electronic health record. Patient demographics, IBD history, and disease activity were acquired from the electronic health record. IBD-related outcomes were compared from the onset of the pandemic in the United States until December 2020 (COVID-19 pandemic year 1) and compared with outcomes in the previous year. A subset of participants provided their perspective on how changes in healthcare delivery and financial stability impacted their IBD through a standardized questionnaire and semi-structured interview. RESULTS Data from a total of 1449 participants were captured, 1324 at the tertiary care university hospital and 125 at the safety-net hospital. During COVID-19, there was a decrease in healthcare utilization at both sites. Race/ethnicity and primary language were not associated with IBD-related hospitalizations or admissions. Patients that were employed and those with insurance had a higher number of IBD-related emergency department visits at both the university and safety-net hospitals (P = .03 and P = .01, respectively). Patients who did not speak English were more likely to report challenges using technology with telehealth and difficulty contacting IBD providers. CONCLUSIONS For IBD populations, during COVID-19, in both hospital settings, emergency department visits, hospitalizations, outpatient surgery, and clinic visits were reduced compared with the year prior. Patients with lower socioeconomic status and limited English proficiency reported facing more challenges with changes to healthcare delivery, healthcare access, and conveying changes in IBD activity. These results highlight the need for payors and providers to specifically attend to those populations most susceptible to these systemic and lasting changes in care delivery and promote greater equity in healthcare.
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Affiliation(s)
- Florence-Damilola Odufalu
- Division of Gastroenterology and Liver Diseases, Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Justin L Sewell
- Gastroenterology Division, Zuckerberg-Chan San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - Vivek Rudrapatna
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ma Somsouk
- Gastroenterology Division, Zuckerberg-Chan San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, USA
| | - Uma Mahadevan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Irigoyen-Otiñano M, Porras-Segovia A, Vega-Sánchez DDL, Arenas-Pijoan L, Agraz-Bota M, Torterolo G, Sánchez-Cazalilla M, Fuentes-Casany D, Adrados-Pérez M, Puigdevall-Ruestes M. Psychiatric Emergencies and Suicide Attempts Before and During COVID-19 Lockdown in Spain. CRISIS 2024; 45:8-17. [PMID: 36637085 DOI: 10.1027/0227-5910/a000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: The COVID-19 pandemic had a significant impact on the mental health of the population. The lockdown period in Spain - from March 14 to June 21, 2020 - was particularly stressful. This study aims to examine the differences in visits to the emergency department for psychiatric reasons before and during the lockdown period in a hospital in the province of Lleida (Catalonia, Spain), which has a catchment area of 431,183 inhabitants. We hope that this study can contribute to the understanding of this difficult period in our recent history and help us to be prepared in case of new social emergencies that may affect the mental health of the general population. Aims: This study aims to examine the differences in ER visits due to psychiatric reasons before and during the COVID-19 lockdown period in a province hospital in Spain. Methods: We compared the n = 1,599 visits to the emergency room and their characteristics before (June 13 to March 13, 2020) and during (March 14 to June 21, 2020) the lockdown period in the province of Lerida, Spain. Data were obtained from the electronic health records. Information collected included sociodemographic variables, reason for consultation, previous diagnosis, and characteristics of suicidal ideation and attempts - including history of previous suicidal behavior, method, days spent in the ER, suicide reattempts at 6-month follow-up. Results: Before lockdown, there were an average of 11.2 psychiatric emergencies per day compared with 9.2 psychiatric emergencies per day during lockdown. Regarding suicidal behavior, before lockdown, there were an average of 0.9 suicide attempts before lockdown compared with 0.7 attempts per day during lockdown. Limitations: Since the data came from the electronic health records, we have relied on the clinical diagnosis made by different psychiatrists. Also, we did not record psychiatric comorbidities, but instead only registered one main Axis I diagnosis and one main Axis II diagnosis. Conclusions: We observed a decrease in the number of visits to the ER in general, as well as a lower frequency of patients with suicidal behavior during the first and only lockdown period in Spain, which occurred during the initial months of the pandemic. This is consistent with previous studies showing a reduction of suicidal behavior during periods of social emergency. However, this decrease could be only temporary, and several authors predict an increase of suicidal behavior in the aftermath of the COVID-19 crisis. Ensuring access to mental healthcare during periods of crisis is crucial for the population.
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Affiliation(s)
- María Irigoyen-Otiñano
- Psychiatry Service, Santa Maria de Lleida University Hospital, Lleida, Spain
- IRB Lleida, Spain
- Psychiatry Service, Vithas Lérida, Spain
| | | | - Diego de la Vega-Sánchez
- Psychiatry Service, Virgen Macarena University Hospital, Seville, Spain
- Department of Psychiatry, University of Seville, Spain
| | - Laura Arenas-Pijoan
- Psychiatry Service, Santa Maria de Lleida University Hospital, Lleida, Spain
| | - Marc Agraz-Bota
- Psychiatry Service, Santa Maria de Lleida University Hospital, Lleida, Spain
| | - Giovanni Torterolo
- Psychiatry Service, Santa Maria de Lleida University Hospital, Lleida, Spain
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26
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Yoo A, Guterman EL, Hwang DY, Holloway RG, George BP. Impact of the COVID-19 Pandemic on Inpatient Utilization for Acute Neurologic Disease. Neurohospitalist 2024; 14:13-22. [PMID: 38235034 PMCID: PMC10790622 DOI: 10.1177/19418744231196984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Background and Objective: The initial months of the Corona Virus 2019 (COVID-19) pandemic resulted in decreased hospitalizations. We aimed to describe differences in hospitalizations and related procedures across neurologic disease. Methods: In our retrospective observational study using the California State Inpatient Database and state-wide population-level estimates, we calculated neurologic hospitalization rates for a control period from January 2019 to February 2020 and a COVID-19 pandemic period from March to December 2020. We calculated incident rate ratios (IRR) for neurologic hospitalizations using negative binomial regression and compared relevant procedure rates over time. Results: Population-based neurologic hospitalization rates were 29.1 per 100,000 (95% CI 26.9-31.3) in April 2020 compared to 43.6 per 100,000 (95% CI 40.4-46.7) in January 2020. Overall, the pandemic period had 13% lower incidence of neurologic hospitalizations per month (IRR 0.87, 95% CI 0.86-0.89). The smallest decreases were in neurotrauma (IRR 0.92, 95% CI 0.89-0.95) and neuro-oncologic cases (IRR 0.93, 95% CI 0.87-0.99). Headache admissions experienced the greatest decline (IRR 0.62, 95% CI 0.58-0.66). For ischemic stroke, greater rates of endovascular thrombectomy (5.6% vs 5.0%; P < .001) were observed in the pandemic. Among all neurologic disease, greater rates of gastrostomy (4.0% vs 3.5%; P < .001), intubation/mechanical ventilation (14.3% vs 12.9%, P < .001), and tracheostomy (1.4 vs 1.2%; P < .001) were observed during the pandemic. Conclusions: During the first months of the COVID-19 pandemic there were fewer hospitalizations to varying degrees for all neurologic diagnoses. Rates of procedures indicating severe disease increased. Further study is needed to determine the impact on triage, patient outcomes, and cost consequences.
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Affiliation(s)
- Alexander Yoo
- Department of Medicine, University of Pennsylvania Perlman School of Medicine, Philadelphia, PA, USA
| | - Elan L. Guterman
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - David Y. Hwang
- Department of Neurology, University of North Carolina, Chapel Hill, NC, USA
| | - Robert G. Holloway
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Benjamin P. George
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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Morales C, Bruckner TA, Du S, Young A, Ro A. Changes in Acute ED Visits by Race/Ethnicity During the Early COVID-19 Pandemic. J Immigr Minor Health 2023; 25:1286-1294. [PMID: 37269403 PMCID: PMC10239213 DOI: 10.1007/s10903-023-01499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/05/2023]
Abstract
Emergency department (ED) visits for conditions unrelated to the Coronavirus Disease 2019 (COVID-19) pandemic decreased during the early pandemic, raising concerns about critically ill patients forgoing care and increasing their risk of adverse outcomes. It is unclear if Hispanic and Black adults, who have a high prevalence of chronic conditions, sought medical assistance for acute emergencies during this time. This study used 2018-2020 ED visit data from the largest safety net hospital in Los Angeles County to estimate ED visit differences for cardiac emergencies, diabetic complications, and strokes, during the first societal lockdown among Black and Hispanic patients using time series analyses. Emergency department visits were lower than the expected levels during the first societal lockdown. However, after the lockdown ended, Black patients experienced a rebound in ED visits while visits for Hispanics remained depressed. Future research could identify barriers Hispanics experienced that contributed to prolonged ED avoidance.
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Affiliation(s)
- Celina Morales
- Department of Population Health and Disease Prevention, University of California Irvine, 653 E. Peltason Dr, Irvine, CA, 92697-3957, USA.
| | - Tim A Bruckner
- Department of Health, Society, and Behavior, University of California Irvine, Irvine, CA, USA
| | - Senxi Du
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew Young
- Harbor UCLA Medical Center, Los Angeles, CA, USA
| | - Annie Ro
- Department of Health, Society, and Behavior, University of California Irvine, Irvine, CA, USA
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Madhok DY, Nardone A, Caceres EU, Wong AHK, Zhang L, Rodriguez RM. The Impact of the COVID-19 Shelter-in-Place Order on Traumatic Brain Injuries in San Francisco, California. J Emerg Med 2023; 65:e479-e486. [PMID: 37914599 DOI: 10.1016/j.jemermed.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/25/2023] [Accepted: 07/15/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND In response to the COVID-19 pandemic, San Francisco, California issued a shelter-in-place (SIP) order in March 2020, during which emergency physicians noted a drop in trauma cases, as well as a change in traditional mechanisms of trauma. OBJECTIVES Our objective was to determine the epidemiology of traumatic brain injury (TBI) pre- and post-COVID-19 SIP. METHODS We reviewed the electronic medical record of the only trauma center in the city of San Francisco, to determine the number of and characteristics of patients with a diagnosis of head injury presenting to the emergency department between December 16, 2019 and June 16, 2020. Using chi-squared and Fisher's exact tests when appropriate, we compared pre- and post- COVID-19 lockdown epidemiology. RESULTS There were 1246 TBI-related visits during the 6-month study period. Bi-weekly TBI cases decreased by 36.64% 2 weeks after the COVID-19 SIP and then increased to near baseline levels by June 2020. TBI patients during SIP were older (mean age: 53.3 years pre-SIP vs. 58.2 post-SIP; p < 0.001), more likely to be male (odds ratio 1.43, 95% confidence interval 1.14-1.81), and less likely to be 17 or younger (8.9% vs. 0.5%, pre- to post-SIP respectively, p = 0.003). Patients were less likely to be Hispanic (27.2% vs. 21.7% pre- to post-SIP, respectively, p = 0.029). The proportion of TBI visits attributable to cycling accidents increased (14.1% to 52.7%, p < 0.001), whereas those attributable to pedestrians involved in road traffic accidents decreased (37.2% to 12.7%, p = 0.003). CONCLUSIONS Understanding the changing epidemiology of TBI during the COVID-19 pandemic can aid in immediate and future disaster resource planning.
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Affiliation(s)
| | - Anthony Nardone
- Department of Emergency Medicine; School of Medicine, University of California San Francisco, San Francisco, California
| | | | | | - Li Zhang
- Department of Medicine and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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van der Windt M, Schoenmakers S, van Rossem L, Steegers-Theunissen RPM. Reported experienced stress during the COVID-19 pandemic and patient preferences for the consultation of periconception blended lifestyle care: a survey among (pre)pregnant women. J Psychosom Obstet Gynaecol 2023; 44:2243647. [PMID: 37671946 DOI: 10.1080/0167482x.2023.2243647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE To assess experienced stress on different aspects of life and evaluate patient preferences for the consultation of periconception blended lifestyle care, combining face-to-face counseling with eHealth, during the COVID-19 pandemic among (pre)pregnant women. Using this two-fold aim, we were able to analyze the levels of stress among (pre)pregnant women during the COVID-19 pandemic, and to study whether their preferences for the consultation modality of periconception blended lifestyle care was influenced by the levels of stress. METHODS A quantitative survey among (pre)pregnant women who received blended periconception lifestyle care between March 2020 and December 2021, from the first until the fourth COVID-19 wave in the Netherlands. The questionnaire used a 5-point Likert scale and measured experienced stress and preferred periconception blended lifestyle care modality. RESULTS 984 women (response rate: 55.2%) filled out the questionnaire. Experienced stress during the COVID-19 pandemic was relatively low and stable over time. The highest percentage of respondents (31.2%) reported to have experienced stress on fertility and pregnancy. 40.4% (309/764) of the respondents indicated that face-to-face consultations could be replaced by digital consultation. Additionally, the mean experienced stress did not differ between the patients who preferred a video consultation (2.60 ± 1.1), or a telephone consultation (2.57 ± 1.2), either a video or telephone consultation (2.54 ± 1.3), still preferred a face-to-face consultation (2.41 ± 1.4) (p = .83). CONCLUSIONS Our findings indicate willingness for wide implementation of telemedicine within health care delivery, and reorganizing of periconception blended lifestyle care toward personalized and value-based health care.
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Affiliation(s)
- M van der Windt
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - S Schoenmakers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - L van Rossem
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - R P M Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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30
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Wallace AS, Raaum SE, Johnson EP, Presson AP, Allen CM, Elliott M, Bristol AA, Elmore CE. Impact of COVID-19 visitation policies and hospital capacity on discharge readiness in medicine patients. DISCOVER HEALTH SYSTEMS 2023; 2:45. [PMID: 38045443 PMCID: PMC10689550 DOI: 10.1007/s44250-023-00060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
Background COVID-19 impacted the experience of being hospitalized with the widespread adoption of strict visitation policies to ensure healthcare worker safety. One result was decreased time of caregivers at the bedside of hospitalized patients. Objective To understand the impact of pandemic-related system effects on patient-reported discharge preparation. Design This mixed methods study included interviews with a sample of discharged patients during April 2020, and quantitative hospital data from April 2020 to February 2021. Participants 616 patients completed a measure of discharge readiness on their day of discharge and 38 patients completed interviews about their discharge experiences. Main measures Readiness for discharge (RHDS), visitation policies, ward structure changes, COVID-19-unit census, time into the COVID-19 pandemic, patient characteristics (age, sex, race/ethnicity), admission type (planned/unplanned, for COVID-19), and discharge destination (home, home health, skilled nursing). Key results Adult patients aged 30-45 (vs. young and older adult patients) and those being discharged to places other than home (e.g., skilled nursing facility) or to out-of-state residences report lower readiness (p < 0.05) on RHDS. Patient interviews revealed some gaps in discharge communication but, overall, patients expressed high discharge readiness and few concerns about how COVID-19 system changes impacted their discharge preparation. Conclusions While there is some evidence that visitation policies and unit census may impact patient perceptions of discharge preparation, personal characteristics contributed more significantly to discharge readiness than system changes during COVID-19. Participant interviews demonstrated agreement, as most participants were discharged home and identified strong personal feelings of readiness for discharge.Clinical trials registration: ClinicalTrials.gov ID NCT04248738, https://clinicaltrials.gov/ct2/show/NCT04248738. Supplementary Information The online version contains supplementary material available at 10.1007/s44250-023-00060-8.
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Affiliation(s)
- Andrea S. Wallace
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Sonja E. Raaum
- University of Utah School of Medicine, Salt Lake City, USA
| | | | | | | | - Mackenzie Elliott
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Alycia A. Bristol
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Catherine E. Elmore
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
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31
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Cho Y, Yeo IH, Lee DE, Kim JK. Coronavirus disease pandemic impact on emergency department visits for cardiovascular disease in Korea: A review. Medicine (Baltimore) 2023; 102:e35992. [PMID: 38013376 PMCID: PMC10681605 DOI: 10.1097/md.0000000000035992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic has affected patient visits to the hospital, including visits to the emergency department (ED). This study aimed to analyze the impact of the COVID-19 pandemic on the patterns of ED visits and treatment in hospitals for diseases requiring urgent diagnosis and treatment. We analyzed entries from the South Korea National Emergency Department Information System claims database between January 1, 2018 and December 31, 2020. We analyzed data of patients who visited the ED with acute myocardial infarction (AMI), acute ischemic stroke (AIS), and acute hemorrhagic stroke (AHS). We found that the COVID-19 pandemic had impacted ED utilization and fatality in patients with AMI, AIS, and AHS.
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Affiliation(s)
- Yeonjoo Cho
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - In Hwan Yeo
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Dong Eun Lee
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jong Kun Kim
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Merino P, Kupferwasser D, Flores EA, Phan Tran D, Ortega A, Miller LG. Skin and soft tissue infection incidence before and during the COVID-19 pandemic. Epidemiol Infect 2023; 151:e190. [PMID: 37929620 PMCID: PMC10728973 DOI: 10.1017/s0950268823001802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/15/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
Skin and Soft Tissue Infections (SSTIs) are common bacterial infections. We hypothesized that due to the COVID-19 pandemic, SSTI rates would significantly decrease due to directives to avoid unneeded care and attenuated SSTIs risk behaviours. We retrospectively examined all patients with an ICD-10 diagnosis code in the Los Angeles County Department of Health Services, the second largest U.S. safety net healthcare system between 16 March 2017 and 15 March 2022. We then compared pre-pandemic with intra-pandemic SSTI rates using an interrupted time series analysis. We found 72,118 SSTIs, 46,206 during the pre-pandemic period and 25,912 during the intra-pandemic period. Pre-pandemic SSTI rate was significantly higher than the intra-pandemic rate (3.27 vs. 2.31 cases per 1,000 empanelled patient-months, P < 0.0001). The monthly SSTI cases decreased by 1.19 SSTIs/1,000 empanelled patient-months between the pre- and intra-pandemic periods (P = 0.0003). SSTI subgroups (inpatient, observation unit, emergency department, and outpatient clinics), all had significant SSTI decreases between the two time periods (P < 0.05) except for observation unit (P = 0.50). Compared to the pre-COVID-19 pandemic period, medically attended SSTI rates in our large U.S. safety net healthcare system significantly decreased by nearly 30%. Whether findings reflect true SSTI decreases or decreased health system utilization for SSTIs requires further examination.
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Affiliation(s)
- Prudencio Merino
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Deborah Kupferwasser
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Evelyn A. Flores
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Donna Phan Tran
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Abisay Ortega
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Loren G. Miller
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
- David Geffen School of Medicine, Los Angeles, CA, USA
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Osula V, Rusk S, Hao L, Hansoti B, Gemmill A, Hong X, Wang G, Pearson C, Adams WG, Wang X. Prospective Cohort Study of Emergency Department Visit Frequency and Diagnoses Before and During COVID-19 Pandemic in Urban, Low-Income, US- and Foreign-Born Mothers in Boston, MA. West J Emerg Med 2023; 24:1117-1127. [PMID: 38165194 PMCID: PMC10754186 DOI: 10.5811/westjem.59639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 01/03/2024] Open
Abstract
Background The coronavirus 2019 (COVID-19) pandemic fundamentally changed how populations interface with the healthcare system. Despite historical spikes in US mortality during the pandemic, emergency department (ED) visits were paradoxically low. This is a concerning phenomenon that raises a red flag regarding access to care, especially among vulnerable populations. In this study we sought to understand how ED utilization evolved during the COVID-19 pandemic among traditionally understudied, low-income, racially diverse US- and foreign-born mothers. Methods This is a secondary analysis of a pre-existing dataset of 3,073 participants enrolled in the Boston Birth Cohort at birth and followed prospectively. We obtained ED visit diagnoses from 2019 and 2020 via electronic health records, categorized according to the International Classification of Diseases, 10th Revision, and compared them using graph plots, chi-square, and negative binomial regression. Results The number of ED visits decreased by 29.1% (P < 0.001) from 2019 (1,376) to 2020 (976). However, visits for infectious and parasitic diseases, including COVID-19, increased by 90.6% (32:61) with COVID-19 accounting for 77% of those visits in 2020 (47/61). Mental health-related visits increased by 40.9% (44:62), with diagnoses of alcohol use disorder increasing by 183% (6:17). Regression analysis showed 50% less ED utilization among foreign- vs US-born participants; however, the increase in infectious diseases visits was greater among foreign-born compared to US-born mothers (185% vs 26%, P = 0.01), while the increase in mental health diagnoses was greater among US-born mothers (69% vs -33%, P = 0.10). Conclusion Despite a decrease in total ED visits during the pandemic, there was an increase in COVID-19- (immigrant > US born) and mental health- (US-born only) related visits. Our findings demonstrate that EDs remain a critical access point for care for minority populations and have implications for preparedness, resources, and services of EDs in urban settings to better address the needs of communities. However, alternative avenues for healthcare services for these populations, particularly during health crises, warrant further investigation.
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Affiliation(s)
- Valerie Osula
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Serena Rusk
- Johns Hopkins Bloomberg School of Public Health, Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Baltimore, Maryland
| | - Lingxin Hao
- Johns Hopkins University, Department of Sociology, Baltimore, Maryland
| | - Bhakti Hansoti
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland
| | - Alison Gemmill
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Baltimore, Maryland
| | - Xiumei Hong
- Johns Hopkins Bloomberg School of Public Health, Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Baltimore, Maryland
| | - Guoying Wang
- Johns Hopkins Bloomberg School of Public Health, Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Baltimore, Maryland
| | - Colleen Pearson
- Boston University School of Medicine, Boston, Massachusetts
- Boston Medical Center, Department of Pediatrics, Boston, Massachusetts
| | - William G. Adams
- Boston University School of Medicine, Boston, Massachusetts
- Boston Medical Center, Department of Pediatrics, Boston, Massachusetts
| | - Xiaobin Wang
- Johns Hopkins Bloomberg School of Public Health, Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Maryland
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Elsener M, Santana Felipes RC, Sege J, Harmon P, Jafri FN. Telehealth-based transitional care management programme to improve access to care. BMJ Open Qual 2023; 12:e002495. [PMID: 37940335 PMCID: PMC10632879 DOI: 10.1136/bmjoq-2023-002495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The transition from hospital to home is a vulnerable time for patients and families that can be improved through care coordination and structured discharge planning. LOCAL PROBLEM Our organisation aimed to develop and expand a programme that could improve 30-day readmission rates on overall and disease-specific populations by assessing the impact of a telehealth outreach by a registered nurse (RN) after discharge from an acute care setting on 30-day hospital readmission. METHODS This is a prospective observational design conducted from May 2021 to December 2022 with an urban, non-academic, acute care hospital in Westchester County, New York. Outcomes for patients discharged home following inpatient hospitalisation were analysed within this study. We analysed overall and disease-specific populations (congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and pneumonia (PNA)) as compared with a 40-month prestudy cohort. INTERVENTIONS Patients were identified in a non-random fashion meeting criterion of being discharged home after an inpatient admission. Participants received a telephonic outreach by an RN within 72 hours of discharge. Contacted patients were asked questions addressing discharge instructions, medication access, follow-up appointments and social needs. Patients were offered services and resources based on their individual needs in response to the survey. RESULTS 68.2% of the 24 808 patients were contacted to assess and offer services. Median readmission rates for these patients were 1.2% less than the prestudy cohort (11.0% to 9.8%). Decreases were also noted for disease-specific conditions (CHF (14.3% to 9.1%), COPD (20.0% to 13.4%) and PNA (14.9% to 14.0%)). Among those in the study period, those that were contacted between 24 and 48 hours after discharge were 1.2 times less likely to be readmitted than if unable to be contacted (254/3742 (6.8%) vs 647/7866 (8.2%); p=0.005). CONCLUSIONS Using a multifaceted telehealth approach to improve patient engagement and access reduced 30-day hospital readmission for patients discharged from the acute care setting.
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Affiliation(s)
- Michelle Elsener
- Transitional Care, White Plains Hospital, White Plains, New York, USA
| | | | - Jonathan Sege
- Transitional Care, White Plains Hospital, White Plains, New York, USA
| | - Priscilla Harmon
- Transitional Care, White Plains Hospital, White Plains, New York, USA
| | - Farrukh N Jafri
- Emergency Department, White Plains Hospital, White Plains, New York, USA
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Bima P, Giamello JD, Rubiolo P, Risi F, Balzaretti P, Lauria G, Vallino D, Lupia E, Morello F. Clinical Presentation and Emergency Department Management Checkpoints of Acute Aortic Syndromes during the First Two Waves of the COVID-19 Pandemic. J Clin Med 2023; 12:6601. [PMID: 37892739 PMCID: PMC10607079 DOI: 10.3390/jcm12206601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
The COVID-19 pandemic has deeply affected the activity and patient flows of Emergency Departments (EDs), and concern for the worsening outcome of cardiovascular emergencies has been raised. However, the impact of COVID-19 on all subtypes of acute aortic syndromes (AASs) has not been evaluated so far. Cases of AASs managed in the ED of three hub hospitals in a large area of Northern Italy were retrospectively analyzed, comparing those registered during the pandemic (March 2020 to May 2021) with corresponding pre-COVID-19 periods. A total of 124 patients with AAS were managed during the COVID-19 period vs. 118 pre-COVID-19 (p = 0.70), despite a -34.6% change in ED visits. Posterior chest pain at presentation was the only clinical variable with a different prevalence (46.0% vs. 32.2%, p = 0.03). Surgery and endovascular treatment rates were unchanged. Time intervals influenced by patient transfer to the hub center were longer during the COVID-19 period and longest during high viral circulation periods. Ninety-day mortality was unchanged, with a higher mortality trend during the pandemic surges. In conclusion, ED presentation and care of AASs were marginally affected by COVID-19, but efforts are needed to preserve efficient patient transfer to specialized centers and prevent mortality, especially during pandemic peaks.
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Affiliation(s)
- Paolo Bima
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.B.); (E.L.)
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
- Cardiovascular Research Institute Basel (CRIB), 4056 Basel, Switzerland
| | - Jacopo Davide Giamello
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
- Medicina d’Urgenza, Ospedale S. Croce e Carle, 12100 Cuneo, Italy
| | - Paolo Rubiolo
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
| | - Francesca Risi
- Dipartimento di Emergenza e Accettazione, Ospedale Mauriziano, 10128 Torino, Italy
| | - Paolo Balzaretti
- Dipartimento di Emergenza e Accettazione, Ospedale Mauriziano, 10128 Torino, Italy
| | - Giuseppe Lauria
- Medicina d’Urgenza, Ospedale S. Croce e Carle, 12100 Cuneo, Italy
| | - Domenico Vallino
- Dipartimento di Emergenza e Accettazione, Ospedale Mauriziano, 10128 Torino, Italy
| | - Enrico Lupia
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.B.); (E.L.)
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
| | - Fulvio Morello
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.B.); (E.L.)
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
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Scofi JE, Underriner E, Sangal RB, Rothenberg C, Patel A, Pickens A, Sather J, Parwani V, Ulrich A, Venkatesh AK. Correlations among common emergency medicine physician performance measures: Mixed messages or balancing forces? Am J Emerg Med 2023; 72:58-63. [PMID: 37481955 DOI: 10.1016/j.ajem.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
The increasing complexity of ED physician performance measures has resulted in significant challenges, including duplicative and conflicting measures that fail to account for different ED settings. We performed a cross sectional analysis of correlations between measures to characterize their relationships and determine if differences exist between academic versus non-academic ED settings. Pearson correlations were calculated for 12 measures among 220 ED physicians at 11 EDs. Higher admission rate was strongly correlated with higher CT utilization rate (R = 0.7, p < 0.01) and longer room to discharge time (R = 0.7, p < 0.01). Higher patients per hour was strongly correlated with shorter room to doctor time (R = -0.7, p < 0.01). Stronger measure correlations were found in the academic setting compared to the non-academic setting. Strong correlations between ED measures imply opportunities to reduce competing performance demands on clinicians. Differences in correlations at academic versus non-academic settings suggest that it may be inappropriate to apply the same performance standards across settings.
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Affiliation(s)
- Jean E Scofi
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America.
| | - Erin Underriner
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Rohit B Sangal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Craig Rothenberg
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Amitkumar Patel
- Joint Data Analytics Team, Yale New Haven Hospital, New Haven, CT, United States of America
| | - Andrew Pickens
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - John Sather
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Vivek Parwani
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Andrew Ulrich
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America; Center for Outcomes Research and Evaluation, Yale University, New Haven, CT, United States of America
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Ghanbari V, Khatony A, Janatolmakan M, Rezaeian S, Rostamnia L. Emergency care utilization and patients' outcome before and after COVID-19 national lockdown in Iran: a cross-sectional study. BMC Emerg Med 2023; 23:114. [PMID: 37775730 PMCID: PMC10542682 DOI: 10.1186/s12873-023-00887-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION COVID-19 rapidly spread throughout the world. Stay-at-home and social distance strategies accompanied by fear of contamination with COVID-19 caused significant disruptions in daily life. The study focused on the impact of the COVID-19 pandemic on emergency visit and patients' outcome in the emergency department (ED). METHOD Administrative and clinical data of 25-hospital EDs in Kermanshah province of Iran from February 20, 2020, to February 18, 2021, were retrospectively analyzed with the comparable periods in the previous year. The incidence rate ratio (IRR) was used to compare the differences between the pandemic and the pre-pandemic period. RESULT The number of ED visits decreased nearly 50% after the declaration of a national lockdown. Moreover, the proportion of patients triaged in ESI 1 and 2 levels increased by 40 and 52%, respectively. The ratio of patients admitted to intensive care units and discharged against medical advice also increased significantly. CONCLUSION Despite the number of ED visits sharply declining, the ratio of patients who came to EDs with higher acuity significantly increased. So, health authorities must sensitize the public about life-threatening signs and symptoms in such conditions.
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Affiliation(s)
- Vahid Ghanbari
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leili Rostamnia
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Zeitouny S, Cheung DC, Bremner KE, Pataky RE, Pequeno P, Matelski J, Peacock S, Del Giudice ME, Lapointe-Shaw L, Tomlinson G, Mendlowitz AB, Mulder C, Tsui TCO, Perlis N, Walker JD, Sander B, Wong WWL, Krahn MD, Kulkarni GS. The impact of the early COVID-19 pandemic on healthcare system resource use and costs in two provinces in Canada: An interrupted time series analysis. PLoS One 2023; 18:e0290646. [PMID: 37682823 PMCID: PMC10490868 DOI: 10.1371/journal.pone.0290646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION The aim of our study was to assess the initial impact of COVID-19 on total publicly-funded direct healthcare costs and health services use in two Canadian provinces, Ontario and British Columbia (BC). METHODS This retrospective repeated cross-sectional study used population-based administrative datasets, linked within each province, from January 1, 2018 to December 27, 2020. Interrupted time series analysis was used to estimate changes in the level and trends of weekly resource use and costs, with March 16-22, 2020 as the first pandemic week. Also, in each week of 2020, we identified cases with their first positive SARS-CoV-2 test and estimated their healthcare costs until death or December 27, 2020. RESULTS The resources with the largest level declines (95% confidence interval) in use in the first pandemic week compared to the previous week were physician services [Ontario: -43% (-49%,-37%); BC: -24% (-30%,-19%) (both p<0.001)] and emergency department visits [Ontario: -41% (-47%,-35%); BC: -29% (-35%,-23%) (both p<0.001)]. Hospital admissions declined by 27% (-32%,-23%) in Ontario and 21% (-26%,-16%) in BC (both p<0.001). Resource use subsequently rose but did not return to pre-pandemic levels. Only home care and dialysis clinic visits did not significantly decrease compared to pre-pandemic. Costs for COVID-19 cases represented 1.3% and 0.7% of total direct healthcare costs in 2020 in Ontario and BC, respectively. CONCLUSIONS Reduced utilization of healthcare services in the overall population outweighed utilization by COVID-19 patients in 2020. Meeting the needs of all patients across all services is essential to maintain resilient healthcare systems.
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Affiliation(s)
- Seraphine Zeitouny
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas C. Cheung
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen E. Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Reka E. Pataky
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - M. Elisabeth Del Giudice
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Andrew B. Mendlowitz
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carol Mulder
- Chiefs of Ontario, Toronto, Ontario, Canada
- Queen’s University, Kingston, Ontario, Canada
| | - Teresa C. O. Tsui
- ICES, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada
| | - Nathan Perlis
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Sprott Department of Surgery, University Health Network, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jennifer D. Walker
- ICES, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - William W. L. Wong
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Murray D. Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Girish S. Kulkarni
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Urology, Sprott Department of Surgery, University Health Network, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Yao J, Irvine MA, Klaver B, Zandy M, Dheri AK, Grafstein E, Smolina K. Changes in emergency department use in British Columbia, Canada, during the first 3 years of the COVID-19 pandemic. CMAJ 2023; 195:E1141-E1150. [PMID: 37669788 PMCID: PMC10480001 DOI: 10.1503/cmaj.221516] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Previous studies have shown reductions in the volume of emergency department visits early in the COVID-19 pandemic, but few have evaluated the pandemic's impact over time or stratified analyses by reason for visits. We aimed to quantify such changes in British Columbia, Canada, cumulatively and during prominent nadirs, and by reason for visit, age and acuity. METHODS We included data from the National Ambulatory Care Reporting System for 30 emergency departments across BC from January 2016 to December 2022. We fitted generalized additive models, accounting for seasonal and annual trends, to the monthly number of visits to estimate changes throughout the pandemic, compared with the expected number of visits in the absence of the pandemic. We determined absolute and relative differences at various times during the study period, and cumulatively since the start of the pandemic until the overall volume of emergency department visits returned to expected levels. RESULTS Over the first 16 months of the pandemic, the volume of emergency department visits was reduced by about 322 300 visits, or 15% (95% confidence interval 12%-18%), compared with the expected volume. A sharp drop in pediatric visits accounted for nearly one-third of the reduction. The timing of the return to baseline volume of visits differed by subgroup. The largest and most sustained decreases were in respiratory-related emergency department visits, visits among children, visits among oldest adults and non-urgent visits. Later in the pandemic, we observed increased volumes of highest-urgency visits, visits among children and visits related to ear, nose and throat. INTERPRETATION We have extended evidence that the impact of the COVID-19 pandemic and associated mitigation strategies on emergency department visits in Canada was substantial. Both our findings and methods are relevant in public health surveillance and capacity planning for emergency departments in pandemic and nonpandemic times.
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Affiliation(s)
- Jiayun Yao
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
| | - Michael A Irvine
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
| | - Braeden Klaver
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
| | - Moe Zandy
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
| | - Aman K Dheri
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
| | - Eric Grafstein
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
| | - Kate Smolina
- British Columbia Centre for Disease Control (Yao, Irvine, Klaver, Zandy, Dheri, Smolina), Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; School of Population and Public Health (Yao, Smolina) and Department of Emergency Medicine (Grafstein), University of British Columbia; Vancouver Coastal Health Authority (Grafstein), Vancouver, BC
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Decker KM, Feely A, Bucher O, Czaykowski P, Hebbard P, Kim JO, Pitz M, Singh H, Thiessen M, Lambert P. New Cancer Diagnoses Before and During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2332363. [PMID: 37669049 PMCID: PMC10481240 DOI: 10.1001/jamanetworkopen.2023.32363] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/30/2023] [Indexed: 09/06/2023] Open
Abstract
Importance Disruptions to health care during the COVID-19 pandemic may have led to missed cancer diagnoses. It is critical to evaluate the association between the COVID-19 pandemic and cancer incidence to address public and patient anxiety, inform recovery efforts, and identify strategies to reduce the system's vulnerability to future disruptions. Objective To examine the association between the COVID-19 pandemic and cancer incidence in Manitoba, Canada. Design, Setting, and Participants A population-based cross-sectional study design was conducted using data from the Manitoba Cancer Registry and an interrupted time-series analysis. All individuals diagnosed with cancer in Manitoba, Canada, from January 1, 2015, until December 31, 2021, were included. Individuals diagnosed with breast, colon, rectal, or lung cancer were grouped by age as follows: younger than 50 years, 50 to 74 years, and 75 years and older. Exposures COVID-19 pandemic. Main Outcomes and Measures Age-standardized cancer incidence rates and the estimated cumulative difference between the number of cases in the absence of COVID-19 and observed (fitted) number of cancer cases. Results A total of 48 378 individuals were included. The median (IQR) age at diagnosis was 68 (59-77) years and 23 972 participants (49.6%) were female. In April 2020, there was a 23% decrease in overall cancer incidence. Cancer incidence decreased by 46% for breast, 35% for colon, 47% for rectal, 50% for head and neck, 65% for melanoma, and 33% for endocrine cancer diagnoses and increased by 12% for hematological cancer diagnoses and 8% for diagnoses of cancers with an unknown primary site. Lung cancer incidence remained stable until December 2020 when it decreased by 11%. Brain and central nervous system and urinary cancer diagnoses decreased consistently over time from April 2020 to December 2021 by 26% and 12%, respectively. No association was observed with gynecologic (1% increase), other digestive (1% decrease), or pancreatic (7% increase) cancer incidence. As of December 2021, Manitoba had an estimated deficit of 692 (5.3%) cancers. The largest estimated deficits were for breast (273 cases, 14.1% deficit), colon (133 cases, 12.2% deficit), and lung cancers (132 cases, 7.6% deficit). Conclusions and Relevance In this study, the COVID-19 pandemic was associated with an initial decrease in cancer diagnosis incidence followed by a recovery for most cancer sites. However, the cumulative deficit for some cancers with high fatality needs immediate attention.
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Affiliation(s)
- Kathleen M. Decker
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Allison Feely
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Piotr Czaykowski
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Pamela Hebbard
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julian O. Kim
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Section of Radiation Oncology, Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Marshall Pitz
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Harminder Singh
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maclean Thiessen
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Pascal Lambert
- Paul Albrechtsen Research Institute CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Grewal K, Atzema CL, Sutradhar R, Yu W, Chartier LB, Friedman SM, Landes M, Borgundvaag B, McLeod SL. Hospital admission from the emergency department for selected emergent diagnoses during the first year of the COVID-19 pandemic in Ontario: a retrospective population-based study. CMAJ Open 2023; 11:E969-E981. [PMID: 37875312 PMCID: PMC10609908 DOI: 10.9778/cmajo.20230017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Avoidance of care during the pandemic may have contributed to delays in care, and as a result, worse patient outcomes. We evaluated markers of illness acuity on presentation to the emergency department among patients with non-COVID-19-related emergent diagnoses and associated outcomes. METHODS We conducted a retrospective study using linked administrative data from Ontario. We selected 4 emergent diagnoses, namely appendicitis, ectopic pregnancy, renal failure and diabetic ketoacidosis. We used the nonemergent diagnosis of cellulitis as a control. Our primary outcome of interest was hospital admission. Secondary outcomes were ambulance arrival, surgical intervention, subsequent hospital admission within 30 days of discharge from the emergency department or hospital and 30-day mortality. We compared outcomes during the first year of the COVID-19 pandemic (Mar. 15-Dec. 31, 2020) with a control period (Mar. 15-Dec. 31, 2018, and Mar. 15-Dec. 31, 2019). RESULTS Emergency department visits for all conditions initially decreased during the pandemic. During this period, patients across all study diagnoses were more likely to arrive to the emergency department via ambulance. Patients with an ectopic pregnancy had higher odds of surgery in the pandemic period (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.04-1.55) but this was not observed among patients with appendicitis. Patients with renal failure had increased odds of hospital admission (OR 1.14, 95% CI 1.04-1.24) and 30-day mortality (OR 1.17, 95% CI 1.04-1.31) during the pandemic period. INTERPRETATION The pandemic period was associated with increased arrival to the emergency department via ambulance across all study diagnoses. Although patients with renal failure had increased hospital admission and death, and patients with ectopic pregnancy had an increased risk of surgery, there were no differences in outcomes for other populations, suggesting the health care system was able to care for these patients effectively.
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Affiliation(s)
- Keerat Grewal
- Schwartz/Reisman Emergency Medicine Institute (Grewal, Borgundvaag, McLeod), Sinai Health; Division of Emergency Medicine, Department of Medicine (Grewal, Atzema, Chartier), Temerty Faculty of Medicine, University of Toronto; ICES (Grewal, Atzema, Sutradhar, Yu); Department of Emergency Services (Atzema), Sunnybrook Health Sciences Centre; Dalla Lana School of Public Health (Sutradhar), University of Toronto; Department of Emergency Medicine (Chartier, Friedman, Landes), University Health Network; Division of Emergency Medicine, Department of Family and Community Medicine (Friedman, Landes, Borgundvaag, McLeod), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Clare L Atzema
- Schwartz/Reisman Emergency Medicine Institute (Grewal, Borgundvaag, McLeod), Sinai Health; Division of Emergency Medicine, Department of Medicine (Grewal, Atzema, Chartier), Temerty Faculty of Medicine, University of Toronto; ICES (Grewal, Atzema, Sutradhar, Yu); Department of Emergency Services (Atzema), Sunnybrook Health Sciences Centre; Dalla Lana School of Public Health (Sutradhar), University of Toronto; Department of Emergency Medicine (Chartier, Friedman, Landes), University Health Network; Division of Emergency Medicine, Department of Family and Community Medicine (Friedman, Landes, Borgundvaag, McLeod), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Rinku Sutradhar
- Schwartz/Reisman Emergency Medicine Institute (Grewal, Borgundvaag, McLeod), Sinai Health; Division of Emergency Medicine, Department of Medicine (Grewal, Atzema, Chartier), Temerty Faculty of Medicine, University of Toronto; ICES (Grewal, Atzema, Sutradhar, Yu); Department of Emergency Services (Atzema), Sunnybrook Health Sciences Centre; Dalla Lana School of Public Health (Sutradhar), University of Toronto; Department of Emergency Medicine (Chartier, Friedman, Landes), University Health Network; Division of Emergency Medicine, Department of Family and Community Medicine (Friedman, Landes, Borgundvaag, McLeod), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Winnie Yu
- Schwartz/Reisman Emergency Medicine Institute (Grewal, Borgundvaag, McLeod), Sinai Health; Division of Emergency Medicine, Department of Medicine (Grewal, Atzema, Chartier), Temerty Faculty of Medicine, University of Toronto; ICES (Grewal, Atzema, Sutradhar, Yu); Department of Emergency Services (Atzema), Sunnybrook Health Sciences Centre; Dalla Lana School of Public Health (Sutradhar), University of Toronto; Department of Emergency Medicine (Chartier, Friedman, Landes), University Health Network; Division of Emergency Medicine, Department of Family and Community Medicine (Friedman, Landes, Borgundvaag, McLeod), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Lucas B Chartier
- Schwartz/Reisman Emergency Medicine Institute (Grewal, Borgundvaag, McLeod), Sinai Health; Division of Emergency Medicine, Department of Medicine (Grewal, Atzema, Chartier), Temerty Faculty of Medicine, University of Toronto; ICES (Grewal, Atzema, Sutradhar, Yu); Department of Emergency Services (Atzema), Sunnybrook Health Sciences Centre; Dalla Lana School of Public Health (Sutradhar), University of Toronto; Department of Emergency Medicine (Chartier, Friedman, Landes), University Health Network; Division of Emergency Medicine, Department of Family and Community Medicine (Friedman, Landes, Borgundvaag, McLeod), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Steven M Friedman
- Schwartz/Reisman Emergency Medicine Institute (Grewal, Borgundvaag, McLeod), Sinai Health; Division of Emergency Medicine, Department of Medicine (Grewal, Atzema, Chartier), Temerty Faculty of Medicine, University of Toronto; ICES (Grewal, Atzema, Sutradhar, Yu); Department of Emergency Services (Atzema), Sunnybrook Health Sciences Centre; Dalla Lana School of Public Health (Sutradhar), University of Toronto; Department of Emergency Medicine (Chartier, Friedman, Landes), University Health Network; Division of Emergency Medicine, Department of Family and Community Medicine (Friedman, Landes, Borgundvaag, McLeod), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Megan Landes
- Schwartz/Reisman Emergency Medicine Institute (Grewal, Borgundvaag, McLeod), Sinai Health; Division of Emergency Medicine, Department of Medicine (Grewal, Atzema, Chartier), Temerty Faculty of Medicine, University of Toronto; ICES (Grewal, Atzema, Sutradhar, Yu); Department of Emergency Services (Atzema), Sunnybrook Health Sciences Centre; Dalla Lana School of Public Health (Sutradhar), University of Toronto; Department of Emergency Medicine (Chartier, Friedman, Landes), University Health Network; Division of Emergency Medicine, Department of Family and Community Medicine (Friedman, Landes, Borgundvaag, McLeod), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Bjug Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute (Grewal, Borgundvaag, McLeod), Sinai Health; Division of Emergency Medicine, Department of Medicine (Grewal, Atzema, Chartier), Temerty Faculty of Medicine, University of Toronto; ICES (Grewal, Atzema, Sutradhar, Yu); Department of Emergency Services (Atzema), Sunnybrook Health Sciences Centre; Dalla Lana School of Public Health (Sutradhar), University of Toronto; Department of Emergency Medicine (Chartier, Friedman, Landes), University Health Network; Division of Emergency Medicine, Department of Family and Community Medicine (Friedman, Landes, Borgundvaag, McLeod), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute (Grewal, Borgundvaag, McLeod), Sinai Health; Division of Emergency Medicine, Department of Medicine (Grewal, Atzema, Chartier), Temerty Faculty of Medicine, University of Toronto; ICES (Grewal, Atzema, Sutradhar, Yu); Department of Emergency Services (Atzema), Sunnybrook Health Sciences Centre; Dalla Lana School of Public Health (Sutradhar), University of Toronto; Department of Emergency Medicine (Chartier, Friedman, Landes), University Health Network; Division of Emergency Medicine, Department of Family and Community Medicine (Friedman, Landes, Borgundvaag, McLeod), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
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Namgung M, Lee DH, Bae SJ, Chung HS, Kim K, Lee CA, Kim DH, Kim EC, Lim JY, Han SS, Choi YH. The impact of COVID-19 pandemic on revisits to emergency department. Australas Emerg Care 2023; 26:221-229. [PMID: 36717326 PMCID: PMC9874043 DOI: 10.1016/j.auec.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/21/2022] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
AIM This study presents the impact of COVID-19 on revisits to the emergency department comparing revisit rates and characteristics between the pre-COVID-19 and COVID-19 periods. METHODS This multi-center retrospective study included patients over 18 years of age who visited emergency departments during the pre-COVID-19 period and the COVID-19 pandemic. The revisit rates were analyzed according to five age groups; 18-34, 35-49, 50-64, 65-79, and ≥ 80 years, and three revisit time intervals; 3, 9, and 30 days. Also, we compared the diagnosis and disposition at revisit between the study periods. RESULTS The revisit rates increased with age in both study periods and the revisit rates among all age groups were higher in the COVID-19 period. The proportion of infectious and respiratory diseases decreased during the COVID-19 period. The ICU admission rate and mortality at the revisit among patients aged ≥ 80 years were lower in the COVID-19 period than in the pre-COVID-19 period. CONCLUSION The revisit rates increased with age in both study periods and there were several changes in the diagnosis and disposition at the revisit in the COVID-19 period.
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Affiliation(s)
- Myeong Namgung
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea
| | - Dong Hoon Lee
- Department of emergency medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, South Korea.
| | - Sung Jin Bae
- Department of emergency medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, South Korea
| | - Ho Sub Chung
- Department of emergency medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, South Korea
| | - Keon Kim
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Choung Ah Lee
- Department of emergency medicine, Hallym univ. Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Duk Ho Kim
- Department of Emergency Medicine, Eulji University, Seoul, South Korea
| | - Eui Chung Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jee Yong Lim
- Department of emergency medicine, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Sang Soo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Yoon Hee Choi
- Department of Emergency Medicine, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
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Kilaru AS, Scheulen JJ, Harbertson CA, Gonzales R, Mondal A, Agarwal AK. Boarding in US Academic Emergency Departments During the COVID-19 Pandemic. Ann Emerg Med 2023; 82:247-254. [PMID: 36681622 PMCID: PMC9851166 DOI: 10.1016/j.annemergmed.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVE The first 2 years of the COVID-19 pandemic brought substantial and dynamic changes to emergency department volumes and throughput. The objective of this study was to describe changes in ED boarding among US academic EDs across the duration of the COVID-19 pandemic. METHODS We conducted a retrospective analysis of monthly data collected from a convenience sample of academic departments of emergency medicine. The study period was from January 2019 to December 2021. The primary outcome was total boarding hours, and secondary outcomes included patient volume stratified by ED disposition. We used multivariable linear panel regression models with fixed effects for individual EDs to estimate adjusted means for 3-month quarters. RESULTS Of the 73 academic departments of emergency medicine contacted, 34 (46.6%) participated, comprising 43 individual EDs in 25 states. The adjusted mean total boarding hours per month significantly decreased during the second quarter of 2020 (4,449 hours; 95% confidence interval [CI] 3,189 to 5,710) compared to the first quarter of 2019 (8,521 hours; 95% CI 7,845 to 9,197). Beginning in the second quarter of 2021, total boarding hours significantly increased beyond pre-pandemic levels, peaking during the fourth quarter of 2021 (12,127 hours; 95% CI 10,925 to 13,328). CONCLUSIONS A sustained and considerable increase in boarding observed in selected US academic EDs during later phases of the COVID-19 pandemic may reflect ongoing stresses to the health care system, with potential consequences for patient outcomes as well as clinician well-being.
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Affiliation(s)
- Austin S Kilaru
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania.
| | - James J Scheulen
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cathi A Harbertson
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Gonzales
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angira Mondal
- Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania
| | - Anish K Agarwal
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania
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Chang MH, Moonesinghe R, Truman BI. Emergency department claims among Medicare beneficiaries with HIV, STDs, viral hepatitis or tuberculosis before and during the COVID-19 pandemic. J Public Health (Oxf) 2023; 45:e417-e425. [PMID: 36626306 DOI: 10.1093/pubmed/fdac165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/05/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Changes in emergency department (ED) usage among US Medicare beneficiaries (MB) with fee-for-service claims for HIV, viral hepatitis, sexually transmitted diseases (STDs) or tuberculosis (TB) (HHST) services have not been assessed since the COVID-19 pandemic. METHODS During 2006-20, we assessed the annual number of MB with each HHST per 1000 persons with ED claims for all conditions, and changes in demographic and geographic distribution of ED claimants for each HHST condition. RESULTS Of all persons who attended an ED for any condition, 10.5 million (27.5%) were MB with ≥1 ED claim in 2006; that number (percentage) increased to 11.0 million (26.7%) in 2019 and decreased to 9.2 million (22.7%) in 2020; < 5 MB per 1000 ED population had HHST ED claims in 2020. The percentage increase in ED claims was higher for MB with STDs than for those with other HHST conditions, including a 10% decrease for MB with TB in 2020. CONCLUSIONS Trends in ED usage for HHST conditions were associated with changes in demographic and geographic distribution among MB during 2006-20. Updated ED reimbursement policies and primary care practices among MB might improve prevention, diagnosis and treatment of HHST conditions in the future.
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Affiliation(s)
- Man-Huei Chang
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Ramal Moonesinghe
- Office of Genomics and Precision Public Health, CDC, Atlanta, GA, USA
| | - Benedict I Truman
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
- Retired in May 2022
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45
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Chang HM, Chang CC, Lin PY, Lee YC, Huang HH, Yen DHT. The impact of COVID-19 epidemic on emergency department visits of older patients in Taiwan. BMC Geriatr 2023; 23:490. [PMID: 37580692 PMCID: PMC10424425 DOI: 10.1186/s12877-023-04164-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/11/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The number of emergency department (ED) visits has significantly declined since the COVID-19 pandemic. In Taiwan, an aged society, it is unknown whether older adults are accessing emergency care during the COVID-19 epidemic. Therefore, this study aimed to investigate the impact of COVID-19 on the ED visits and triage, admission, and intensive care unit (ICU) hospitalization of the geriatric population in a COVID-19-dedicated medical center throughout various periods of the epidemic. METHODS A retrospective chart review of ED medical records from April 9 to August 31, 2021 were conducted, and demographic information was obtained from the hospital's computer database. The period was divided into pre-, early-, peak-, late-, and post-epidemic stages. For statistical analysis, one-way analysis of variance followed by multiple comparison tests (Bonferroni correction) were used. RESULTS A statistically significant decrease in the total number of patients attending the ED was noted during the peak-, late-, and post-epidemic stages. In the post-epidemic stage, the number of older patients visiting ED was nearly to that of the pre-epidemic stage, indicating that older adults tend to seek care at the ED earlier than the general population. Throughout the entire epidemic period, there was no statistically significant reduction in the number of the triage 1& 2 patients seeking medical attention at the emergency department. In the entire duration of the epidemic, there was no observed reduction in the admission of elderly patients to our hospital or ICU through the ED. However, a statistically significant decrease was observed in the admission of the general population during the peak epidemic stage. CONCLUSIONS During the peak of COVID-19 outbreak, the number of ED visits was significantly affected. However, it is noteworthy that as the epidemic was gradually controlled, the older patients resumed their ED visits earlier that the general population as indicated by the surge in their number. Additionally, in the patient group of triage 1& 2, which represents a true emergency, the number did not show a drastic change.
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Affiliation(s)
- Hao-Ming Chang
- Department of Emergency Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Chih-Chen Chang
- Department of Emergency Medicine, Taoyuan Branch, Taipei Veterans General Hospital, Taoyuan, 330, Taiwan
| | - Pei-Ying Lin
- Department of Emergency Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Yi-Chen Lee
- Department of Emergency Medicine, Taoyuan Branch, Taipei Veterans General Hospital, Taoyuan, 330, Taiwan
| | - Hsien-Hao Huang
- Department of Emergency Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan.
- Department of Emergency Medicine, Taoyuan Branch, Taipei Veterans General Hospital, Taoyuan, 330, Taiwan.
- Institute of Emergency and Critical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan.
| | - David Hung-Tsang Yen
- Department of Emergency Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan.
- Department of Emergency Medicine, Taoyuan Branch, Taipei Veterans General Hospital, Taoyuan, 330, Taiwan.
- Institute of Emergency and Critical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan.
- Chang Bing Show-Chwan Memorial Hospital, Changhua, 505, Taiwan.
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, 300, Taiwan.
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Goodman KL, Kamke K, Mullin TM. Online Help-Seeking Among Youth Victims of Sexual Violence Before and During COVID-19 (2016-2021): Analysis of Hotline Use Trends. JMIR Public Health Surveill 2023; 9:e44760. [PMID: 37566446 PMCID: PMC10457693 DOI: 10.2196/44760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/22/2023] [Accepted: 06/16/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Three years since the onset of COVID-19, pandemic-related trends in child sexual abuse (CSA) remain poorly understood. Common administrative surveillance metrics may have underestimated abuse during the pandemic, given youths' limited access to mandatory reporters. Research using anonymous service-use data showed increased violence-related online help-seeking but overlooked youth-specific help-seeking for CSA during COVID-19. Understanding pandemic-related trends in CSA can inform abuse detection practices and mental health service provision for youth victims. OBJECTIVE The purpose of this study was to harness anonymous help-seeking data from the National Sexual Assault Online Hotline (NSAOH) to glean insights about CSA occurrence in the United States during the COVID-19 pandemic. METHODS We used an archival sample of victims who contacted NSAOH from 2016 to 2021 (n=41,561). We examined differences in the proportion of youth and adult victims contacting NSAOH during the first COVID-19 year (March 2020 to February 2021) compared to the prior year (March 2019 to February 2020; n=11,719). Further, we compared key characteristics of hotline interactions among youth victims during the first COVID-19 year to the prior year (n=5913). Using joinpoint regression analysis, we examined linear trends in the number of monthly sampled youth and adult victims (excluding victims of unknown age) from 2016 to 2021 who discussed any victimization event (n=26,904) and who discussed recent events (ie, events occurring during the pandemic; n=9932). RESULTS Most youth victims were abused by family members prior to (1013/1677, 60.4%) and after (2658/3661, 72.6%) the onset of COVID-19. The number of youth victims contacting NSAOH spiked in March 2020 and peaked in November 2020 for all youth (slope=28.2, 95% CI 18.7-37.7) and those discussing recent events (slope=17.4, 95% CI 11.1-23.6). We observed a decline in youth victims into spring 2021 for all youth (slope=-56.9, 95% CI -91.4 to -22.3) and those discussing recent events (slope=-33.7, 95% 47.3 to -20.0). The number of adult victims discussing any victimization event increased steadily from January 2018 through May 2021 (slope=3.6; 95% CI 2.9-4.2) and then declined (slope=-13.8, 95% CI -22.8 to -4.7). Trends were stable for adults discussing recent events. CONCLUSIONS This study extends the use of hotline data to understand the implications of the pandemic on CSA. We observed increased youth help-seeking through the NSAOH coinciding with the onset of COVID-19. Trends persisted when limiting analyses to recent victimization events, suggesting increased help-seeking reflected increased CSA during COVID-19. These findings underscore the utility of anonymous online services for youth currently experiencing abuse. Further, the findings support calls for increased youth mental health services and efforts to incorporate online chat into youth-targeted services.
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Affiliation(s)
| | - Kristyn Kamke
- Rape, Abuse, and Incest National Network, Washington, DC, United States
| | - Tara M Mullin
- Rape, Abuse, and Incest National Network, Washington, DC, United States
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Nocci M, Villa G, Ragazzoni L, Tofani L, Romagnoli S, Baldini G, Bertini P, Hubloue I, Scolletta S, Mechi MT, Della Corte F. Relationship between intensive care surge capacity and hospital factors: an extensive experience. Intern Emerg Med 2023; 18:1521-1532. [PMID: 36859647 PMCID: PMC9977086 DOI: 10.1007/s11739-023-03233-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023]
Abstract
As a prolonged surge scenario, the COVID-19 pandemic has offered an unparalleled opportunity to improve hospital surge capacity (SC) understanding and the ability to manage it. In this study, the authors report the experience of a large hospital network and evaluate potential relationships between Intensive Care Units SC (ICU-SC) and some hospital-related variables: bed occupancy, emergency department admissions, ward admission from ED, and elective surgery procedures. Pearson's partial correlation coefficient (r) has been used to define the relationship between SC and the daily values of the above variables, collected through a dedicated digital platform that also ensured a regular quality check of the data. The observation has concerned several levels of analysis, namely two different types of SC calculation (SC base-SCb and SC actual-SCa), hospital category level and multi-hospital level, and two consecutive pandemic waves. Among the 16 hospitals observed, the correlation was shown to be moderate-positive with non-ICU bed occupancy (r/ = 0.62, r/ = 0.54), strong/moderate with ICU bed occupancy (r/ = 0.72, r/ = 0.54), and moderate with ward admissions from ED (r/ = 0.50, r/ = 0.51) On the contrary, the correlation proved to be moderate-negative with ED admissions (r/ = - 0.69, r/ = - 0.62) and low with the number of elective surgery procedures (r/ = - 0.10, r/ = - 0.16). This study identified a positive correlation between SC and three variables monitored: ICU bed occupancy, non-ICU bed occupancy, and ward admissions from ED. On the contrary, the correlation was negative for ED admission and the number of elective surgery procedures. The results have been confirmed across all levels of analysis adopted.
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Affiliation(s)
- Matteo Nocci
- Section of Anesthesia and Critical Care, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi-Università di Firenze, 50134, Florence, Italy.
- International Joint PhD in Global Health, Humanitarian Aid and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy.
- Vrije Universiteit Brussel-VUB, Brussels, Belgium.
| | - Gianluca Villa
- Section of Anesthesia and Critical Care, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi-Università di Firenze, 50134, Florence, Italy
| | - Luca Ragazzoni
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Lorenzo Tofani
- Department of Statistics, Informatics, Applications, Università Di Firenze, Florence, Italy
| | - Stefano Romagnoli
- Section of Anesthesia and Critical Care, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi-Università di Firenze, 50134, Florence, Italy
| | - Gabriele Baldini
- Section of Anesthesia and Critical Care, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi-Università di Firenze, 50134, Florence, Italy
| | - Pietro Bertini
- Cardiothoracic and Vascular Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Ives Hubloue
- Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussels, Brussels, Belgium
| | - Sabino Scolletta
- Unit of Anesthesia and Intensive Care Unit, Department of Emergency, Urgency and Transplantation, University Hospital of Siena, Siena, Italy
| | - Maria Teresa Mechi
- Hospital Health Direction, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesco Della Corte
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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Stevens MA, Melnick ER, Savitz ST, Jeffery MM, Nath B, Janke AT. National trends in emergency conditions through the Omicron COVID-19 wave in commercial and Medicare Advantage enrollees. J Am Coll Emerg Physicians Open 2023; 4:e13023. [PMID: 37576118 PMCID: PMC10423035 DOI: 10.1002/emp2.13023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/11/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Objective To evaluate trends in emergency care sensitive conditions (ECSCs) from pre-COVID (March 2018-February 2020) through Omicron (December 2021-February 2022). Methods This cross-sectional analysis evaluated trends in ECSCs using claims (OptumLabs Data Warehouse) from commercial and Medicare Advantage enrollees. Emergency department (ED) visits for ECSCs (acute appendicitis, aortic aneurysm/dissection, cardiac arrest/severe arrhythmia, cerebral infarction, myocardial infarction, pulmonary embolism, opioid overdose, pre-eclampsia) were reported per 100,000 person months from March 2018 to February 2022 by pandemic wave. We calculated the percent change for each pandemic wave compared to the pre-pandemic period. Results There were 10,268,554 ED visits (March 2018-February 2022). The greatest increases in ECSCs were seen for pulmonary embolism, cardiac arrest/severe arrhythmia, myocardial infarction, and pre-eclampsia. For commercial enrollees, pulmonary embolism visit rates increased 22.7% (95% confidence interval [CI], 18.6%-26.9%) during Waves 2-3, 37.2% (95% CI, 29.1%-45.8%] during Delta, and 27.9% (95% CI, 20.3%-36.1%) during Omicron, relative to pre-pandemic rates. Cardiac arrest/severe arrhythmia visit rates increased 4.0% (95% CI, 0.2%-8.0%) during Waves 2-3; myocardial infarction rates increased 4.9% (95% CI, 2.1%-7.8%) during Waves 2-3. Similar patterns were seen in Medicare Advantage enrollees. Pre-eclampsia visit rates among reproductive-age female enrollees increased 31.1% (95% CI, 20.9%-42.2%), 23.7% (95% CI, 7.5%,-42.3%), and 34.7% (95% CI, 16.8%-55.2%) during Waves 2-3, Delta, and Omicron, respectively. ED visits for other ECSCs declined or exhibited smaller increases. Conclusions ED visit rates for acute cardiovascular conditions, pulmonary embolism and pre-eclampsia increased despite declines or stable rates for all-cause ED visits and ED visits for other conditions. Given the changing landscape of ECSCs, studies should identify drivers for these changes and interventions to mitigate them.
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Affiliation(s)
- Maria A Stevens
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester Minnesota USA
- Division of Health Care Delivery Research Mayo Clinic Rochester Minnesota USA
- Department of Health Policy and Management University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
- OptumLabs Eden Prairie Minnesota USA
| | - Edward R Melnick
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- Department of Biostatistics (Health Informatics) Yale School of Public Health New Haven USA
| | - Samuel T Savitz
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester Minnesota USA
- Division of Health Care Delivery Research Mayo Clinic Rochester Minnesota USA
| | - Molly Moore Jeffery
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester Minnesota USA
- Division of Health Care Delivery Research Mayo Clinic Rochester Minnesota USA
- Department of Emergency Medicine Mayo Clinic Rochester USA
| | - Bidisha Nath
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
| | - Alexander T Janke
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- Institute for Healthcare Policy and Innovation University of Michigan/VA Ann Arbor Ann Arbor Michigan USA
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Arafa M, El Ansari W, Qasem F, Al Ansari A, Al Dosari MAA, Mukhtar K, Alhabash MA, Awad K, Al Rumaihi K. Reinventing Patient Support and Continuity of Care Using Innovative Physician-staffed Hotline: More than 60,000 Patients Served Across 15 Medical and Surgical Specialties During the First Wave of COVID-19 Lockdown in Qatar. J Med Syst 2023; 47:77. [PMID: 37466754 PMCID: PMC10356882 DOI: 10.1007/s10916-023-01973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
Rising disease prevalence early during the COVID-19 pandemic in the State of Qatar led to stoppage of all non-emergency health care services. To maintain continuity of care and information exchanges for non-emergency patients, a physician-operated telephone hotline was set up that involved triage followed by immediate consultation with a specialized physician. We describe the initiation and evaluate the operations of the Urgent Consultation Centre (UCC) hotline manned by 150 physicians and aimed at urgent non-life-threatening consultations at Hamad Medical Corporation, the public health provider in Qatar. UCC established a hotline to triage inbound patient calls related to 15 medical and surgical specialties. For calls between April-August 2020, we describe call volume, distribution by specialty, outcomes, performance of UCC team, as well as demographics of callers. During the study period, UCC received 60229 calls (average 394 calls/day) from Qatari nationals (38%) and expatriates (62%). Maximum total daily calls peaked at 1670 calls on June 14, 2020. Call volumes were the highest from 9 AM to 2 PM. Response rate varied from 89% to 100%. After an initial telephone triage, calls were most often related to and thus directed to internal medicine (24.61%) and geriatrics (11.97%), while the least percentage of calls were for pain management and oncology/hematology (around 2% for each). By outcome of consultation, repeat prescriptions were provided for 60% of calls, new prescriptions (15%), while referrals were to outpatient department (17%), emergency department/pediatric emergency center (5%), and primary health care centres (3%). We conclude that during a pandemic, physician-staffed telephone hotline is feasible and can be employed in innovative ways to conserve medical resources, maintain continuity of care, and serve patients requiring urgent care.
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Affiliation(s)
- Mohamed Arafa
- Urology Department, Hamad Medical Corporation, Doha, Qatar
- Andrology Department, Cairo University, Cairo, Egypt
- Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Walid El Ansari
- Weill Cornell Medicine - Qatar, Doha, Qatar.
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.
- College of Medicine, Qatar University, Doha, Qatar.
| | - Fadi Qasem
- Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdulla Al Ansari
- Urology Department, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine - Qatar, Doha, Qatar
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Khalid Mukhtar
- Department of Orthopedics, Hamad Medical Corporation, Doha, Qatar
| | | | - Khalid Awad
- Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Al Rumaihi
- Urology Department, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine - Qatar, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
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50
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Hegenberg K, Althammer A, Gehring C, Prueckner S, Trentzsch H. Pre-Hospital Emergency Medical Services Utilization Amid COVID-19 in 2020: Descriptive Study Based on Routinely Collected Dispatch Data in Bavaria, Germany. Healthcare (Basel) 2023; 11:1983. [PMID: 37510425 PMCID: PMC10379196 DOI: 10.3390/healthcare11141983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND AND IMPORTANCE The COVID-19 pandemic affected the utilization of health care services and posed organizational challenges. While many previous studies focused on the misuse of pre-hospital EMS for low-urgency health problems, the pandemic has put more emphasis on the avoidance of medically necessary calls. OBJECTIVE To compare the utilization of pre-hospital emergency medical services before and after specific pandemic periods. DESIGN, SETTING AND PARTICIPANTS This was a retrospective, descriptive analysis of routine data from 26 dispatch centers in Bavaria, Germany. OUTCOMES MEASURE AND ANALYSIS We investigated the number of emergencies per 100,000 population, as well as the relative change in the emergency rates and transport rates in 2020, compared to the two previous years. Boxplots showed the distributions across the Bavarian districts per calendar week. The mean rates and standard deviations as well as the relative changes were presented for the specific periods. A paired samples t-test was used to compare the rates. MAIN RESULTS Compared to the average of the two previous years, the emergency rates in 2020 were lower in 35 out of 52 calendar weeks. The strongest reductions were observed during the first wave, where the average emergency rate declined by 12.9% (SD 6.8, p < 0.001). There was no statistically significant difference in the overall emergency rate during the summer holidays. Lower transport rates were observed throughout the year, especially during the first wave. CONCLUSIONS Utilization of pre-hospital emergency medical services decreased in 2020, especially during the periods with strict measures. This could be due to the lower morbidity from the behavioral changes during the pandemic, but also to the avoidance of medical services for both less urgent and severe conditions. While a reduction in unnecessary care would be beneficial, patients must be encouraged to seek necessary urgent care, even during a pandemic.
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Affiliation(s)
- Kathrin Hegenberg
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
| | - Alexander Althammer
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
| | - Christian Gehring
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
| | - Stephan Prueckner
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
| | - Heiko Trentzsch
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
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