Multiple studies conducted (referenced below) have found a substantial decrease in the number of non–COVID-19 hospitalizations across a range of diagnoses during the peak COVID-19 period. The decrease was observed for exacerbations of chronic conditions (heart failure, COPD), acute medical events that typically require inpatient management (myocardial infarction, appendicitis), and injuries. Most of these studies relied on diagnostic codes, which have imperfect capture of both COVID-19 and other diagnoses. To summarize the trends observed above, clearly patients with chronic conditions accessed fewer acute care and post discharge services as compared with years prior. Can we safely conclude that some of acute and post acute care services accessed in years prior could have been excess or unnecessary? One of the theory outlined in a study was that due to the COVID pandemic, patients started practicing better infection prevention and practiced social distancing. That could be so, but such practices cannot be the only contributor to improved health outcomes of patients suffering from chronic conditions. This same study outlined that the population suffering from chronic conditions could have also improved in self-management skills and this could have contributed to reduced admissions to acute care. I do not fully agree with this theory due to the fact that its difficult to develop self management skills overnight or even over a few weeks. The theory I agree with is that patients needing care delayed in accessing care. This delay in accessing care contributed to the excess deaths associated with COVID - 19 Pandemic. Number of …
Multiple studies conducted (referenced below) have found a substantial decrease in the number of non–COVID-19 hospitalizations across a range of diagnoses during the peak COVID-19 period.
The decrease was observed for exacerbations of chronic conditions (heart failure, COPD), acute medical events that typically require inpatient management (myocardial infarction, appendicitis), and injuries. Most of these studies relied on diagnostic codes, which have imperfect capture of both COVID-19 and other diagnoses.
To summarize the trends observed above, clearly patients with chronic conditions accessed fewer acute care and post discharge services as compared with years prior. Can we safely conclude that some of acute and post acute care services accessed in years prior could have been excess or unnecessary?
One of the theory outlined in a study was that due to the COVID pandemic, patients started practicing better infection prevention and practiced social distancing. That could be so, but such practices cannot be the only contributor to improved health outcomes of patients suffering from chronic conditions.
This same study outlined that the population suffering from chronic conditions could have also improved in self-management skills and this could have contributed to reduced admissions to acute care. I do not fully agree with this theory due to the fact that its difficult to develop self management skills overnight or even over a few weeks.
The theory I agree with is that patients needing care delayed in accessing care. This delay in accessing care contributed to the excess deaths associated with COVID – 19 Pandemic. Number of deaths due to any cause increased by approximately 122 000 from March 1 to May 30, 2020, which is 28% higher than the reported number of COVID-19 deaths.
Therefore, implications of the decreases in hospitalizations for chronic disease are concerning for the possibility that sick patients are not obtaining necessary hospital care.
Reference:
- Bhambhvani HP, Rodrigues AJ, Yu JS, Carr JB, Hayden Gephart M. Hospital Volumes of 5 Medical Emergencies in the COVID-19 Pandemic in 2 US Medical Centers. JAMA Intern Med. Published online October 26, 2020. doi:10.1001/jamainternmed.2020.3982
- Blecker S, Jones SA, Petrilli CM, et al. Hospitalizations for Chronic Disease and Acute Conditions in the Time of COVID-19. JAMA Intern Med. Published online October 26, 2020. doi:10.1001/jamainternmed.2020.3978
- Weinberger DM, Chen J, Cohen T, et al. Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020. JAMA Intern Med. 2020;180(10):1336–1344. doi:10.1001/jamainternmed.2020.3391
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