Newly available data shows that the rise in the number of COVID-19 cases in the fall of 2020 was accompanied by a decline in non-COVID-19 hospital admissions during that time period. Our analysis includes medical records data of hospital admissions through December 5, 2020 from the Epic Health Research Network and updates an earlier paper that analyzed hospital admissions data through August 8, 2020. These new data provide additional information to help assess the economic impact of the COVID-19 pandemic on hospitals and insurers and also adds to our understanding of the extent to which people are continuing to delay or forgo care nearly one year into the pandemic.
During the initial wave of the Covid-19 pandemic, hospitals worldwide diverted resources from routine inpatient critical care and outpatient clinics to meet the surge in demand. Because of the resulting resource constraints and fear of infection, clinicians and non-Covid patients deferred “non-urgent” visits, evaluations, diagnostics, surgeries and therapeutics. Indeed, early in the pandemic physicians and leading public health officials noted a dramatic decline in non-Covid-related health emergencies, including upwards of a 60% decrease in patients with acute myocardial infarctions and strokes.
While these postponements may have reduced the amount of unnecessary services used, they likely also caused a perilous deferral of needed services, which many believe will lead to later hospitalizations requiring higher levels of care, longer lengths of stay, and increased hospital readmissions, thereby further straining hospitals’ inpatient capacity. It is critical that we not only focus on the acute care of Covid-19 patients, but that we also proactively manage patients without Covid-19, particularly those with time-sensitive and medically complex conditions who are postponing their care. This is important not only to sustain health and life, but to preserve future hospital capacity.
We analyze trends in total hospital admissions and then separately analyze non-COVID-19 admissions both overall and by patient region, age, and sex. We calculate actual admissions as a share of total predicted admissions in 2020 based on trends from past years. Key findings include:
• Total hospital admissions dropped to 69.2% of predicted admissions during the week ending April 4, 2020—the lowest point in the year—before rising again and staying at or above 90% since June 2020. As of the week ending December 5, 2020, total admissions were at 94.2% of what was predicted.
• The decrease in hospital admissions from March 8 to December 5, 2020 represent 8.5% of the total expected admissions for all of 2020.
• In November 2020, as COVID-19 cases surged, non-COVID-19 hospitalizations started to decline again and were about 80% of predicted hospitalizations by the end of the month. This suggests that people may once again be delaying or forgoing care due to the pandemic, in some cases likely due to hospital capacity constraints.
• Based on our data through the beginning of December, the more recent decline in non-COVID-19 admissions has been steepest in the Midwest and West. In both of those regions, non-COVID-19 admissions were at roughly 76% of predicted levels at the end of November, as COVID-19 cases were surging in many parts of those regions.
This new analysis is based on electronic medical record (EMR) data from Epic Health Research Network (EHRN) and includes all inpatient hospital admission volume from Dec 31, 2017 to December 5, 2020, involving patients who either were discharged or died as of January 13, 2021. Data are aggregated weekly and pooled from 34 health care organizations in the United States, representing 97 hospitals that span 26 states and cover 20 million patients. These states represent 73.0% of COVID-19 cases as of January 21, 2021 and also represent 76.7% of the U.S. population.1 Predicted volume was calculated using historical data from Dec 31, 2017 to Jan 25, 2020.2 COVID-19 admissions were identified as admissions with either a documented COVID-19 diagnosis (U07.01) or other respiratory diagnosis involving a patient who either had tested positive or presumptive positive for COVID-19 or received a COVID-19 diagnosis within 14 days of the admission.
This updated analysis from the Epic Health Research Network provides additional insights into patterns of hospital admissions during the COVID-19 pandemic—and the impact that trends in COVID-19 cases has on non-COVID-19 admissions. By looking at the patterns in non-COVID-19 admissions, we can see how changes in behavior had a differential impact by region, age, and sex. The levels of non-COVID-19 admissions seen in the fall of 2020 suggest that people may be delaying care in ways that could be harmful to their long-term health. The impact of that forgone care will be an important subject of future analysis.
Team Redan Notes:
During the rise in COVID-19 hospitalization and the lack of resources for non-COVID-19 patients, the trends that Team Redan has witnessed among its patients highlights a few points:
1. Many smaller, non-essential procedures get rescheduled and postponed several times until if an opening would be available, yet not guaranteed.
2. Other more essential, yet simple, procedures would be done in extended areas of hospitals, perhaps in outdoor area, usually with same-day discharge.
3. Outpatient programs are being extended largely to accommodate an extensive population of less critical patients, normally to be treated as inpatient.
4. Patients are being discharged following a shorter recovery period post-surgery or rehabilitation.
5. In most of the situations, they mandate having licensed caregiving services in place as part of the discharge routine, where occasionally they would allow discharge without the presence of the caregiver in the hospital, accompanying the patient home.
Please let us know if you are planning to go through a surgical procedures, and we could plan ahead for putting caregiving service in place for you. Call us at 949.666.2233 Ext. 1 or email us at caring@redanmedical.com .
This content is extracted from KFF and Harvard Business Review, and edited for style and length. Readers are advised to use their discretion and consult with their care physician for medical advice.
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