Abstract:The coronavirus disease 2019 (COVID-19) pandemic has triggered the implementation of public health measures globally. The health department of local governments has played a critical role in confronting COVID-19. In Japan, public health centers (PHCs) are focal points for COVID-19 response. Understanding the response to COVID-19 in local areas is critical to ensure adequate preparation for future emergencies. Therefore, the purpose of this study is to clarify how the COVID-19 operations by PHCs in Japan were m… Show more
“…The reason for this restriction was that the Japanese government sought to optimize limited polymerase chain reaction (PCR) testing capacity and to conduct epidemiological surveys . The sheer number of febrile patients made it difficult to connect to a public health center’s telephone lines, and access to PCR testing was further challenged by the limited number of designated clinics and by the stringent criteria for PCR testing eligibility (eg, history of intense contact with confirmed cases of COVID-19, fever and dyspnea, or travel to an endemic area within the past 2 weeks) . Following the government guidelines, many medical institutions turned away febrile patients and instructed them to consult with their public health centers first.…”
Section: Discussionmentioning
confidence: 99%
“…16,26 The sheer number of febrile patients made it difficult to connect to a public health center's telephone lines, and access to PCR testing was further challenged by the limited number of designated clinics and by the stringent criteria for PCR testing eligibility (eg, history of intense contact with confirmed cases of COVID-19, fever and dyspnea, or travel to an endemic area within the past 2 weeks). 16,27,28 Following the government guidelines, many medical institutions turned away febrile patients and instructed them to consult with their public health centers first. In addition, many patients may have been reluctant to seek care in hospitals for fear of contracting COVID-19 infection.…”
Section: Jama Network Open | Health Policymentioning
ImportanceThe COVID-19 pandemic may have played a role in the deterioration of access to medical care for ambulatory care–sensitive conditions (ACSCs).ObjectiveTo ascertain whether the number of in-hospital deaths and in-hospital mortality rate associated with ACSC changed after the declaration of the COVID-19 national state of emergency in Japan.Design, Setting, and ParticipantsThis cohort study used a difference-in-differences design to compare outcomes for ACSC in the period before (January 1, 2015, to December 31, 2019) vs the period after (January 1, 2020, to December 31, 2020) Japan declared a national state of emergency for the COVID-19 pandemic. Analyses used discharge summary data from 242 acute care hospitals across Japan. The sample comprised unscheduled hospitalizations of patients with ACSC during the study period (January 1, 2015, to December 31, 2020). Data analyses were performed between August 16 and December 7, 2022.ExposureThe declaration of the COVID-19 national state of emergency announced by the Japanese government in April 2020 was considered to be an exogenous shock.Main Outcomes and MeasuresPrimary outcomes were the ACSC-associated number of in-hospital deaths, number of hospitalizations, and in-hospital mortality rate.ResultsA total of 28 321 ACSC-related hospitalizations were observed involving 15 318 males (54.1%), with a median (IQR) age of 76 (58-85) years. The number of in-hospital deaths was 2117 (7.5%). The number of hospitalizations decreased overall (incidence rate ratio [IRR], 0.84; 95% CI, 0.75-0.94), for chronic conditions (IRR, 0.84; 95% CI, 0.77-0.92), and for vaccine-preventable conditions (IRR, 0.58; 95% CI, 0.44-0.76). However, in-hospital deaths (IRR, 1.66; 95% CI, 1.15-2.39) and in-hospital deaths within 24 hours of hospital arrival (IRR, 7.27 × 106; 95% CI, 1.83 × 106 to 2.89 × 107) increased for acute conditions. The in-hospital mortality rate increased for acute conditions (IRR, 1.71; 95% CI, 1.16-2.54), and the 24-hour in-hospital mortality rates also increased overall (IRR, 1.87; 95% CI, 1.19-2.96), for acute conditions (IRR, 2.15 × 106; 95% CI, 5.25 × 105 to 8.79 × 106), and for vaccine-preventable conditions (IRR, 4.64; 95% CI, 1.28-16.77).Conclusions and RelevanceThis cohort study found that in Japan, the number of in-hospital deaths increased after the declaration of the COVID-19 national state of emergency in 2020, particularly for acute ACSC and deaths within 24 hours of hospital admission. This finding suggests that access to good-quality primary care and inpatient care for patients with acute ACSC may have been compromised during the pandemic.
“…The reason for this restriction was that the Japanese government sought to optimize limited polymerase chain reaction (PCR) testing capacity and to conduct epidemiological surveys . The sheer number of febrile patients made it difficult to connect to a public health center’s telephone lines, and access to PCR testing was further challenged by the limited number of designated clinics and by the stringent criteria for PCR testing eligibility (eg, history of intense contact with confirmed cases of COVID-19, fever and dyspnea, or travel to an endemic area within the past 2 weeks) . Following the government guidelines, many medical institutions turned away febrile patients and instructed them to consult with their public health centers first.…”
Section: Discussionmentioning
confidence: 99%
“…16,26 The sheer number of febrile patients made it difficult to connect to a public health center's telephone lines, and access to PCR testing was further challenged by the limited number of designated clinics and by the stringent criteria for PCR testing eligibility (eg, history of intense contact with confirmed cases of COVID-19, fever and dyspnea, or travel to an endemic area within the past 2 weeks). 16,27,28 Following the government guidelines, many medical institutions turned away febrile patients and instructed them to consult with their public health centers first. In addition, many patients may have been reluctant to seek care in hospitals for fear of contracting COVID-19 infection.…”
Section: Jama Network Open | Health Policymentioning
ImportanceThe COVID-19 pandemic may have played a role in the deterioration of access to medical care for ambulatory care–sensitive conditions (ACSCs).ObjectiveTo ascertain whether the number of in-hospital deaths and in-hospital mortality rate associated with ACSC changed after the declaration of the COVID-19 national state of emergency in Japan.Design, Setting, and ParticipantsThis cohort study used a difference-in-differences design to compare outcomes for ACSC in the period before (January 1, 2015, to December 31, 2019) vs the period after (January 1, 2020, to December 31, 2020) Japan declared a national state of emergency for the COVID-19 pandemic. Analyses used discharge summary data from 242 acute care hospitals across Japan. The sample comprised unscheduled hospitalizations of patients with ACSC during the study period (January 1, 2015, to December 31, 2020). Data analyses were performed between August 16 and December 7, 2022.ExposureThe declaration of the COVID-19 national state of emergency announced by the Japanese government in April 2020 was considered to be an exogenous shock.Main Outcomes and MeasuresPrimary outcomes were the ACSC-associated number of in-hospital deaths, number of hospitalizations, and in-hospital mortality rate.ResultsA total of 28 321 ACSC-related hospitalizations were observed involving 15 318 males (54.1%), with a median (IQR) age of 76 (58-85) years. The number of in-hospital deaths was 2117 (7.5%). The number of hospitalizations decreased overall (incidence rate ratio [IRR], 0.84; 95% CI, 0.75-0.94), for chronic conditions (IRR, 0.84; 95% CI, 0.77-0.92), and for vaccine-preventable conditions (IRR, 0.58; 95% CI, 0.44-0.76). However, in-hospital deaths (IRR, 1.66; 95% CI, 1.15-2.39) and in-hospital deaths within 24 hours of hospital arrival (IRR, 7.27 × 106; 95% CI, 1.83 × 106 to 2.89 × 107) increased for acute conditions. The in-hospital mortality rate increased for acute conditions (IRR, 1.71; 95% CI, 1.16-2.54), and the 24-hour in-hospital mortality rates also increased overall (IRR, 1.87; 95% CI, 1.19-2.96), for acute conditions (IRR, 2.15 × 106; 95% CI, 5.25 × 105 to 8.79 × 106), and for vaccine-preventable conditions (IRR, 4.64; 95% CI, 1.28-16.77).Conclusions and RelevanceThis cohort study found that in Japan, the number of in-hospital deaths increased after the declaration of the COVID-19 national state of emergency in 2020, particularly for acute ACSC and deaths within 24 hours of hospital admission. This finding suggests that access to good-quality primary care and inpatient care for patients with acute ACSC may have been compromised during the pandemic.
“…Under the jurisdiction of prefectural governments, Public Health Centers have been central to COVID-19 responses, including conducting PCR testing, coordinating the treatment of COVID-19-positive patients, and identifying individuals who have been in close contact with COVID-19 patients through an epidemiological study of each positive case in Japan. 23 , 24 Hospitals and medical laboratories must report positive results to their Public Health Center, which collects and manages data on the total number of daily infections and occupied hospital beds that care for patients. Figure 3 Shifts in stakeholder relationships in the PCR testing system during the exploration and stabilized phases.…”
Background
During the COVID-19 pandemic, there was an increasing need to expand diagnostic testing in hospitals. At Keio University Hospital (KUH), clinical staff were concerned that the demand for PCR testing might exceed the capacity of the Clinical Laboratory. In response, basic researchers at Keio University School of Medicine (KUSM) set out to build a new, collaborative, PCR testing system. To be authorized to perform such diagnostic PCR testing, KUSM registered its core laboratory as an external clinical laboratory (ECL).
Methods
In the pandemic, there was a pressure to build the PCR system quickly. Speed required discussions that developed a shared understanding of the unprecedented, new KUH/KUSM PCR system. To design, construct, and archive the new PCR testing system, we used a systems engineering (SE) approach. This included diagram visualization of functional flows and application of the Unified Architecture Framework (UAF), both of which are often used in system building. We considered daily demand for PCR testing at KUH and KUSM, and daily COVID-19 infections in Japan.
Results
We operated the collaborative PCR testing system from August 2020 to June 2022. Given public health insurance reimbursement policies, KUH focused on individuals with suspicious symptoms, while the ECL at KUSM screened samples from asymptomatic individuals. KUSM performed about half as many tests as KUH. Interviewing KUH staff revealed that diagrams helped promote a better understanding of the KUH/KUSM PCR testing system.
Conclusion
When designing temporary systems that may be repurposed in the future, we suggest using an SE approach with diagrams and UAF perspectives. This approach will enable stakeholders to understand what is being proposed to be built, and facilitate achieving an informed consensus on the proposed system. We suggest that SE approaches should be widely used in projects that involve building and operating complex, collaborative systems, and documenting the process.
“…Even prior to the pandemic, these health centers were instrumental in sustaining local public health [8]. Based on the Community Health Act of 1994, Japan had 469 public health centers in prefectures, ordinance-designated cities, and core cities in 2020 [9]. Responding to infectious disease outbreaks was one of their many responsibilities for public health.…”
Background
In Japan, over 450 public health centers played a central role in the operation of the local public health system in response to the COVID-19 pandemic. This study aimed to identify key issues for improving the system for public health centers for future pandemics.
Methods
We conducted a cross-sectional study using an online questionnaire. The respondents were first line workers in public health centers or local governments during the pandemic. We solicited open-ended responses concerning improvements needed for future pandemics. Issues were identified from these descriptions using morphological analysis and a topic model with KHcoder3.0. The number of topics was estimated using Perplexity as a measure, and Latent Dirichlet Allocation for meaning identification.
Results
We received open-ended responses from 784 (48.6%) of the 1,612 survey respondents, which included 111 physicians, 330 nurses, and 172 administrative staff. Morphological analysis processed these descriptions into 36,632 words. The topic model summarized them into eight issues: 1) establishment of a crisis management system, 2) division of functions among public health centers, prefectures, and medical institutions, 3) clear role distribution in public health center staff, 4) training of specialists, 5) information sharing system (information about infectious diseases and government policies), 6) response to excessive workload (support from other local governments, cooperation within public health centers, and outsourcing), 7) streamlining operations, and 8) balance with regular duties.
Conclusions
This study identified key issues that need to be addressed to prepare Japan’s public health centers for future pandemics. These findings are vital for discussions aimed at strengthening the public health system based on experiences from the COVID-19 pandemic.
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