Utilization of in- and outpatient hospital care in Germany during the Covid-19 pandemic insights from the German-wide Helios hospital network

Abstract

Background During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting. Methods and findings Using claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the “protection” stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06–1.15], P<0.01) and in oncology cases (4.5 vs. 4.3%, OR 1.06 [95% CI 1.01–1.11], P<0.01), it was similar in surgical (0.9 vs. 0.8%, OR 1.06 [95% CI 1.00–1.13], P = 0.07) and in psychiatry cases (0.4 vs. 0.5%, OR 1.01 [95% CI 0.78–1.31], P<0.95). Conclusions There have been varying changes in care pathways and in-hospital mortality in different disciplines during the Covid-19 pandemic in Germany. Despite all the inherent and well-known limitations of claims data use, this data may be used for health care surveillance as the pandemic continues worldwide. While this study provides an up-to-date analysis of utilization of hospital care in the largest German hospital network, short- and long-term consequences are unknown and deserve further studies.

Access to Mental Health Care during the First Wave of the COVID-19 Pandemic in Italy: Results from the COMET Multicentric Study

“…During the first weeks of the pandemic, a significant reduction in accessing emergency rooms [ 30 , 31 , 32 ] and in psychiatric hospitalization rates [ 31 , 33 ] was documented in both the United States and European countries, including Italy. Moreover, a mean decrease of 37% in overall access to healthcare has been reported worldwide, both in outpatient visits and inpatient admissions to different healthcare services [ 34 , 35 ].…”

Impact of COVID-19 on Head and Neck Cancer Advancement Measured by the Increasing Numbers of Acute Dyspnea Cases. What Can be Improved for the Future?

“…The coronavirus pandemic, and the subsequent need for disease transmission mitigation efforts, signi cantly altered the delivery of cancer care [1,2]. In developed countries, the use of inpatient care and subsequent hospitalization de cit in oncology was estimated to be 7%-35% [19][20][21][22]. All oncological subspecialties in the US experienced signi cant decreases in new patient visits and surgery capacity during COVID-19 [23], with a 25% reduction in newly diagnosed head and neck malignancies [24].…”

Impact of COVID-19 on head and neck cancer advancement measured by the increasing numbers of acute dyspnea cases. What can be improved for the future?

“…The coronavirus pandemic, and the subsequent need for disease transmission mitigation efforts, signi cantly altered the delivery of cancer care [1,2]. In developed countries, the use of inpatient care and subsequent hospitalization de cit in oncology was estimated to be 7%-35% [19][20][21][22]. All oncological subspecialties in the US experienced signi cant decreases in new patient visits and surgery capacity during COVID-19 [23], with a 25% reduction in newly diagnosed head and neck malignancies [24].…”