ABSTRACT
Background: Routine data have shown a stark increase in home mechanical ventilation (HMV) in Germany in recent years. However, the development of HMV in the first year of the COVID-19 pandemic is unknown. Methods: Case numbers of initiations, control examinations, and terminations of invasive and non-invasive HMV in 2017-2020 were analysed. ICD-10 diagnoses of cases with an initiation of invasive HMV in 2017- 2020 were examined (data from the German Federal Statistical Office). Expenses of the statutory health insurances for ambulatory intensive care in 2017-2020 were analysed (data from the German Federal Ministry of Health). Results: Contrary to the trend in recent years, HMV initiations declined by 14.9 % in 2020, from n = 17,958 (2019) to n = 15,279 (2020). This development was due to a 15.9 % decline in initiations of non-invasive HMV. In contrast, initiations of invasive HMV remained stable in 2020, despite regional differences. For invasive and non-invasive HMV, control examinations (-28 % and -24 %, respectively) and ventilation terminations (-45.3 % and -15.1 %, respectively) dropped in 2020. Patients for whom invasive HMV was initiated had numerous comorbidities and care needs. Expenses of statutory health insurances for ambulatory intensive care increased from EUR 1.52 billion (2017) to EUR 2.16 billion (2020;+42.3 %). Conclusions: After an increase in control examinations and terminations of HMV in recent years, we observe a trend reversal in 2020. Additionally, initiations of non-invasive HMV decreased in 2020. Future studies need to explore the association between this development and the COVID-19 pandemic.
ABSTRACT
BACKGROUND: Hospitalized coronavirus disease 2019 (COVID-19) patients have a high morbidity and mortality and are often dependent on intensive care, especially mechanical ventilation. Little is as yet known about COVID-19 patient allocation. OBJECTIVES: Analysis of the structures of German hospital care for COVID-19 patients up to July 2020 in terms of number of beds and previous ventilation experience. DATA AND METHODS: For the analysis of the care structures, only completed COVID-19 cases in which the virus was detected by a PCR test were evaluated. Claims data from the German Local Health Care Funds (Allgemeine Ortskrankenkassen, AOK) were analysed. The sample includes 17,094 COVID-19 cases that were treated in 1082 hospitals. RESULTS: A total of 77% of all hospitals participated in the treatment COVID-19 patients and 48% of all hospitals provided intensive care for these patients. One half of the hospitals that treated COVID-19 cases cared for 88% of all cases. Although this suggests a centralization effect of COVID-19 cases in specific hospitals, the remaining 12% of the cases were distributed among many hospitals with often very small numbers of cases. Furthermore, 23% of the ventilated COVID-19 cases were treated in hospitals with below-average ventilation experience. CONCLUSIONS: In the context of increasing numbers of infections, it is both necessary to improve the allocation of hospitalized, and therefore potentially ventilated, COVID-19 cases by means of clearly defined and centrally controlled pyramid-type concepts and to continue to care for patients without COVID-19. For Germany, a comprehensive pyramid-type concept with a greater concentration in the best-qualified hospitals seems reasonable for the care of these patients with complex diseases.