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

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.

Decreased Incidence of Oncology Admissions in 75 Helios Hospitals in Germany during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic lead to a massive shutdown of social life in Germany starting in March 2020. Elective medical treatment was substantially reduced but urgent diagnostics and treatment including cancer care should not have been affected. MATERIALS AND METHODS: We analyzed the number of oncology admissions to 75 German Helios hospitals during 2 time periods in 2020 and compared the data with the respective periods in 2019. The study included nearly 69,000 admissions in total. RESULTS: A highly significant reduction in overall cancer admissions was seen for the early lockdown period from 13 March to 28 April 2020 compared to the same period in 2019. After an official communication advising the health system to return to normal practice on 29 April 2020, we again found a highly significant difference in admissions compared to the respective time in the previous year. Subgroup analysis shows a significant impact of age >75 years, high hospital volume, and intermediate or high COVID-19 case volume in the federal states. Gender had no impact on admission numbers. The effects and significance levels were comparable in nearly all different diagnostic subgroups according to the ICD codes. CONCLUSIONS: For cancer diagnosis and treatment, we found a statistically significant decrease in hospital admissions in the range of 10-20% for both study periods in comparison to the previous year.