ABSTRACT
Background: The COVID-19 pandemic forced policy makers to find solutions to protect hospitals from revenue shortfalls and provide high quality of care for COVID-19 and other patients. In Thailand, hospitals have adjusted the hospital services arrangement to new normal hospital services to prevent the spread of coronavirus while maintaining essential hospital services for non-COVID-19 patients. Objective(s): To describe the COVID-19 patient flow and estimate the costs of the new normal hospital services implemented in six public hospitals across Thailand. Material(s) and Method(s): The authors conducted a cross-sectional study to describe the COVID-19 patient flow in each participating hospital between January and November 2020, representing the first wave of the COVID-19 outbreak in Thailand. Data were collected from hospital staff interviews, hospital historical budget review, and hospital databases. The hospital costs of the new normal hospital services were estimated using an activity-based costing approach from the provider's perspective. Result(s): The COVID-19 patients could access the new normal hospital services through three channels including 1) walk-in, 2) transfer from other hospitals, and 3) active surveillance from communities. The ratio of costs of the new normal hospital services during the COVID-19 outbreak and the normal situation were one to two times and one to five times for patients with mild infection admitted to secondary and tertiary care hospitals, respectively, but one to three times for those with moderate-to-severe infection admitted to tertiary care hospitals. Conclusion(s): The COVID-19 pandemic imposed additional costs to Thai hospitals. The magnitude of the incremental costs depended on COVID-19 severity and hospital level. Copyright © 2022 Medical Association of Thailand. All rights reserved.
ABSTRACT
Background: The coronavirus (COVID-19) pandemic has resulted in an abrupt transition to virtual oncology care at most cancer centres worldwide. A pillar of the American Medical Association's proposed framework for digitally enabled care is assessing clinical quality, safety, and outcomes. This study's objective is to evaluate chemotherapy quality and clinical outcomes in patients receiving intravenous chemotherapy for colorectal cancer before and during the COVID-19 pandemic. Methods: This is an observational study assessing patients treated with intravenous chemotherapy for colorectal cancer consecutively at the Ottawa Hospital Cancer Centre from June 2019 to September 2021. Patients with non-metastatic rectal cancer were excluded. Patient were stratified by whether they were started on chemotherapy pre-pandemic (June 2019 - Jan 2020) versus intra-pandemic (Feb 2020 - Sept 2021). Baseline characteristics and treatment data were collected from the electronic medical records. Outcomes of interest included chemotherapy delays, dose reductions, emergency department (ED) visits and hospitalizations. We used generalized linear and binary logistic regression modelling to compare outcomes between pre- and intra-pandemic periods. Results: There were 220 patients included in this study with 108 (49%) diagnosed with metastatic disease. In total, there were 66 (30%) patients treated in the pre-pandemic and 154 (70%) in the intra-pandemic period. As expected, virtual care consultations increased during the pandemic from 1.5% to 43.5% (p < 0.001). Likewise, the proportion of follow-up visits also increased from 37% to 84% (p < 0.001). There was no difference in the incidence of treatment delays (odds ratio [OR] = 1.01, p = 0.78), dose reductions (OR = 0.99, p = 0.69), ED visits (OR = 1.23, p = 0.37), hospitalizations (OR = 0.73, p = 0.43) or the total length of time off treatment (OR = 0.85, p = 0.17) between the pre- and intra-pandemic periods by multivariable analysis. A subgroup analysis was performed based on stage, which showed no difference in outcomes independent of the presence of metastases. Conclusions: This study demonstrates no significant difference in chemotherapy interruptions, dose intensity, or clinical outcomes in patients treated for colorectal cancer during the COVID-19 pandemic. These findings serve as an important quality-care indictor and demonstrate that virtual oncology care appears safe in a cohort of high-risk colorectal cancer patients. Future work dedicated to other tumor sites would allow for broader application of these findings.