Trends in Hospitalizations for Ambulatory Care-Sensitive Conditions During the COVID-19 Pandemic.
JAMA Netw Open
; 5(3): e222933, 2022 03 01.
Article
in English
| MEDLINE | ID: covidwho-1748800
ABSTRACT
Importance The association of the COVID-19 pandemic with the quality of ambulatory care is unknown. Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are a well-studied measure of the quality of ambulatory care; however, they may also be associated with other patient-level and system-level factors. Objective:
To describe trends in hospital admissions for ACSCs in the prepandemic period (March 2019 to February 2020) compared with the pandemic period (March 2020 to February 2021). Design, Setting, andParticipants:
This cross-sectional study of adults enrolled in a commercial health maintenance organization in Michigan included 1â¯240â¯409 unique adults (13â¯011â¯176 person-months) in the prepandemic period and 1â¯206â¯361 unique adults (12â¯759â¯675 person-months) in the pandemic period. Exposure COVID-19 pandemic (March 2020 to February 2021). Main Outcomes andMeasures:
Adjusted relative risk (aRR) of ACSC hospitalizations and intensive care unit stays for ACSC hospitalizations and adjusted incidence rate ratio of the length of stay of ACSC hospitalizations in the prepandemic (March 2019 to February 2020) vs pandemic (March 2020 to February 2021) periods, adjusted for patient age, sex, calendar month of admission, and county of residence.Results:
The study population included 1â¯240â¯409 unique adults (13â¯011â¯176 person-months) in the prepandemic period and 1â¯206â¯361 unique adults (12â¯759â¯675 person-months) in the pandemic period, in which 51.3% of person-months (n = 6â¯547â¯231) were for female patients, with a relatively even age distribution between the ages of 24 and 64 years. The relative risk of having any ACSC hospitalization in the pandemic period compared with the prepandemic period was 0.72 (95% CI, 0.69-0.76; P < .001). This decrease in risk was slightly larger in magnitude than the overall reduction in non-ACSC, non-COVID-19 hospitalization rates (aRR, 0.82; 95% CI, 0.81-0.83; P < .001). Large reductions were found in the relative risk of respiratory-related ACSC hospitalizations (aRR, 0.54; 95% CI, 0.50-0.58; P < .001), with non-statistically significant reductions in diabetes-related ACSCs (aRR, 0.91; 95% CI, 0.83-1.00; P = .05) and a statistically significant reduction in all other ACSC hospitalizations (aRR, 0.79; 95% CI, 0.74-0.85; P < .001). Among ACSC hospitalizations, no change was found in the percentage that included an intensive care unit stay (aRR, 0.99; 95% CI, 0.94-1.04; P = .64), and no change was found in the length of stay (adjusted incidence rate ratio, 1.02; 95% CI, 0.98-1.06; P = .33). Conclusions and Relevance In this cross-sectional study of adults enrolled in a large commercial health maintenance organization plan, the COVID-19 pandemic was associated with reductions in both non-ACSC and ACSC hospitalizations, with particularly large reductions seen in respiratory-related ACSCs. These reductions were likely due to many patient-level and health system-level factors associated with hospitalization rates. Further research into the causes and long-term outcomes associated with these reductions in ACSC admissions is needed to understand how the pandemic has affected the delivery of ambulatory and hospital care in the US.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Critical Care
/
Ambulatory Care
/
COVID-19
/
Hospitalization
Type of study:
Observational study
/
Prognostic study
/
Randomized controlled trials
Limits:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
/
Young adult
Country/Region as subject:
North America
Language:
English
Journal:
JAMA Netw Open
Year:
2022
Document Type:
Article
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