COVID-19 surges and hospital outcomes in the United States.

ABSTRACT

OBJECTIVES: To examine the impact of COVID-19 surges on hospital outcomes, particularly among non-COVID-19 patients. STUDY DESIGN: An interrupted time series design. METHODS: Using data from a large insurance claims clearinghouse, the study estimates the impact of the onset of the pandemic and the share of hospital COVID-19 patients on the likelihood of (1) in-hospital death, (2) in-hospital death or discharge to hospice, (3) discharge to other hospitals, (4) discharge to skilled nursing facilities (SNFs), and (5) discharge to home care. RESULTS: The odds of in-hospital death were about 1.7 times that before the onset of the pandemic among all patients and 1.2 times that among non-COVID-19 patients. Increased share of COVID-19 patients was associated with higher odds of in-hospital death among all patients and non-COVID-19 patients. The effects were more pronounced among patients 45 years and older and those with septicemia or pneumonia, and they were also stronger during the months in which COVID-19 cases surged. Although no sizable changes were found in the odds of discharge to other hospitals or SNFs, transfers to home care grew during the pandemic. CONCLUSIONS: The negative impact of the pandemic on mortality among non-COVID-19 patients confirms existing concerns about patient care. No evidence suggests large-scale changes in practices regarding discharge/transfer to other facilities. The findings shed light on future efforts to monitor and improve inpatient care as the pandemic evolves.