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Care Disruption During COVID-19: a National Survey of Hospital Leaders.
Huggins, Ashley; Husaini, Mustafa; Wang, Fengxian; Waken, R J; Epstein, Arnold M; Orav, E John; Joynt Maddox, Karen E.
  • Huggins A; Washington University School of Medicine, St. Louis, MO, USA.
  • Husaini M; Cardiology Division, Department of Medicine, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.
  • Wang F; Cardiology Division, Department of Medicine, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.
  • Waken RJ; Cardiology Division, Department of Medicine, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.
  • Epstein AM; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Orav EJ; Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
  • Joynt Maddox KE; Cardiology Division, Department of Medicine, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA. kjoyntmaddox@wustl.edu.
J Gen Intern Med ; 38(5): 1232-1238, 2023 04.
Article in English | MEDLINE | ID: covidwho-2296728
ABSTRACT

BACKGROUND:

The COVID-19 pandemic caused massive disruption in usual care delivery patterns in hospitals across the USA, and highlighted long-standing inequities in health care delivery and outcomes. Its effect on hospital operations, and whether the magnitude of the effect differed for hospitals serving historically marginalized populations, is unknown.

OBJECTIVE:

To investigate the perspectives of hospital leaders on the effects of COVID-19 on their facilities' operations and patient outcomes.

METHODS:

A survey was administered via print and electronic means to hospital leaders at 588 randomly sampled acute-care hospitals participating in Medicare's Inpatient Prospective Payment System, fielded from November 2020 to June 2021. Summary statistics were tabulated, and responses were adjusted for sampling strategy and non-response.

RESULTS:

There were 203 responses to the survey (41.6%), with 20.7% of respondents representing safety-net hospitals and 19.7% representing high-minority hospitals. Over three-quarters of hospitals reported COVID testing shortages, about two-thirds reported staffing shortages, and 78.8% repurposed hospital spaces to intensive care units, with a slightly higher proportion of high-minority hospitals reporting these effects. About half of respondents felt that non-COVID inpatients received worsened quality or outcomes during peak COVID surges, and almost two-thirds reported worsened quality or outcomes for outpatient non-COVID patients as well, with few differences by hospital safety-net or minority status. Over 80% of hospitals participated in alternative payment models prior to COVID, and a third of these reported decreasing these efforts due to the pandemic, with no differences between safety-net and high-minority hospitals.

CONCLUSIONS:

COVID-19 significantly disrupted the operations of hospitals across the USA, with hospitals serving patients in poverty and racial and ethnic minorities reporting relatively similar care disruption as non-safety-net and lower-minority hospitals.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Testing / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Humans Country/Region as subject: North America Language: English Journal: J Gen Intern Med Journal subject: Internal Medicine Year: 2023 Document Type: Article Affiliation country: S11606-022-08002-5

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Testing / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Humans Country/Region as subject: North America Language: English Journal: J Gen Intern Med Journal subject: Internal Medicine Year: 2023 Document Type: Article Affiliation country: S11606-022-08002-5