医院类型与 COVID-19 案件压力期间复原力之间的关系:一项回顾性队列研究。

IF 19.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Maniraj Neupane,Sarah Warner,Alex Mancera,Junfeng Sun,Christina Yek,Sadia H Sarzynski,Roxana Amirahmadi,Mary Richert,Emad Chishti,Morgan Walker,Bruce J Swihart,Steven H Mitchell,John Hick,Bram Rochwerg,Eddy Fan,Cumhur Y Demirkale,Sameer S Kadri
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Understanding which hospital types were more resilient to pandemic overcrowding-related excess deaths may prioritize patient safety during future crises.\r\n\r\nOBJECTIVE\r\nTo determine whether hospital type classified by capabilities and resources (that is, extracorporeal membrane oxygenation [ECMO] capability, multiplicity of intensive care unit [ICU] types, and large or small hospital) influenced COVID-19 volume-outcome relationships during Delta wave surges.\r\n\r\nDESIGN\r\nRetrospective cohort study.\r\n\r\nSETTING\r\n620 U.S. hospitals in the PINC AI Healthcare Database.\r\n\r\nPARTICIPANTS\r\nAdult inpatients with COVID-19 admitted July to November 2021.\r\n\r\nMEASUREMENTS\r\nHospital-months were ranked by previously validated surge index (severity-weighted COVID-19 inpatient caseload relative to hospital bed capacity) percentiles. 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引用次数: 0

摘要

背景在大流行期间,医院的工作量和护理资源之间的不平衡使美国医院不堪重负,而在大流行之后,由于人员持续短缺,这种不平衡依然存在。目的确定按能力和资源划分的医院类型(即体外膜肺氧合[ECMO]能力、重症监护病房[ICU]类型的多样性以及大医院或小医院)是否会影响德尔塔浪涌期间 COVID-19 的数量-结果关系。设计回顾性队列研究.设置PINC人工智能医疗数据库中的620家美国医院.参与者2021年7月至11月收治的COVID-19成人住院患者.测量按照之前验证的激增指数(相对于医院床位容量的严重加权COVID-19住院患者数量)百分位数对医院月份进行排序。采用层次模型评估对数变换的激增指数对院内死亡或出院安宁疗护的边际调整概率的影响。结果在德尔塔波期间记录了 223 380 名 COVID-19 住院患者的 620 家医院中,有 208 家具备 ECMO 功能,216 家为多重症监护病房,36 家为大型(≥200 张床位)单重症监护病房,160 家为小型(<200 张床位)单重症监护病房。总体而言,50 752 名(23%)患者需要入住重症监护室,34 274 名(15.3%)患者死亡。对数激增指数每增加一个单位,死亡率的边际调整概率为 5.51% (95% CI, 4.53% to 6.50%)(应变归因死亡率 = 7375 [CI, 5936 to 8813] 或每 5 例 COVID-19 死亡中就有 1 例)。交互作用检验显示,4种医院类型的对数激增指数与死亡率之间的关系没有差异(P = 0.32)。排除转院患者、限制急性呼吸衰竭和机械通气患者以及使用其他应变指标后,结果一致。从大流行病中吸取的这些教训表明,在公共卫生和人员危机期间,所有类型的医院都需要最大限度地减少病例数激增及其影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association Between Hospital Type and Resilience During COVID-19 Caseload Stress : A Retrospective Cohort Study.
BACKGROUND Imbalances between hospital caseload and care resources that strained U.S. hospitals during the pandemic have persisted after the pandemic amid ongoing staff shortages. Understanding which hospital types were more resilient to pandemic overcrowding-related excess deaths may prioritize patient safety during future crises. OBJECTIVE To determine whether hospital type classified by capabilities and resources (that is, extracorporeal membrane oxygenation [ECMO] capability, multiplicity of intensive care unit [ICU] types, and large or small hospital) influenced COVID-19 volume-outcome relationships during Delta wave surges. DESIGN Retrospective cohort study. SETTING 620 U.S. hospitals in the PINC AI Healthcare Database. PARTICIPANTS Adult inpatients with COVID-19 admitted July to November 2021. MEASUREMENTS Hospital-months were ranked by previously validated surge index (severity-weighted COVID-19 inpatient caseload relative to hospital bed capacity) percentiles. Hierarchical models were used to evaluate the effect of log-transformed surge index on the marginally adjusted probability of in-hospital mortality or discharge to hospice. Effect modification was assessed for by 4 mutually exclusive hospital types. RESULTS Among 620 hospitals recording 223 380 inpatients with COVID-19 during the Delta wave, there were 208 ECMO-capable, 216 multi-ICU, 36 large (≥200 beds) single-ICU, and 160 small (<200 beds) single-ICU hospitals. Overall, 50 752 (23%) patients required admission to the ICU, and 34 274 (15.3%) died. The marginally adjusted probability for mortality was 5.51% (95% CI, 4.53% to 6.50%) per unit increase in the log surge index (strain attributable mortality = 7375 [CI, 5936 to 8813] or 1 in 5 COVID-19 deaths). The test for interaction showed no difference (P = 0.32) in log surge index-mortality relationship across 4 hospital types. Results were consistent after excluding transferred patients, restricting to patients with acute respiratory failure and mechanical ventilation, and using alternative strain metrics. LIMITATION Residual confounding. CONCLUSION Comparably detrimental relationships between COVID-19 caseload and survival were seen across all hospital types, including highly advanced centers, and well beyond the pandemic's learning curve. These lessons from the pandemic heighten the need to minimize caseload surges and their effects across all hospital types during public health and staffing crises. PRIMARY FUNDING SOURCE Intramural Research Program of the National Institutes of Health Clinical Center.
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来源期刊
Annals of Internal Medicine
Annals of Internal Medicine 医学-医学:内科
CiteScore
23.90
自引率
1.80%
发文量
1136
审稿时长
3-8 weeks
期刊介绍: Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
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