COVID-19 大流行期间卫生系统的复原力:对 32 个国家医疗服务中断情况的比较分析。

IF 3.1 2区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Jorge R Ledesma,Stavroula A Chrysanthopoulou,Mark N Lurie,Jennifer B Nuzzo,Irene Papanicolas
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Stringency index (β = 0.98 [0.98, 0.99]) and excess all-cause deaths (β = 0.98 [0.96, 0.99]) were associated with more missed hospitalizations.\r\n\r\nCONCLUSIONS\r\nThere was marked cross-country variability in disruptions to hospitalizations and ambulatory care. Certain health system characteristics appeared to be more protective, such as insurance coverage, and number of inputs including healthcare workforce and beds.\r\n\r\nWHAT IS KNOWN ON THIS TOPIC\r\nSubstantial disruptions in health services associated with the coronavirus disease 2019 pandemic have placed a renewed interest in health system resilience. While there is a growing body of evidence documenting disruptions in services, there are limited comparative assessments across diverse countries with different health system designs, preparedness levels, and public health responses. 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引用次数: 0

摘要

目的量化 32 个国家在冠状病毒病 2019(COVID-19)大流行期间的住院和门诊护理中断情况,并研究卫生系统特征和 COVID-19 应对策略对中断情况的影响。协变量数据提取自经济合作与发展组织卫生数据库、世界卫生组织和牛津 COVID-19 政府响应跟踪器。研究设计这是一项描述性研究,使用时间序列分析来量化 COVID-19 大流行对 20 种诊断类别和 15 种外科手术的非 COVID-19 住院治疗的年度影响。我们利用 2010 年至 2019 年的数据,通过自回归综合移动平均模型估算出了在 2020-2021 年从未发生大流行的情况下的预期住院率,并将其与观察到的住院率进行了比较。作为 COVID-19 影响的衡量指标,我们计算了观察值与预期值的比率和错过的住院人次。主要发现COVID-19大流行与2020年1,630万人次(95%不确定区间为1,470万人次-1,790万人次;18.0% [16.5%-19.4%])的错过住院率有关。呼吸系统疾病(-2,030,000 [-2,300,000至-1,780,000])、循环系统疾病(-1,680,000 [-1,960,000至-1,410,000])和肌肉骨骼系统疾病(-1,480,000 [-1,720,000至-1,260,000])是导致住院率下降的主要原因。2021 年,漏诊住院人数将增加 14,700,000 人(95% 不确定区间为 13,100,000-16,400,000 人;16.3% [14.9%-17.9%])。人均医护人员总数(β = 1.02 [95% CI 1.00, 1.04])和保险覆盖率(β = 1.05 [1.02, 1.09])与较少的错过住院率相关。严格指数 (β = 0.98 [0.98, 0.99])和超额全因死亡 (β = 0.98 [0.96, 0.99])与更多错过住院治疗有关。某些医疗系统特征似乎更具有保护作用,如保险覆盖率、投入数量(包括医疗保健劳动力和床位)。虽然记录服务中断的证据越来越多,但在具有不同卫生系统设计、准备水平和公共卫生应对措施的不同国家之间进行的比较评估却很有限。2020-2021 年,所有国家的住院治疗和外科手术都受到了干扰,总共有 3,000 万人次错过了住院治疗,400 万人次错过了外科手术,但各国的干扰情况明显不同。医护人员、保险覆盖率和医院床位基线较高的国家,医疗服务中断的比例较低。国家卫生规划讨论可能需要平衡卫生系统的复原力和效率,以避免可预防的发病率和死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Health system resilience during the COVID-19 pandemic: A comparative analysis of disruptions in care from 32 countries.
OBJECTIVE To quantify disruptions in hospitalization and ambulatory care throughout the coronavirus disease 2019 (COVID-19) pandemic for 32 countries, and examine associations of health system characteristics and COVID-19 response strategies on disruptions. DATA SOURCES We utilized aggregated inpatient hospitalization and surgical procedure data from the Organization for Economic Co-operation and Development Health Database from 2010 to 2021. Covariate data were extracted from the Organization for Economic Co-operation and Development Health Database, World Health Organization, and Oxford COVID-19 Government Response Tracker. STUDY DESIGN This is a descriptive study using time-series analyses to quantify the annual effect of the COVID-19 pandemic on non-COVID-19 hospitalizations for 20 diagnostic categories and 15 surgical procedures. We compared expected hospitalizations had the pandemic never occurred in 2020-2021, estimated using autoregressive integrated moving average modeling with data from 2010 to 2019, with observed hospitalizations. Observed-to-expected ratios and missed hospitalizations were computed as measures of COVID-19 impact. Mixed linear models were employed to examine associations between hospitalization observed-to-expected ratios and covariates. PRINCIPAL FINDINGS The COVID-19 pandemic was associated with 16,300,000 (95% uncertainty interval 14,700,000-17,900,000; 18.0% [16.5%-19.4%]) missed hospitalizations in 2020. Diseases of the respiratory (-2,030,000 [-2,300,000 to -1,780,000]), circulatory (-1,680,000 [-1,960,000 to -1,410,000]), and musculoskeletal (-1,480,000 [-1,720,000 to -1,260,000]) systems contributed most to the declines. In 2021, there were an additional 14,700,000 (95% uncertainty interval 13,100,000-16,400,000; 16.3% [14.9%-17.9%]) missed hospitalizations. Total healthcare workers per capita (β = 1.02 [95% CI 1.00, 1.04]) and insurance coverage (β = 1.05 [1.02, 1.09]) were associated with fewer missed hospitalizations. Stringency index (β = 0.98 [0.98, 0.99]) and excess all-cause deaths (β = 0.98 [0.96, 0.99]) were associated with more missed hospitalizations. CONCLUSIONS There was marked cross-country variability in disruptions to hospitalizations and ambulatory care. Certain health system characteristics appeared to be more protective, such as insurance coverage, and number of inputs including healthcare workforce and beds. WHAT IS KNOWN ON THIS TOPIC Substantial disruptions in health services associated with the coronavirus disease 2019 pandemic have placed a renewed interest in health system resilience. While there is a growing body of evidence documenting disruptions in services, there are limited comparative assessments across diverse countries with different health system designs, preparedness levels, and public health responses. Learning and adapting from health system-specific gaps and challenges highlighted by the pandemic will be critical for improving resilience. WHAT THIS STUDY ADDS All countries experienced disruptions to hospitalizations and surgical procedures with a combined total of 30 million missed hospitalizations and 4 million missed surgical procedures in 2020-2021, but there was marked cross-country heterogeneity in disruptions. Countries with greater baseline healthcare workers, insurance coverage, and hospital beds had disproportionately lower disruptions in care. National health planning discussions may need to balance health system resiliency and efficiency to avert preventable morbidity and mortality.
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来源期刊
Health Services Research
Health Services Research 医学-卫生保健
CiteScore
4.80
自引率
5.90%
发文量
193
审稿时长
4-8 weeks
期刊介绍: Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.
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