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The Impact of COVID-19 on Hospital Admissions in Croatia
Karolina Kalanj1, Ric Marshall2, Karl Karol3
1Department of Medical Oncology, Clinic of Oncology, Clinical Hospital Center, Zagreb, Croatia.
Insights
The COVID-19 pandemic caused a 21% drop in Croatian hospital admissions, particularly for critical conditions. However, COVID-19 related cases increased by 37%, highlighting significant disruption to essential health services.
Area of Science:
- Public Health
- Health Services Research
- Epidemiology
Background:
- The COVID-19 pandemic presented unprecedented challenges to healthcare systems globally, impacting routine hospital operations and patient care.
- Hospitals worldwide had to balance managing a highly infectious disease with maintaining essential health services for the community.
- This study specifically investigates the direct impact of the COVID-19 pandemic on inpatient care delivery within Croatia.
Purpose of the Study:
- To analyze the direct effects of the COVID-19 pandemic on inpatient care in Croatia.
- To compare hospital admission rates across Diagnosis Related Group (DRG) classes before and during the pandemic.
- To identify shifts in healthcare utilization patterns attributable to the pandemic.
Main Methods:
- A retrospective, comparative analysis of hospital admission data was conducted.
- Data encompassed all non-specialized acute hospitals in Croatia, representing 96% of national inpatient activity.
- Diagnosis Related Group (DRG) data and COVID-19 data from the Croatian Institute of Public Health were utilized.
Main Results:
- A significant 21% overall decrease in hospital admissions was observed during 2020 (IRR 0.8, p < 0.0001).
- The most substantial decline in admissions occurred in April 2020, with a 51% reduction.
- Non-elective DRG classes, including cancers, stroke, and heart failure, experienced decreased activity, while COVID-19 related DRG classes saw a 37% increase (IRR 1.39, p < 0.0001).
Conclusions:
- The decline in hospital activity was likely influenced by factors including lockdowns, quarantines, hospital reorganizations, workforce rationing, and patient hesitancy to seek care.
- The findings underscore the significant disruption to essential healthcare services caused by the pandemic.
- Further research is recommended to understand the long-term consequences, and multidisciplinary strategies are needed to mitigate the impact of future health emergencies on community healthcare needs.
Abstract:
Background: The COVID-19 pandemic disrupted hospital care, as hospitals had to deal with a highly infectious virus, while at the same time continuing to fulfill the ongoing health service needs of their communities. This study examines the direct effects of COVID-19 on the delivery of inpatient care in Croatia. Materials and Methods: The research is a retrospective, comparative analysis of the hospital admission rate across all Diagnosis Related Group (DRG) classes before and during the pandemic. It is based on DRG data from all non-specialized acute hospitals in Croatia, which account for 96% of national inpatient activity. The study also used COVID-19 data from the Croatian Institute of Public Health (CIPH). Results: The results show a 21% decrease in the total number of admissions [incident rate ratio (IRR) 0.8, p < 0.0001] across the hospital network during the pandemic in 2020, with the greatest drop occurring in April, when admissions plunged by 51%. The decrease in activity occurred in non-elective DRG classes such as cancers, stroke, major chest procedures, heart failure, and renal failure. Coinciding with this reduction however, there was a 37% increase (IRR 1.39, p < 0.0001) in case activity across six COVID-19 related DRG classes. Conclusions: The reduction in hospital inpatient activity during 2020, can be attributed to a number of factors such as lock-downs and quarantining, reorganization of hospital operations, the rationing of the medical workforce, and the reluctance of people to seek hospital care. Further research is needed to examine the consequences of disruption to hospital care in Croatia. Our recommendation is to invest multidisciplinary effort in reviewing response procedures to emergencies such as COVID-19 with the aim of minimizing their impact on other, and equally important community health care needs.
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