COVID-19 Admission Rates and Changes in Care Quality in US Hospitals

Area of Science:

• Health Services Research
• Quality Improvement
• Epidemiology

Background:

• The COVID-19 pandemic led to unprecedented hospital occupancy rates in 2020.
• Concerns arose regarding the quality of care for non-COVID-19 patients during these surges.
• Understanding the impact of COVID-19 admissions on general hospital care quality is crucial.

Purpose of the Study:

• To examine changes in hospital nonsurgical care quality for patients without COVID-19.
• To compare care quality during periods of high versus low COVID-19 hospital admissions.

Main Methods:

• Cross-sectional study using 2019-2020 Healthcare Cost and Utilization Project data from 36 states.
• Included non-COVID-19, non-pneumonia patients at risk for selected quality indicators.
• Categorized hospital weeks by COVID-19 admissions per 100 beds; analyzed adverse outcomes and mortality rates.

Main Results:

• Analysis included over 19 million discharges from 3,283 hospitals.
• During high COVID-19 admission weeks (≥15 per 100 beds), quality indicators worsened significantly compared to low-admission weeks (<1 per 100 beds).
• Observed increases in pressure ulcer rates (24.3%), heart failure mortality (21.1%), and hip fracture mortality (29.4%).

Conclusions:

• COVID-19 surges were associated with significant declines in hospital care quality for non-COVID-19 patients.
• Increased adverse outcomes highlight the strain on healthcare systems during peak demand.
• Strategies are needed to maintain high-quality care during periods of high hospital utilization.