Health Policy Journal Club, Health Policy, Advocacy, COVID-19

Health Policy Journal Club: Patient Visits Plummet During Pandemic

Will patients get needed care during COVID in timely, just, and equitable manner?

After the declaration of the COVID-19 pandemic in the United States in March 2020, hospital admissions nationwide, including those for non-COVID-19 diagnoses, fell substantially. Despite an uptick in health care use beginning in June/July 2020, non-COVID-19 admissions remained significantly beneath pre-pandemic baseline volumes as many patients continued to defer hospital care for acute and even life-threatening medical conditions. However, the differential impacts of the pandemic and rebound on admission patterns among demographic groups are not well-understood.

A recent study investigated the pandemic's impact on admissions in relation to patient demographic factors and admission diagnoses. Using a nationally representative hospital group's data comprising over a million admissions across 36 states, the authors compared weekly non-COVID-19 and total admissions in 2020 to corresponding weeks in 2019. They also collected data on patient demographics including age, race, ethnicity, poverty rate of the patient's ZIP code, insurance coverage, and hospital COVID-19 volume.

The authors found that non-COVID-19 admissions decreased 42.8% below baseline as of the nadir in April 2020 before rebounding to 15.9% below baseline in the summer of 2020. Somewhat larger but significant declines were witnessed in patients over the age of 70; patients residing in majority-Hispanic, majority-Black, or high-poverty ZIP codes; uninsured patients; and hospitals belonging to the highest quintile of COVID-19 exposure. Most notably, during the rebound in June and July, non COVID-19 admissions for patients residing in majority-Hispanic ZIP codes remained especially low at 31.8% below baseline. Moreover, admissions for non-COVID-19 diagnoses in this study decreased by at least 20% by April 2020 and remained below pre-pandemic baselines during the rebound.

COVID-19 has presented unique public health challenges highlighting the systemic inequities in the modern health care system and access barriers facing patients requiring hospital care. Deferred treatment for acute medical conditions contributes to adverse outcomes that disproportionately harm minority and low-income populations. Without a quick return to normalcy immediately within reach, hospitals, health care systems, and public health authorities must collaborate to ensure that all patients can obtain needed hospital care during the pandemic in a timely, just, and equitable manner.

Abstract: Birkmeyer JD, Barnato A, Birkmeyer N, Bessler R, Skinner J. The Impact of the COVID-19 Pandemic on Hospital Admissions in the United States. Health Aff (Millwood). 2020;39(11):2010-2017.

Hospital admissions in the U.S. fell dramatically with the onset of the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about differences in admissions patterns among patient groups or the extent of the rebound.

In this study of approximately 1 million medical admissions from a large, nationally representative hospitalist group, we found that declines in non-COVID-19 admissions from February to April 2020 were generally similar across patient demographic subgroups and exceeded 20% for all primary admission diagnoses. By late June/early July 2020, overall non-COVID-19 admissions had rebounded to 16% below prepandemic baseline volume (8% including COVID-19 admissions).

Non-COVID-19 admissions were substantially lower for patients residing in majority-Hispanic neighborhoods (32% below baseline) and remained well below baseline for patients with pneumonia (-44%), chronic obstructive pulmonary disease/asthma (-40%), sepsis (-25%), urinary tract infection (-24%), and acute ST-elevation myocardial infarction (-22%).

Health system leaders and public health authorities should focus on efforts to ensure that patients with acute medical illnesses can obtain hospital care as needed during the pandemic to avoid adverse outcomes.

PMID: 32970495

EMRA + PolicyRx Health Policy Journal Club: A collaboration between Policy Prescriptions and EMRA

As emergency physicians, we care for all members of society, and as such have a unique vantage point on the state of health care. What we find frustrating in our EDs - such as inadequate social services, the dearth of primary care providers, and the lack of mental health services - are universal problems. As EM residents and fellows,  we learn the management of myocardial infarctions and traumas, and how to intubate, but we are not taught how health policy affects all aspects of our experience in the ED. Furthermore, given our unique position in the health care system, we have an incredible opportunity to advocate for our patients, for society, and for physicians. Yet, with so many competing interests vying for our conference education time, advocacy is often not included in the curricula. This is the gap this initiative aims to fill.  Each month, you will see a review of a new health policy article and how it is applicable to emergency physicians.