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.
Highlights
The World Health Organization (WHO) declared the novel coronavirus (COVID-19) outbreak a Public Health Emergency of International Concern on 30 January 2020, and a Pandemic on 11 March 2020 [1]
We show that Croatia experienced both a decrease in inpatient activity and decline in non-elective admissions for conditions which incidence is not related to the COVID19 pandemic, but which otherwise pose a serious health risk if left untreated
The regular and frequent publication of DRG activity data provides opportunities for timely decision making in responding to unfolding emergencies situations such as COVID-19
Summary
The World Health Organization (WHO) declared the novel coronavirus (COVID-19) outbreak a Public Health Emergency of International Concern on 30 January 2020, and a Pandemic on 11 March 2020 [1]. In the face of an increasing COVID-19 patient load and growing risk of contagion, the Croatian Government took steps to adapt hospital care delivery to the perceived needs of the pandemic. Four similar centers were established in the regions and in addition, most major hospitals established COVID-19 isolation wards. Under this reorganization, 15% of hospital beds in Croatia were designated as COVID-19 beds (3,599 beds out of a total of 23,597) [4]. 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
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