Joint Degree Program Perelman School of Medicine and the Wharton School of the University of Pennsylvania, Philadelphia, PA, USA.
Division of General Internal Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Healthc (Amst). 2020 Dec;8(4):100489. doi: 10.1016/j.hjdsi.2020.100489. Epub 2020 Oct 22.
In anticipation of patient surge due to COVID-19, many states are working to increase the available healthcare workforce. To help inform state policies and initiatives aimed at physician deployment during COVID-19, we used predictions of peak patient volume for hospitals and intensive care units (ICU) and regional physician workforce estimates to measure patient to physician ratios at the peak of the pandemic for each state.
We estimated the number of potentially available physicians based on Medicare Part B billings for the care of hospitalized and critically ill patients in 2017, adjusted for attrition due to exposure to SARS-CoV-2 and relevant experience. We used estimates from the Institute of Health Metrics and Evaluation to determine the number of hospitalized and ICU patients expected at the peak of the pandemic in each state. We then determined the expected ratio of patients per physician for each state at the peak of the pandemic.
The median number of hospitalized patients per physician was 13 (low estimate) to 18 (high estimate). At the high estimate of hospitalized patients, 35 states would have a patient to physician ratio of more than 15:1 (patient to physician ratios above 15:1 have been associated with poor outcomes). For ICU patients, the median number of patients each physician would treat across states would be 8-11 patients. Nine states would experience patient to physician ratios above 15:1 at the higher end of estimates. Patient-physician ratios decreased if the available physician pool was broadened to include physicians without recent experience treating hospitalized patients, and physicians in surgical specialties with experience treating acutely hospitalized patients.
CONCLUSIONS/IMPLICATIONS: We estimate that most states will have sufficient physician capacity to manage hospitalized patients at the peak of the pandemic. However, at the high estimates of hospitalized patients, some Midwestern states will experience high patient to provider ratios that may adversely affect patient outcomes.
State.
为应对因 COVID-19 导致的患者激增，许多州正在努力增加可用医疗保健人员数量。为帮助为 COVID-19 期间的医生部署提供信息，我们使用了对医院和重症监护病房（ICU）的高峰患者量以及区域医生劳动力的预测，以衡量每个州大流行高峰期的患者与医生比例。
我们根据 2017 年医疗保险 B 部分对住院和危重病患者的护理账单，估算了潜在可用医生的数量，并根据因接触 SARS-CoV-2 以及相关经验而减员的情况进行了调整。我们使用健康计量评估研究所的估计数，确定了每个州在大流行高峰期预计住院和 ICU 患者的数量。然后，我们确定了每个州大流行高峰期每位医生预计的患者人数。
中位每位医生的住院患者数为 13（低估计）至 18（高估计）。在住院患者高估计值的情况下，35 个州的患者与医生比例将超过 15:1（患者与医生比例超过 15:1 与不良结果相关）。对于 ICU 患者，各州每位医生治疗的患者中位数将为 8-11 人。在估计值较高的情况下，有 9 个州将出现患者与医生比例超过 15:1。如果扩大可用医生范围，包括没有最近治疗住院患者经验的医生和有治疗急性住院患者经验的外科专业医生，那么患者与医生的比例将会降低。
结论/意义：我们估计大多数州将有足够的医生能力来管理大流行高峰期的住院患者。然而，在住院患者高估计的情况下，一些中西部州将出现高患者与提供者比例，这可能对患者结果产生不利影响。
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