由于冠状病毒大流行（COVID-19）导致需求激增而暂停择期入院的影响。
The Impact of Halting Elective Admissions in Anticipation of a Demand Surge Due to the Coronavirus Pandemic (COVID-19).
机构信息
Departments of Orthopaedics.
Population Health Sciences.
出版信息
Med Care. 2021 Mar 1;59(3):213-219. doi: 10.1097/MLR.0000000000001496.
BACKGROUND
In anticipation of a demand surge for hospital beds attributed to the coronavirus pandemic (COVID-19) many US states have mandated that hospitals postpone elective admissions.
OBJECTIVES
To estimate excess demand for hospital beds due to COVID-19, the net financial impact of eliminating elective admissions in order to meet demand, and to explore the scenario when demand remains below capacity.
RESEARCH DESIGN
An economic simulation to estimate the net financial impact of halting elective admissions, combining epidemiological reports, the US Census, American Hospital Association Annual Survey, and the National Inpatient Sample. Deterministic sensitivity analyses explored the results while varying assumptions for demand and capacity.
SUBJECTS
Inputs regarding disease prevalence and inpatient utilization were representative of the US population. Our base case relied on a hospital admission rate reported by the Center for Disease Control and Prevention of 137.6 per 100,000, with the highest rates in people aged 65 years and older (378.8 per 100,000) and 50-64 years (207.4 per 100,000). On average, elective admissions accounted for 20% of total hospital admissions, and the average rate of unoccupied beds across hospitals was 30%.
MEASURES
Net financial impact of halting elective admissions.
RESULTS
On average, hospitals COVID-19 demand for hospital bed-days fell well short of hospital capacity, resulting in a substantial financial loss. The net financial impact of a 90-day COVID surge on a hospital was only favorable under a narrow circumstance when capacity was filled by a high proportion of COVID-19 cases among hospitals with low rates of elective admissions.
CONCLUSIONS
Hospitals that restricted elective care took on a substantial financial risk, potentially threatening viability. A sustainable public policy should therefore consider support to hospitals that responsibly served their communities through the crisis.
背景
由于冠状病毒病（COVID-19）大流行，预计对医院病床的需求将会激增，因此许多美国州已强制要求医院推迟选择性入院。
目的
估计由于 COVID-19 而导致的医院病床需求过剩，消除选择性入院以满足需求的净财务影响，并探讨需求仍然低于容量的情况。
研究设计
一种经济模拟方法，用于估算停止选择性入院的净财务影响，结合流行病学报告，美国人口普查，美国医院协会年度调查和国家住院样本。确定性敏感性分析在改变需求和能力假设的情况下探讨了结果。
研究对象
疾病流行率和住院患者利用率的投入代表了美国人口。我们的基本情况基于疾病预防控制中心报告的每 10 万人中有 137.6 例的住院率，其中年龄在 65 岁及以上的人群（每 10 万人中有 378.8 例）和 50-64 岁的人群（每 10 万人中有 207.4 例）的住院率最高。平均而言，选择性入院占总入院人数的 20％，并且医院平均有空床率为 30％。
措施
停止选择性入院的净财务影响。
结果
平均而言，医院 COVID-19 对医院病床的需求远远低于医院的能力，导致了巨大的财务损失。如果在低选择性入院率的医院中，COVID-19 病例占医院能力的很大比例，那么 COVID 需求激增 90 天对医院的净财务影响仅在一种狭窄的情况下才是有利的。
结论
限制择期护理的医院承担了巨大的财务风险，可能威胁到其生存能力。因此，可持续的公共政策应考虑为在危机期间负责任地为社区服务的医院提供支持。
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