Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Jazan, Saudi Arabia.
Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Jazan, Saudi Arabia.
J Infect Public Health. 2021 Jun;14(6):717-723. doi: 10.1016/j.jiph.2021.04.012. Epub 2021 May 12.
Saudi Arabia has succeeded in having one of the lowest rates of COVID-19 worldwide due to the government's initiatives in taking swift action to control both the spread and severity of the virus. However, Covid-19 can serve as a test case of the expected response of the new healthcare system under Vision 2030. This study used data from the thirteen present administrative regions of KSA to simulate the variations in ICU admission as a quality indicator in the five business units proposed by a new Model of Care.
We determined the rates of ICU admission for patients with confirmed SARS-CoV-2 (COVID-19) from March to mid-July 2020. The final sample included 1743 inpatients with moderate to severe COVID-19. Patient characteristics, including demographics, pre-existing chronic conditions, and COVID-19 complications, were collected. Business units (BUs) were compared with respect to the relative odds of ICU admission by using multiple logistic regression.
After keeping patient and clinical characteristics constant, clear BU differences were observed in the relative odds of ICU admission of COVID-19 patients. Inpatient admission to ICU in our total sample was almost 50%. Compared to the Central BU, the Northern and Western BUs showed significantly higher odds of ICU admission while the Eastern & Southern BUs had significantly lower odds.
ICU use for COVID-19 patients differed significantly in KSA healthcare BUs, consistent with variations in care for other non-COVID-19-related conditions. These differences cannot be explained by patient or clinical characteristics, suggesting quality-of-care differences. We believe that privatization and the shift to fewer administrative BUs will help lessen or eliminate altogether the present variations in healthcare service provision.
由于政府迅速采取行动控制病毒的传播和严重程度，沙特阿拉伯成功地成为全球 COVID-19 发病率最低的国家之一。然而，Covid-19 可以作为新医疗保健系统在 2030 年愿景下预期反应的一个测试案例。本研究使用来自沙特阿拉伯十三个现有行政区的数据，模拟了在新护理模式提出的五个业务单元中作为质量指标的 ICU 入院率的变化。
我们确定了 2020 年 3 月至 7 月中旬确诊 SARS-CoV-2（COVID-19）患者的 ICU 入院率。最终样本包括 1743 名中度至重度 COVID-19 住院患者。收集了患者的特征，包括人口统计学、预先存在的慢性疾病和 COVID-19 并发症。使用多变量逻辑回归比较了业务单元（BU）之间 ICU 入院的相对优势。
在保持患者和临床特征不变的情况下，COVID-19 患者 ICU 入院的相对优势明显存在 BU 差异。在我们的总样本中，住院患者入住 ICU 的比例接近 50%。与中央 BU 相比，北部和西部 BU 的 ICU 入院几率明显较高，而东部和南部 BU 的 ICU 入院几率明显较低。
沙特阿拉伯医疗保健业务单元 COVID-19 患者的 ICU 使用情况存在显著差异，与其他非 COVID-19 相关疾病的护理差异一致。这些差异不能用患者或临床特征来解释，表明存在医疗质量差异。我们相信，私有化和向更少的行政 BU 转移将有助于减少或完全消除目前医疗服务提供方面的差异。
