Division of Gastroenterology and HepatologyDepartment of Medicine IIIMedical University of ViennaViennaAustria.
Vienna Hepatic Hemodynamic LabMedical University of ViennaViennaAustria.
Hepatol Commun. 2021 Oct;5(10):1660-1675. doi: 10.1002/hep4.1758. Epub 2021 Jul 1.
The coronavirus disease 2019 (COVID-19) pandemic necessitated down-scaling of in-hospital care to prohibit the spread of severe acute respiratory syndrome-coronavirus-2. We (1) assessed patient perceptions on quality of care by telesurvey (cohort 1) and written questionnaire (cohort 2), and (2) analyzed trends in elective and nonelective admissions before (December 2019 to February 2020) and during (March to May 2020) the COVID-19 pandemic in Austria. A total of 279 outpatients were recruited into cohort 1 and 138 patients into cohort 2. All admissions from December 2019 to May 2020 to the Division of Gastroenterology/Hepatology at the Vienna General Hospital were analyzed. A total of 32.6% (n = 91 of 279) of cohort 1 and 72.5% (n = 95 of 131) of cohort 2 had telemedical contact, whereas 59.5% (n = 166 of 279) and 68.2% (n = 90 of 132) had face-to-face visits. A total of 24.1% (n = 32 of 133) needed acute medical help during health care restrictions; however, 57.3% (n = 51 of 89) reported that contacting their physician during COVID-19 was difficult or impossible. Patient-reported satisfaction with treatment decreased significantly during restrictions in cohort 1 (visual analog scale [VAS] 0-10: 9.0 ± 1.6 to 8.6 ± 2.2; P < 0.001) and insignificantly in cohort 2 (VAS 0-10: 8.9 ± 1.6 to 8.7 ± 2.1; P = 0.182). Despite fewer hospital admissions during COVID-19, the proportion of nonelective admissions (+6.3%) and intensive care unit admissions (+6.7%) increased. Patients with cirrhosis with nonelective admissions during COVID-19 had significantly higher Model for End-Stage Liver Disease (MELD) (25.5 [14.2] vs. 17.0 [interquartile range: 8.8]; P = 0.003) and ΔMELD (difference from last MELD: 3.9 ± 6.3 vs. 8.7 ± 6.4; P = 0.008), required immediate intensive care more frequently (26.7% vs. 5.6%; P = 0.034), and had significantly increased 30-day liver-related mortality (30.0% vs. 8.3%; P = 0.028). Conclusion: The COVID-19 pandemic's effects on quality of liver care is evident from decreased patient satisfaction, hospitalization of sicker patients with advanced chronic liver disease, and increased liver-related mortality. Strategies for improved telemedical liver care and preemptive treatment of cirrhosis-related complications are needed to counteract the COVID-19-associated restrictions of in-hospital care.
2019 年冠状病毒病（COVID-19）大流行需要减少医院内的护理，以防止严重急性呼吸系统综合征冠状病毒 2 型的传播。我们（1）通过远程调查（队列 1）和书面问卷（队列 2）评估了患者对护理质量的看法，以及（2）分析了奥地利 COVID-19 大流行期间（2019 年 12 月至 2020 年 2 月）和期间（2020 年 3 月至 5 月）之前和期间择期和非择期入院的趋势。共有 279 名门诊患者被纳入队列 1，138 名患者被纳入队列 2。分析了 2019 年 12 月至 2020 年 5 月期间维也纳总医院胃肠病学/肝病科所有入院情况。队列 1 中有 32.6%（n=91）和队列 2 中有 72.5%（n=95）进行了远程医疗联系，而 59.5%（n=166）和 68.2%（n=90）进行了面对面访问。共有 24.1%（n=32）在医疗保健限制期间需要急性医疗帮助；然而，57.3%（n=51）报告说，在 COVID-19 期间联系他们的医生很困难或不可能。队列 1 中治疗满意度显著下降（视觉模拟量表[VAS]0-10：9.0±1.6 至 8.6±2.2；P<0.001），队列 2 中治疗满意度略有下降（VAS 0-10：8.9±1.6 至 8.7±2.1；P=0.182）。尽管 COVID-19 期间医院入院人数减少，但非择期入院（+6.3%）和重症监护病房入院（+6.7%）的比例增加。COVID-19 期间非择期入院的肝硬化患者的终末期肝病模型（MELD）（25.5[14.2]与 17.0[四分位距：8.8]；P=0.003）和 MELD 差异（与最后一次 MELD 的差异：3.9±6.3 与 8.7±6.4；P=0.008）明显更高，更频繁地需要立即重症监护（26.7%与 5.6%；P=0.034），30 天肝脏相关死亡率明显增加（30.0%与 8.3%；P=0.028）。结论：COVID-19 大流行对肝脏护理质量的影响明显，表现为患者满意度下降、患有晚期慢性肝病的患者住院治疗情况恶化，以及肝脏相关死亡率增加。需要制定改进远程医疗肝脏护理和预防治疗肝硬化相关并发症的策略，以应对 COVID-19 相关的医院内护理限制。
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