Division of General Medicine, University of Michigan Medical School, Ann Arbor.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
JAMA Netw Open. 2022 Mar 1;5(3):e222933. doi: 10.1001/jamanetworkopen.2022.2933.
The association of the COVID-19 pandemic with the quality of ambulatory care is unknown. Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are a well-studied measure of the quality of ambulatory care; however, they may also be associated with other patient-level and system-level factors.
To describe trends in hospital admissions for ACSCs in the prepandemic period (March 2019 to February 2020) compared with the pandemic period (March 2020 to February 2021).
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of adults enrolled in a commercial health maintenance organization in Michigan included 1 240 409 unique adults (13 011 176 person-months) in the prepandemic period and 1 206 361 unique adults (12 759 675 person-months) in the pandemic period.
COVID-19 pandemic (March 2020 to February 2021).
Adjusted relative risk (aRR) of ACSC hospitalizations and intensive care unit stays for ACSC hospitalizations and adjusted incidence rate ratio of the length of stay of ACSC hospitalizations in the prepandemic (March 2019 to February 2020) vs pandemic (March 2020 to February 2021) periods, adjusted for patient age, sex, calendar month of admission, and county of residence.
The study population included 1 240 409 unique adults (13 011 176 person-months) in the prepandemic period and 1 206 361 unique adults (12 759 675 person-months) in the pandemic period, in which 51.3% of person-months (n = 6 547 231) were for female patients, with a relatively even age distribution between the ages of 24 and 64 years. The relative risk of having any ACSC hospitalization in the pandemic period compared with the prepandemic period was 0.72 (95% CI, 0.69-0.76; P < .001). This decrease in risk was slightly larger in magnitude than the overall reduction in non-ACSC, non-COVID-19 hospitalization rates (aRR, 0.82; 95% CI, 0.81-0.83; P < .001). Large reductions were found in the relative risk of respiratory-related ACSC hospitalizations (aRR, 0.54; 95% CI, 0.50-0.58; P < .001), with non-statistically significant reductions in diabetes-related ACSCs (aRR, 0.91; 95% CI, 0.83-1.00; P = .05) and a statistically significant reduction in all other ACSC hospitalizations (aRR, 0.79; 95% CI, 0.74-0.85; P < .001). Among ACSC hospitalizations, no change was found in the percentage that included an intensive care unit stay (aRR, 0.99; 95% CI, 0.94-1.04; P = .64), and no change was found in the length of stay (adjusted incidence rate ratio, 1.02; 95% CI, 0.98-1.06; P = .33).
In this cross-sectional study of adults enrolled in a large commercial health maintenance organization plan, the COVID-19 pandemic was associated with reductions in both non-ACSC and ACSC hospitalizations, with particularly large reductions seen in respiratory-related ACSCs. These reductions were likely due to many patient-level and health system-level factors associated with hospitalization rates. Further research into the causes and long-term outcomes associated with these reductions in ACSC admissions is needed to understand how the pandemic has affected the delivery of ambulatory and hospital care in the US.
重要性： 新冠疫情与门诊医疗服务质量的关联尚不清楚。急性病医疗服务敏感条件（ACSC）的住院率是评估门诊医疗服务质量的一个很好的研究指标；然而，它也可能与其他患者层面和系统层面的因素相关。
目的： 描述大流行前时期（2019 年 3 月至 2020 年 2 月）和大流行时期（2020 年 3 月至 2021 年 2 月）门诊 ACSC 住院率的趋势。
设计、地点和参与者： 这项对密歇根州一家商业健康维护组织中成年人的横断面研究包括大流行前时期的 1240409 名独特成年人（13011176 人月）和大流行时期的 1206361 名独特成年人（12759675 人月）。
暴露： 新冠疫情（2020 年 3 月至 2021 年 2 月）。
主要结果和措施： ACSC 住院和 ACSC 住院 ICU 停留的调整相对风险（aRR），以及大流行前（2019 年 3 月至 2020 年 2 月）与大流行期间（2020 年 3 月至 2021 年 2 月）住院率的调整发病率比，调整了患者年龄、性别、入院日历月和居住地县。
结果： 研究人群包括大流行前时期的 1240409 名独特成年人（13011176 人月）和大流行时期的 1206361 名独特成年人（12759675 人月），其中 51.3%（n=6547231）为女性患者，年龄分布在 24 至 64 岁之间相对均衡。与大流行前时期相比，大流行时期任何 ACSC 住院的相对风险为 0.72（95%CI，0.69-0.76；P<0.001）。这种风险降低的幅度略大于非 ACSC、非 COVID-19 住院率的总体降低幅度（aRR，0.82；95%CI，0.81-0.83；P<0.001）。发现呼吸道相关 ACSC 住院的相对风险显著降低（aRR，0.54；95%CI，0.50-0.58；P<0.001），糖尿病相关 ACSC 略有降低（aRR，0.91；95%CI，0.83-1.00；P=0.05），而所有其他 ACSC 住院则显著降低（aRR，0.79；95%CI，0.74-0.85；P<0.001）。在 ACSC 住院中，包括 ICU 停留的百分比没有变化（aRR，0.99；95%CI，0.94-1.04；P=0.64），住院时间也没有变化（调整发病率比，1.02；95%CI，0.98-1.06；P=0.33）。
结论和相关性： 在这项对大型商业健康维护组织计划中成年人的横断面研究中，新冠疫情与非 ACSC 和 ACSC 住院率的降低相关，呼吸道相关 ACSC 的降低幅度尤其大。这些降低可能是由于与住院率相关的许多患者层面和医疗系统层面的因素所致。需要进一步研究这些 ACSC 入院率降低的原因和长期结果，以了解大流行如何影响美国的门诊和医院护理服务。
