Department of Emergency Medicine, Reading Hospital, West Reading, PA.
Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA.
Ann Emerg Med. 2022 Oct;80(4):291-300. doi: 10.1016/j.annemergmed.2022.01.044. Epub 2022 Apr 6.
To examine the distribution of hospitalized COVID-19 patients among adult acute care facilities in the Greater Philadelphia area and identify factors associated with hospitals carrying higher burdens of COVID-19 patients.
In this observational descriptive study, we obtained self-reported daily COVID-19 inpatient censuses from 28 large (>100 beds) adult acute care hospitals in the Greater Philadelphia region during the initial wave of the COVID-19 pandemic (March 23, 2020, to July 28, 2020). We examined hospitals based on their size, location, trauma certification, median household income, and reliance on public insurance. COVID-19 inpatient burdens (ie, beds occupied by COVID-19 patients), relative to overall facility capacity (ie, total beds), were reported and assessed using thresholds established by the Institute of Health Metrics and Evaluation to approximate the stress induced by different COVID-19 levels.
Maximum (ie, peak) daily COVID-19 occupancy averaged 27.5% (SD 11.2%) across the 28 hospitals. However, there was dramatic variation between hospitals, with maximum daily COVID-19 occupancy ranging from 5.7% to 50.0%. Smaller hospitals remained above 20% COVID-19 capacity for longer (small hospital median 27.5 days [interquartile range {IQR}: 4 to 32]; medium hospital median 18.5 days [IQR: 0.5 to 37]; large hospital median 13 days [IQR: 6 to 32]). Trauma centers reached 20% capacity sooner (median 19 days [IQR: 16-25] versus nontrauma median 30 days [IQR: 20 to 128]), remained above 20% capacity for longer (median 31 days [IQR: 11 to 38]; nontrauma median 8 days [IQR: 0 to 30]), and had higher observed burdens relative to their total capacity (median 5.8% [IQR: 2.4% to 8.3%]; nontrauma median 2.5% [IQR: 1.6% to 2.8%]). Urban location was also predictive of higher COVID-19 patient burden (urban median 3.8% [IQR: 2.6% to 6.7%]; suburban median 2.2% [IQR: 1.5% to 2.8%]). Heat map analyses demonstrated that hospitals in lower-income areas and hospitals in areas of higher reliance on public insurance also exhibited substantially higher COVID-19 occupancy and longer periods of higher COVID-19 occupancy.
Substantial discrepancies in COVID-19 inpatient burdens existed among Philadelphia-region adult acute care facilities during the initial COVID-19 surge. Trauma center status, urban location, low household income, and high reliance on public insurance were associated with both higher COVID-19 burdens and longer periods of high occupancy. Improved data collection and centralized sharing of pandemic-specific data between health care facilities may improve resource balancing and patient care during current and future response efforts.
调查大费城地区成人急症护理机构中 COVID-19 住院患者的分布情况，并确定与 COVID-19 患者负担较重的医院相关的因素。
在这项观察性描述性研究中，我们在 COVID-19 大流行的初始阶段（2020 年 3 月 23 日至 2020 年 7 月 28 日），从大费城地区的 28 家大型（>100 张病床）成人急症护理医院中获取了自我报告的每日 COVID-19 住院患者普查数据。我们根据医院的规模、位置、创伤认证、家庭中位数收入以及对公共保险的依赖程度对医院进行了检查。COVID-19 住院患者负担（即 COVID-19 患者占用的床位）相对于整个设施的能力（即总床位）进行了报告，并使用卫生计量与评估研究所确定的阈值进行了评估，以近似不同 COVID-19 水平所引起的压力。
28 家医院的最大（即峰值）每日 COVID-19 入住率平均为 27.5%（标准差 11.2%）。然而，医院之间存在明显差异，最大每日 COVID-19 入住率范围为 5.7%至 50.0%。较小的医院保持 20%以上 COVID-19 入住率的时间更长（小医院中位数为 27.5 天[四分位距 {IQR}：4 至 32]；中医院中位数为 18.5 天[IQR：0.5 至 37]；大医院中位数为 13 天[IQR：6 至 32]）。创伤中心达到 20%入住率的时间更早（中位数 19 天[IQR：16-25]与非创伤中位数 30 天[IQR：20 至 128]），保持 20%以上入住率的时间更长（中位数 31 天[IQR：11 至 38]；非创伤中位数 8 天[IQR：0 至 30]），并且相对于其总容量观察到更高的负担（中位数 5.8%[IQR：2.4%至 8.3%]；非创伤中位数 2.5%[IQR：1.6%至 2.8%]）。城市位置也预示着 COVID-19 患者负担更高（城市中位数 3.8%[IQR：2.6%至 6.7%]；郊区中位数 2.2%[IQR：1.5%至 2.8%]）。热图分析表明，低收入地区和高度依赖公共保险的地区的医院也表现出更高的 COVID-19 入住率和更长的高入住率时期。
在 COVID-19 大流行的初始阶段，大费城地区成人急症护理机构之间存在着相当大的 COVID-19 住院患者负担差异。创伤中心地位、城市位置、低收入和高度依赖公共保险与 COVID-19 负担较高和高入住率时期较长有关。在当前和未来的应对工作中，医疗保健机构之间改进的大流行特定数据的收集和集中共享，可能会改善资源平衡和患者护理。
