Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni 135, 10623, Berlin, Germany.
European Observatory on Health Systems and Policies, Place Victor Horta 40/30, Brussels, 1060, Belgium.
BMC Health Serv Res. 2023 Aug 31;23(1):938. doi: 10.1186/s12913-023-09929-z.
The delivery of health services around the world faced considerable disruptions during the COVID-19 pandemic. While this has been discussed for a number of conditions in the adult population, related patterns have been studied less for children. In light of the detrimental effects of the pandemic, particularly for children and young people under the age of 18, it is pivotal to explore this issue further.
Based on complete national hospital discharge data available via the German National Institute for the Reimbursement of Hospitals (InEK) data browser, we compare the top 30 diagnoses for which children were hospitalised in 2019, 2020, 2021 and 2022. We analyse the development of monthly admissions between January 2019 and December 2022 for three tracers of variable time-sensitivity: acute lymphoblastic leukaemia (ALL), appendicitis/appendectomy and tonsillectomy/adenoidectomy.
Compared to 2019, total admissions were approximately 20% lower in 2020 and 2021, and 13% lower in 2022. The composition of the most frequent principal diagnoses remained similar across years, although changes in rank were observed. Decreases were observed in 2020 for respiratory and gastrointestinal infections, with cases increasing again in 2021. The number of ALL admissions showed an upward trend and a periodicity prima vista unrelated to pandemic factors. Appendicitis admissions decreased by about 9% in 2020 and a further 8% in 2021 and 4% in 2022, while tonsillectomies/adenoidectomies decreased by more than 40% in 2020 and a further 32% in 2021 before increasing in 2022; for these tracers, monthly changes are in line with pandemic waves.
Hospital care for critical and urgent conditions among patients under the age of 18 was largely upheld in Germany during the COVID-19 pandemic, potentially at the expense of elective treatments. There is an alignment between observed variations in hospitalisations and pandemic mitigation measures, possibly also reflecting changes in demand. This study highlights the need for comprehensive, intersectoral data that would be necessary to better understand changing demand, unmet need/foregone care and shifts from inpatient to outpatient care, as well as their link to patient outcomes and health care efficiency.
在 COVID-19 大流行期间，全球各地的医疗服务都面临着相当大的中断。虽然这在成人人群中已经讨论了许多疾病，但对于儿童的相关模式研究较少。鉴于大流行对儿童和 18 岁以下的年轻人造成的不利影响，进一步探讨这个问题至关重要。
我们基于德国国家医院报销研究所 (InEK) 数据浏览器提供的完整国家医院出院数据，比较了 2019 年、2020 年、2021 年和 2022 年因住院的儿童前 30 大诊断。我们分析了 2019 年 1 月至 2022 年 12 月期间三种具有不同时间敏感性的追踪指标的每月入院情况：急性淋巴细胞白血病 (ALL)、阑尾炎/阑尾切除术和扁桃体切除术/腺样体切除术。
与 2019 年相比，2020 年和 2021 年的总入院人数减少了约 20%，2022 年减少了 13%。多年来，最常见的主要诊断的构成基本保持不变，尽管排名有所变化。2020 年呼吸道和胃肠道感染病例减少，2021 年再次增加。ALL 入院人数呈上升趋势，且与大流行因素无关的周期性变化。2020 年阑尾炎入院人数减少了约 9%，2021 年减少了 8%，2022 年减少了 4%，而扁桃体切除术/腺样体切除术在 2020 年减少了 40%以上，2021 年又减少了 32%，然后在 2022 年增加；对于这些追踪指标，每月变化与大流行波相一致。
在 COVID-19 大流行期间，德国基本维持了 18 岁以下患者的危急和紧急情况的住院治疗，这可能是以选择性治疗为代价的。观察到的住院治疗变化与大流行缓解措施之间存在一致性，这可能也反映了需求的变化。这项研究强调需要全面的、跨部门的数据，以更好地了解不断变化的需求、未满足的需求/放弃的治疗以及从住院到门诊治疗的转变，以及它们与患者结果和医疗保健效率的关系。
