Oreel Tom H, Hadjisotiriou Sophie, Vasconcelos Vítor V, Marchau Vincent A W J, Rouwette Etiënne A J A, Quax Rick, Nespeca Vittorio, Coenen Jannie, Korzilius Hubert P L M, Wertheim Heiman, Olde Rikkert Marcel G M
Department of Geriatrics, Department of Geriatric Medicine Radboud University Medical Center Nijmegen The Netherlands.
Computational Science Lab, Informatics Institute University of Amsterdam Amsterdam The Netherlands.
Health Sci Rep. 2025 Jun 23;8(6):e70789. doi: 10.1002/hsr2.70789. eCollection 2025 Jun.
Healthcare system resilience is generally understood as the capacity of a healthcare system to prepare, withstand, and adapt to disruptive health events while maintaining the continuity and quality of essential health services. So-called dynamic indicators of resilience (DIORs) allow us to examine resilience by analysing patterns of functioning of the healthcare system in time series data. The aim of this study was to examine whether DIORs can be estimated from time series data of the functioning of the Dutch healthcare system before, during and after the COVID-19 pandemic, and whether these DIORs are indicative of the resilience of the Dutch healthcare system during the COVID-19 pandemic.
To select a measure of healthcare functioning, healthcare experts completed a questionnaire in which they selected the five most relevant indicators of healthcare availability (table s14). Based on the questionnaire results and datasets available, time series data of sick-leave absenteeism rates among Dutch healthcare workers before, during and after the COVID-19 pandemic were used to quantify the functioning of the Dutch healthcare system. DIORs were estimated using moving window techniques on the time series data of each healthcare sector, each safety region in the Netherlands, and all healthcare sectors and safety regions in the Netherlands combined.
Short-term sick-leave increased from 3.2% to 4.5% and long-term from 3.0% to 4.0% post-pandemic ( < 0.001). DIORs showed significantly increasing autocorrelation during the pandemic (Kendall's = 0.46-0.52), indicated an increased loss of resilience of the Dutch healthcare system as the COVID-19 pandemic progressed. Trends were consistent across healthcare sectors but varied across regions, with some regions showing stable or improving resilience.
Our results indicate that DIORs, estimated from time series data of sick-leave absenteeism rates among healthcare workers in the Netherlands during the COVID-19 pandemic, potentially provide useful insights into healthcare system's resilience during and following disruptive health events, such as the COVID-19 pandemic.
医疗系统恢复力通常被理解为医疗系统在维持基本医疗服务的连续性和质量的同时，准备、承受并适应破坏性健康事件的能力。所谓的恢复力动态指标（DIORs）使我们能够通过分析时间序列数据中医疗系统的运行模式来研究恢复力。本研究的目的是检验是否可以从荷兰医疗系统在新冠疫情之前、期间和之后的运行时间序列数据中估计DIORs，以及这些DIORs是否能表明荷兰医疗系统在新冠疫情期间的恢复力。
为了选择一种衡量医疗运行的指标，医疗专家填写了一份问卷，从中选出五个最相关的医疗可及性指标（表s14）。根据问卷结果和可用数据集，使用荷兰医疗工作者在新冠疫情之前、期间和之后的病假缺勤率时间序列数据来量化荷兰医疗系统的运行情况。使用移动窗口技术对每个医疗部门、荷兰的每个安全区域以及荷兰所有医疗部门和安全区域组合的时间序列数据估计DIORs。
疫情后短期病假从3.2%增加到4.5%，长期病假从3.0%增加到4.0%（<0.001）。DIORs在疫情期间显示出自相关性显著增加（肯德尔系数=0.46 - 0.52），表明随着新冠疫情发展，荷兰医疗系统的恢复力损失增加。各医疗部门的趋势一致，但各地区有所不同，一些地区显示恢复力稳定或有所改善。
我们的结果表明，从荷兰医疗工作者在新冠疫情期间的病假缺勤率时间序列数据估计出的DIORs，可能为了解破坏性健康事件（如新冠疫情）期间及之后医疗系统的恢复力提供有用的见解。
