Consequences of the COVID-19 pandemic on the treatment of patients in German hospitals – A first impression

Sept. 3, 2020 / By Raphael Graf, Andre Cools, Daniel Schmithausen

It is undeniably clear that the COVID-19 pandemic has had and continues to have a big impact on us all. In discussions with our customers, they reported that many patients with an acute need for treatment are somehow not showing up in hospitals in these exceptional times. Together with our customer “Initiative Qualitätsmedizin” (IQM) [1] we analyzed structured inpatient data from 310 German hospitals to verify these statements. On March 12, the German Ministry of Health issued a hospital guideline to reschedule unnecessary procedures (elective surgery) with the aim of keeping beds open for COVID-19 patients. On April 19, the Ministry of Health lifted restrictions, advising hospitals to start going back to normal. We analyzed the period from January 1 to March 12 and from March 13 to April 19. The same period in 2019 was taken as a reference to obtain valid comparable results.

The routine administrative data, normally used for statistical purposes, as well as for improving the DRG System in Germany, is analyzed in a half-year cycle to calculate Quality Indicator (QI) sets like the German Inpatient Quality Indicators (G-IQI) [2] and AHRQ Patient Safety Indicators (PSI) [3]. The 310 hospitals in this study were willing to deliver “preliminary” data, which covers an overall  1,283,190 cases from January 2020. We mainly focused on the count of cases per MDC, as well as on a relevant selection of G-IQI results. Together with another partner we introduced a new set of COVID-Indicators to get a better understanding on how COVID-19 inpatients were treated. This indicator set was also included in our study.

A first look at the results comparing March 13-April 19 2020 to March 13-April 19 2019:

The following results are always related to the time between March 13 and April 19 in both years, 2020 and 2019. Data completeness is key to a good comparison of cohorts within strict periods of time, especially when hospitals deliver data on very short notice. As a first indicator for this, we looked at birth rates since these are relatively constant between years. Compared to 2019, 8 percent fewer children were born in 2020 (2020: 17.330, 2019: 18.909), based on the data we processed. Some explainable seasonal variations are present and probably more babies were born at home, but we also believe incomplete coding could be a reason for this decrease.  

To check if the guidelines for reducing the number of elective operations were followed by hospitals, first time knee endoprosthesis implantation for patients with gonarthrosis and chronic arthritis can be used as an indicator. Data showed that only 711 patients were treated in 2020, which is only 17 percent of the number of patients being treated in 2019 (4,305). A similar picture can be seen for patients with first time hip endoprosthesis implantation having coxarthrosis and chronic arthritis (2020: 995, 2019: 4,401).

Based on our initial question, it was interesting to see that 34 percent fewer patients with acute myocardial infarction were treated in 2020 (4,292) compared to 2019 (6,491). Data also shows that the average length of stay for these patients was reduced from 7.2 days in 2019 to 5.5 days in 2020. Our analysis also showed that 28 percent fewer patients with stroke were treated in 2020 (5,981) when compared to the same period in 2019 (8,360)

The number of patients treated for pneumonia was almost the same in 2019 (11,061) and 2020 (10,572) which seems to be reasonable due to the nature of the pandemic.

We understand these results as a first hint that there are indeed patients with an acute need of treatment avoiding hospital visits due to COVID-19 anxiety. A follow up study with more participants and an additional period from April 20 to June 30 is in preparation. This will not only include German hospitals but also hospitals from Switzerland.

More results can be seen in the publication in the Ärzteblatt. [4]

Raphael Graf, Medical Consultant at 3M Health Information Systems in Germany; Andre Cools, Health Economics Consultant at 3M Health Information Systems in Germany; Daniel Schmithausen, Business Manager, Sales Lead Analytics at 3M Health Information Systems in Germany

References:

[1] “Initiative Qualitätsmedizin e. V.” – Accessed 13 July 2020.

[2] Nimptsch U, Mansky T: G-IQI – German Inpatient Quality Indicators. Version 5.2. Accessed 14 July 2020.

[3] S.E. Drösler, A. Cools, T. Köpfer, J. Stausberg: Are Quality Indicators Derived from Routine Data Suitable for Evaluating Hospital Performance? First Results Using the AHRQ Patient Safety Indicators in Germany. Z. Ärztl. Fortbild. Qualitatssich., 101 (2007), pp. 35-42. Accessed 14 July 2020.

[4] Kuhlen R, Schmithausen D, Winklmair C, Schick J, Scriba P: The effects of the COVID-19 pandemic and lockdown on routine hospital care for other illnesses. Dtsch Arztebl Int 2020; 117: 488–9. 
DOI: 10.3238/arztebl.2020.0489. Accessed 13 July 2020.