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Lenhard A, Daoud M, Donahue L, Jones S, Kip PL, Zapf RL, Minnier TE. How SWAT Changed the Conversation: Implementation of a Discharge SWAT Team Improves Morale and Facilitates Communication During the COVID-19 Pandemic. Prof Case Manag 2024:01269241-990000000-00009. [PMID: 38421720 DOI: 10.1097/ncm.0000000000000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE OF STUDY Hospital overcrowding and delays in discharge are serious issues in the modern health care landscape and can lead to poor patient outcomes and health care personnel (HCP) burnout. The goal of this project was to develop a collaborative forum where HCP representing the entire spectrum of the inpatient care team, including case management team members, could connect to discuss challenges and barriers to patient discharge. The following describes the development, implementation, and outcomes of the discharge SWAT (Solutions, Wins, Actions, and Tactics) team, which is a 30-min virtual daily meeting where discussion is primarily centered around challenges in discharging individual patients and addressing case manager needs. The primary aim of SWAT meetings is fostering a positive atmosphere to address barriers to discharge while prioritizing patient care and outcomes. PRIMARY PRACTICE SETTING This study was conducted in a 40-hospital academic health system in the United States. METHODOLOGY AND SAMPLE SWAT meetings were first implemented at a representative flagship facility in a health system. HCP at this first facility were surveyed to assess satisfaction with SWAT meetings. SWAT meetings then were implemented at the majority of facilities in a 40-hospital academic health system. During SWAT implementation, average inpatient length of stay (LOS) and patient care transitions were monitored for participating and nonparticipating service lines. RESULTS Among surveyed HCP, the majority view SWAT meetings favorably and reported that it was a valuable use of their time and positively impacted their work in the patient discharge space. Nonprovider and case management staff in particular valued the SWAT meetings and found them beneficial. LOS remained stable for patients under the care of participating providers, despite the upheaval of the ongoing COVID-19 pandemic, and the research team also observed a positive impact of SWAT meetings on appropriate inpatient care transitions.
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Affiliation(s)
- Amanda Lenhard
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
| | - Majd Daoud
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
| | - Lisa Donahue
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
| | - Sherri Jones
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
| | - Paula L Kip
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
| | - Rachel L Zapf
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
| | - Tamra E Minnier
- Amanda Lenhard, MD, is the Chief of Medicine at UPMC Shadyside, Senior Medical Director for Care Coordination and Discharge Planning at UPMC, and Associate Professor of Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, PA
- Majd Daoud, MD, MHMS, is Project Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Lisa Donahue, DNP, RN, CPPS, is the Senior Director of Patient Safety, Innovation and Quality at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at UPMC Presbyterian Shadyside in Pittsburgh, PA
- Paula L. Kip, PhD, RN, is Senior Manager, Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Rachel L. Zapf, PhD, is Research Writer at Wolff Center, UPMC, in Pittsburgh, PA
- Tamra E. Minnier, MSN, RN, FACHE, FAAN, is the Senior Vice President of UPMC Health Services Division and the Chief Quality and Operational Excellence Officer at Wolff Center, UPMC, in Pittsburgh, PA
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Razimoghadam M, Yaseri M, Rezaee M, Fazaeli A, Daroudi R. Non-COVID-19 hospitalization and mortality during the COVID-19 pandemic in Iran: a longitudinal assessment of 41 million people in 2019-2022. BMC Public Health 2024; 24:380. [PMID: 38317148 PMCID: PMC10840276 DOI: 10.1186/s12889-024-17819-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND During a COVID-19 pandemic, it is imperative to investigate the outcomes of all non-COVID-19 diseases. This study determines hospital admissions and mortality rates related to non-COVID-19 diseases during the COVID-19 pandemic among 41 million Iranians. METHOD This nationwide retrospective study used data from the Iran Health Insurance Organization. From September 23, 2019, to Feb 19, 2022, there were four study periods: pre-pandemic (Sept 23-Feb 19, 2020), first peak (Mar 20-Apr 19, 2020), first year (Feb 20, 2020-Feb 18, 2021), and the second year (Feb 19, 2021-Feb 19, 2022) following the pandemic. Cause-specific hospital admission and in-hospital mortality are the main outcomes analyzed based on age and sex. Negative binomial regression was used to estimate the monthly adjusted Incidence Rate Ratio (IRR) to compare hospital admission rates in aggregated data. A logistic regression was used to estimate the monthly adjusted in-hospital mortality Odds Ratio (OR) for different pandemic periods. RESULTS During the study there were 6,522,114 non-COVID-19 hospital admissions and 139,679 deaths. Prior to the COVID-19 outbreak, the standardized hospital admission rate per million person-month was 7115.19, which decreased to 2856.35 during the first peak (IRR 0.40, [0.25-0.64]). In-hospital mortality also increased from 20.20 to 31.99 (OR 2.05, [1.97-2.13]). All age and sex groups had decreased admission rates, except for females at productive ages. Two years after the COVID-19 outbreak, the non-COVID-19 hospital admission rate (IRR 1.25, [1.13-1.40]) and mortality rate (OR 1.05, [1.04-1.07]) increased compared to the rates before the pandemic. The respiratory disease admission rate decreased in the first (IRR 0.23, [0.17-0.31]) and second years (IRR 0.35, [0.26-0.47] compared to the rate before the pandemic. There was a significant reduction in hospitalizations for pneumonia (IRR 0.30, [0.21-0.42]), influenza (IRR 0.04, [0.03-0.06]) and COPD (IRR 0.39, [0.23-0.65]) during the second year. There was a significant and continuous rise in the hematological admission rate during the study, reaching 186.99 per million person-month in the second year, reflecting an IRR of 2.84 [2.42-3.33] compared to the pre-pandemic period. The mortality rates of mental disorders (OR 2.15, [1.65-2.78]) and musculoskeletal (OR 1.48, [1.20-1.82), nervous system (OR 1.42, [1.26-1.60]), metabolic (OR 1.99, [1.80-2.19]) and circulatory diseases (OR 1.35, [1.31-1.39]) increased in the second year compare to pre-pandemic. Myocardial infarction (OR 1.33, [1.19-1.49]), heart failure (OR 1.59, [1.35-1.87]) and stroke (OR 1.35, [1.24-1.47]) showed an increase in mortality rates without changes in hospitalization. CONCLUSIONS In the era of COVID-19, the changes seem to have had a long-term effect on non-COVID-19 diseases. Countries should prepare for similar crises in the future to ensure medical services are not suspended.
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Affiliation(s)
- Mahya Razimoghadam
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rezaee
- Department of Orthopedics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | - Aliakbar Fazaeli
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Behnoush AH, Bazmi E, Khalaji A, Jafari-Mehdiabad A, Barzegari N, Dehpour AR, Behnoush B. The trend of poisonings before and after the COVID-19 pandemic. Sci Rep 2024; 14:2098. [PMID: 38267612 PMCID: PMC10808127 DOI: 10.1038/s41598-024-52537-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/19/2024] [Indexed: 01/26/2024] Open
Abstract
The COVID-19 pandemic has substantially affected people and healthcare systems. One of the main challenges was the reduction and change in the pattern of non-COVID-19 diseases and conditions. Moreover, due to the mental burden of the pandemic, the trend of poisonings and abuses changed. In this study, we aimed to assess the trends of poisonings from different agents before and during the COVID-19 pandemic using the interrupted time series method. This study was conducted at one of the main Tehran referral centers for poisoning, Baharloo Hospital. Pre-COVID-19 period was defined as April 2018 to January 2020 while the COVID-19 time was from February 2020 to March 2022. The total number of monthly poisoning cases in addition to eight categories of drugs/substances/agents were identified, including drugs (such as psychiatric drugs, cardiovascular drugs, and analgesics), opioids, stimulants, methanol, ethanol, cannabis, pesticides, and carbon monoxide. Interrupted time series analysis was performed to compare the pre-pandemic trend of total monthly cases from each category in addition to the proportion (%) of each one. In total, 13,020 cases were poisoned during the study period, among which 6088 belonged to the pre-pandemic period and 6932 were admitted during the COVID-19 era. There was no significant difference in terms of demographic characteristics of patients before and during the pandemic (p-value > 0.05). At the beginning of the pandemic, there was a sudden fall in the number of poisoning patients (- 77.2 cases/month, p-value = 0.003), however, there was a significant increasing trend during the COVID time (3.9 cases/month, p-value = 0.006). Most of the categories had a sharp decrease at the beginning of the pandemic except for methanol and ethanol which had increases, although not significant. Cannabis also had a significant change in slope (- 0.6 cases/month, p-value = 0.016), in addition to the sudden decrease at the beginning of the pandemic (- 10 cases/month, p-value = 0.007). Regarding the proportion of each category from total monthly poisoning cases, methanol, and ethanol had immediate rises of 4.2% per month and 10.1% per month, respectively (both significant). The pandemic had significant effects on the pattern of poisonings from different agents in Iran, the most important of which were alcohol (ethanol and methanol). These differences had policy implications that can be helpful for policymakers and healthcare systems in combating similar situations in the future.
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Affiliation(s)
| | - Elham Bazmi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | | | | | - Nasrin Barzegari
- School of Medicine, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad-Reza Dehpour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Behnoush
- Department of Forensic Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Razimoghadam M, Yaseri M, Effatpanah M, Daroudi R. Changes in emergency department visits and mortality during the COVID-19 pandemic: a retrospective analysis of 956 hospitals. Arch Public Health 2024; 82:5. [PMID: 38216989 PMCID: PMC10785366 DOI: 10.1186/s13690-023-01234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/26/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, many non-COVID-19 emergency department (ED) visits were indirectly affected. ED visits and mortality were assessed during different pandemic time periods compared with pre-pandemic. METHODS The study used data from 41 million Iran Health Insurance Organization members. The outcomes were non-COVID-19 ED visits and associated mortality in 956 hospitals. An analysis of ED visits was conducted both for all-cause and cause-specific conditions: cardiovascular diseases (CVD), mental and substance use disorders, unintentional injuries, and self-harm. In addition, total in-hospital ED mortality was analyzed. A negative binomial regression and a Poisson regression with a log link were used to estimate the incidence rate ratio (IRR) of visits and mortality relative risk (RR). RESULTS 1,789,831 ED visits and 12,377 deaths were reported during the study. Pre-pandemic (Sep 2019 to Feb 2020), there were 2,767 non-COVID-19 visits rate per million person-month, which decreased to 1,884 during the first COVID-19 wave with a national lockdown from Feb 20 to Apr 19, 2020 (IRR 0.68, [0.56-0.84]). The non-COVID-19 ED mortality risk was 8.17 per 1,000 visit-month during the pre-pandemic period, rising to 12.80 during the first wave of COVID-19 (RR 1.57, [1.49-165]). Non-COVID-19 ED visit rates decreased during the first pandemic year from Sep 2020 to Feb 2021 (IRR 0.73, [0.63-0.86]), but increased after COVID-19 vaccination two years later from Sep 2021 to Feb 2022 (IRR 1.11, [0.96-0.17]). The total ED mortality risk for non-COVID-19 was significantly higher after the COVID-19 outbreak in the first (RR 1.66, [1.59-1.72]) and second years (RR 1.27, [1.22-1.32]) of the pandemic. The visit incidence rate for mental health and substance use disorders declined from 8.18 per million person-month to 4.57 (IRR 0.53, [0.32 to 0.90]) in the first wave. In the second year, unintentional injury visits increased significantly compared with pre-pandemic (IRR 1.63, [1.30-2.03]). As compared to before the pandemic, there was no significant change in CVD and self-harm visit rates during the pandemic. Cardiac arrest was the leading cause of death in Iran hospitals' EDs. CONCLUSION In the first year of the COVID-19 pandemic, non-COVID-19 hospital ED visits declined and mortality risk increased. Despite two years since the COVID-19 outbreak, non-COVID-19 ED mortality risk remains high.
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Affiliation(s)
- Mahya Razimoghadam
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Effatpanah
- Pediatric department, School of Medicine, Imam Khomeini hospital, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Costello RE, Tazare J, Piehlmaier D, Herrett E, Parker EP, Zheng B, Mansfield KE, Henderson AD, Carreira H, Bidulka P, Wong AY, Warren-Gash C, Hayes JF, Quint JK, MacKenna B, Mehrkar A, Eggo RM, Katikireddi SV, Tomlinson L, Langan SM, Mathur R. Ethnic differences in the indirect effects of the COVID-19 pandemic on clinical monitoring and hospitalisations for non-COVID conditions in England: a population-based, observational cohort study using the OpenSAFELY platform. EClinicalMedicine 2023; 61:102077. [PMID: 37434746 PMCID: PMC10331810 DOI: 10.1016/j.eclinm.2023.102077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
Background The COVID-19 pandemic disrupted healthcare and may have impacted ethnic inequalities in healthcare. We aimed to describe the impact of pandemic-related disruption on ethnic differences in clinical monitoring and hospital admissions for non-COVID conditions in England. Methods In this population-based, observational cohort study we used primary care electronic health record data with linkage to hospital episode statistics data and mortality data within OpenSAFELY, a data analytics platform created, with approval of NHS England, to address urgent COVID-19 research questions. We included adults aged 18 years and over registered with a TPP practice between March 1, 2018, and April 30, 2022. We excluded those with missing age, sex, geographic region, or Index of Multiple Deprivation. We grouped ethnicity (exposure), into five categories: White, Asian, Black, Other, and Mixed. We used interrupted time-series regression to estimate ethnic differences in clinical monitoring frequency (blood pressure and Hba1c measurements, chronic obstructive pulmonary disease and asthma annual reviews) before and after March 23, 2020. We used multivariable Cox regression to quantify ethnic differences in hospitalisations related to diabetes, cardiovascular disease, respiratory disease, and mental health before and after March 23, 2020. Findings Of 33,510,937 registered with a GP as of 1st January 2020, 19,064,019 were adults, alive and registered for at least 3 months, 3,010,751 met the exclusion criteria and 1,122,912 were missing ethnicity. This resulted in 14,930,356 adults with known ethnicity (92% of sample): 86.6% were White, 7.3% Asian, 2.6% Black, 1.4% Mixed ethnicity, and 2.2% Other ethnicities. Clinical monitoring did not return to pre-pandemic levels for any ethnic group. Ethnic differences were apparent pre-pandemic, except for diabetes monitoring, and remained unchanged, except for blood pressure monitoring in those with mental health conditions where differences narrowed during the pandemic. For those of Black ethnicity, there were seven additional admissions for diabetic ketoacidosis per month during the pandemic, and relative ethnic differences narrowed during the pandemic compared to the White ethnic group (Pre-pandemic hazard ratio (HR): 0.50, 95% confidence interval (CI) 0.41, 0.60, Pandemic HR: 0.75, 95% CI: 0.65, 0.87). There was increased admissions for heart failure during the pandemic for all ethnic groups, though highest in those of White ethnicity (heart failure risk difference: 5.4). Relatively, ethnic differences narrowed for heart failure admission in those of Asian (Pre-pandemic HR 1.56, 95% CI 1.49, 1.64, Pandemic HR 1.24, 95% CI 1.19, 1.29) and Black ethnicity (Pre-pandemic HR 1.41, 95% CI: 1.30, 1.53, Pandemic HR: 1.16, 95% CI 1.09, 1.25) compared with White ethnicity. For other outcomes the pandemic had minimal impact on ethnic differences. Interpretation Our study suggests that ethnic differences in clinical monitoring and hospitalisations remained largely unchanged during the pandemic for most conditions. Key exceptions were hospitalisations for diabetic ketoacidosis and heart failure, which warrant further investigation to understand the causes. Funding LSHTM COVID-19 Response Grant (DONAT15912).
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Affiliation(s)
| | - John Tazare
- London School of Hygiene and Tropical Medicine, London, UK
| | - Dominik Piehlmaier
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- University of Sussex Business School, Jubilee Building, Brighton, UK
| | - Emily Herrett
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Bang Zheng
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | - Joseph F. Hayes
- Division of Psychiatry, University College London, London, UK
| | - Jennifer K. Quint
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | | | | | - Rohini Mathur
- London School of Hygiene and Tropical Medicine, London, UK
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
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