The Urgency of Care during the Covid-19 Pandemic - Learning as We Go.
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ABSTRACT:
SUBMITTER: Rubin EJ
PROVIDER: S-EPMC7224605 | biostudies-literature | 2020 Jun
REPOSITORIES: biostudies-literature
Publications
The Urgency of Care during the Covid-19 Pandemic - Learning as We Go.
Rubin Eric J EJ Harrington David P DP Hogan Joseph W JW Gatsonis Constantine C Baden Lindsey R LR Hamel Mary Beth MB
The New England journal of medicine 20200507 25
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Project description:To understand and analyse the global impact of COVID-19 on outpatient services, inpatient care, elective surgery, and perioperative colorectal cancer care, a DElayed COloRectal cancer surgery (DECOR-19) survey was conducted in collaboration with numerous international colorectal societies with the objective of obtaining several learning points from the impact of the COVID-19 outbreak on our colorectal cancer patients which will assist us in the ongoing management of our colorectal cancer patients and to provide us safe oncological pathways for future outbreaks.
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Project description:ImportanceThe extent of the disruption to surgical care during the COVID-19 pandemic has not been empirically characterized on a national level.ObjectiveTo characterize the use of surgical care across cohorts of surgical urgency during the COVID-19 pandemic, and to assess for racial and ethnic disparities.Design setting and participantsThis was a retrospective observational study using the geographically diverse, all payer data from 767 hospitals in the Premier Healthcare Database. Procedures were categorized into 4 cohorts of surgical urgency (elective, nonelective, emergency, and trauma). A generalized linear regression model with hospital-fixed effects assessed the relative monthly within-hospital reduction in surgical encounters in 2020 compared with 2019.Main outcomes and measuresOutcomes were the monthly relative reduction in overall surgical encounters and across surgical urgency cohorts and race and ethnicity.ResultsThe sample included 13 175 087 inpatient and outpatient surgical encounters. There was a 12.6% relative reduction in surgical use in 2020 compared to 2019. Across all surgical cohorts, the most prominent decreases in encounters occurred during Spring 2020 . For example, elective encounters began falling in March, reached a trough in April, and subsequently recovered but never to prepandemic levels (March: -26.8%; 95% CI, -29.6% to -23.9%; April: -74.6%; 95% CI, -75.5% to -73.5%; December: -13.3%; 95% CI, -16.6%, -9.8%). Across all operative surgical urgency cohorts, White patients had the largest relative reduction in encounters.Conclusions and relevanceAs shown by this cohort study, the COVID-19 pandemic resulted in large disruptions to surgical care across all categories of operative urgency, especially elective procedures. Racial and ethnic minority groups experienced less of a disruption to surgical care than White patients. Further research is needed to explore whether the decreased surgical use among White patients was owing to patient discretion and to document whether demand for surgical care will rebound to baseline levels.
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Project description:BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of using information and communication technology (ICT) to address daily and healthcare needs. The barriers for older adults in the United States to learn a new technology to go online during the pandemic remain to be studied.MethodsUsing data from the 2019-2020 National Health and Aging Trends Study (NHATS), a nationally representative survey of older Medicare beneficiaries aged 65 years and older in the United States, we used multivariable logistic regression models to identify sociodemographic and clinical factors associated with learning a new technology to go online during the COVID-19 pandemic.ResultsOur sample represented 23,547,688 older adults nationally, of which the majority (60.2%) increased ICT use during the COVID-19 pandemic. However, most older adults (71.8%) did not report learning a new technology to go online. Those who did not learn a new technology to go online had less of an increase in ICT use than those who learned either with help or by themselves (50.7% vs. 78.4% or 89.2% respectively, p < 0.01). The odds of learning a new technology decreased with increasing age (aOR [95%CI] = 0.96 [0.94-0.98]), being male (aOR [95%CI] = 0.56 [0.45-0.72]), having lower than high school educational attainment (aOR [95%CI] = 0.38 [0.29-0.50]), decreasing income levels (aORs ranged from 0.28 to 0.54), and self-reported fair or poor general health (aOR [95%CI] = 0.65 [0.47-0.90]).ConclusionThe identified sociodemographic and clinical factors could inform targeted intervention strategies to improve ICT use among older adults during the evolving COVID-19 pandemic and in the future.
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Project description:Due to COVID 19 (Corona virus disease)pandemic, majority of surgeries, including surgery for cancer patients got delayed across the globe. Surgeries were limited to emergency set up only. At our institute we tried to perform colorectal cancer surgeries through out the pandemic, albeit in less numbers, as we thought cancer in itself is an emergency setting. we are planning to analyse the prospectively managed database of this particular group of patients over a period of last six 6 months and look out at 30 day post operative morbidity and mortality. Besides we will try to analyse the implications of our decision to carry on with cancer surgeries in terms of number of health care workers who got infected while being involved in primary care of these patients.
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