Utilization of in- and outpatient hospital care in Germany during the Covid-19 pandemic insights from the German-wide Helios hospital network
During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospital...
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| Published in | PloS one Vol. 16; no. 3; p. e0249251 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
25.03.2021
Public Library of Science (PLoS) |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1932-6203 1932-6203 |
| DOI | 10.1371/journal.pone.0249251 |
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| Abstract | During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting.
Using claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the "protection" stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06-1.15], P<0.01) and in oncology cases (4.5 vs. 4.3%, OR 1.06 [95% CI 1.01-1.11], P<0.01), it was similar in surgical (0.9 vs. 0.8%, OR 1.06 [95% CI 1.00-1.13], P = 0.07) and in psychiatry cases (0.4 vs. 0.5%, OR 1.01 [95% CI 0.78-1.31], P<0.95).
There have been varying changes in care pathways and in-hospital mortality in different disciplines during the Covid-19 pandemic in Germany. Despite all the inherent and well-known limitations of claims data use, this data may be used for health care surveillance as the pandemic continues worldwide. While this study provides an up-to-date analysis of utilization of hospital care in the largest German hospital network, short- and long-term consequences are unknown and deserve further studies. |
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| AbstractList | BackgroundDuring the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting.Methods and findingsUsing claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the "protection" stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06-1.15], P<0.01) and in oncology cases (4.5 vs. 4.3%, OR 1.06 [95% CI 1.01-1.11], P<0.01), it was similar in surgical (0.9 vs. 0.8%, OR 1.06 [95% CI 1.00-1.13], P = 0.07) and in psychiatry cases (0.4 vs. 0.5%, OR 1.01 [95% CI 0.78-1.31], P<0.95).ConclusionsThere have been varying changes in care pathways and in-hospital mortality in different disciplines during the Covid-19 pandemic in Germany. Despite all the inherent and well-known limitations of claims data use, this data may be used for health care surveillance as the pandemic continues worldwide. While this study provides an up-to-date analysis of utilization of hospital care in the largest German hospital network, short- and long-term consequences are unknown and deserve further studies. During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting.BACKGROUNDDuring the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting.Using claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the "protection" stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06-1.15], P<0.01) and in oncology cases (4.5 vs. 4.3%, OR 1.06 [95% CI 1.01-1.11], P<0.01), it was similar in surgical (0.9 vs. 0.8%, OR 1.06 [95% CI 1.00-1.13], P = 0.07) and in psychiatry cases (0.4 vs. 0.5%, OR 1.01 [95% CI 0.78-1.31], P<0.95).METHODS AND FINDINGSUsing claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the "protection" stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06-1.15], P<0.01) and in oncology cases (4.5 vs. 4.3%, OR 1.06 [95% CI 1.01-1.11], P<0.01), it was similar in surgical (0.9 vs. 0.8%, OR 1.06 [95% CI 1.00-1.13], P = 0.07) and in psychiatry cases (0.4 vs. 0.5%, OR 1.01 [95% CI 0.78-1.31], P<0.95).There have been varying changes in care pathways and in-hospital mortality in different disciplines during the Covid-19 pandemic in Germany. Despite all the inherent and well-known limitations of claims data use, this data may be used for health care surveillance as the pandemic continues worldwide. While this study provides an up-to-date analysis of utilization of hospital care in the largest German hospital network, short- and long-term consequences are unknown and deserve further studies.CONCLUSIONSThere have been varying changes in care pathways and in-hospital mortality in different disciplines during the Covid-19 pandemic in Germany. Despite all the inherent and well-known limitations of claims data use, this data may be used for health care surveillance as the pandemic continues worldwide. While this study provides an up-to-date analysis of utilization of hospital care in the largest German hospital network, short- and long-term consequences are unknown and deserve further studies. About the Authors: Andreas Bollmann Roles Conceptualization, Supervision, Writing – original draft, Writing – review & editing * E-mail: andreas.bollmann@helios-gesundheit.de Affiliation: Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany ORCID logo https://orcid.org/0000-0002-5441-3906 Sven Hohenstein Roles Formal analysis, Methodology, Visualization, Writing – review & editing Affiliation: Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany ORCID logo https://orcid.org/0000-0002-9708-1593 Vincent Pellissier Roles Formal analysis, Methodology, Visualization, Writing – review & editing Affiliation: Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany Katharina Stengler Roles Writing – review & editing Affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Helios Park Hospital, Leipzig, Germany Peter Reichardt Roles Writing – review & editing Affiliation: Oncology Center Berlin-Buch, Helios Hospital Berlin-Buch and Berlin Cancer Institute, Berlin, Germany Jörg-Peter Ritz Roles Writing – review & editing Affiliation: Department of Surgery, Helios Hospital Schwerin, Schwerin, Germany Holger Thiele Roles Writing – review & editing Affiliation: Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany Michael A. Borger Roles Writing – review & editing Affiliation: Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany Gerhard Hindricks Roles Writing – review & editing Affiliation: Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany Andreas Meier-Hellmann Roles Project administration, Writing – review & editing Affiliation: Helios Kliniken, Berlin, Germany Ralf Kuhlen Roles Project administration, Writing – review & editing Affiliation: Helios Health, Berlin, Germany Introduction During the early phase of the Covid-19 pandemic, reductions of hospital admissions have been observed for several medical and surgical conditions [1–4]. [...]there is only scarce data on trends during later stages of the pandemic [5–7]. [...]the major focus of those studies was on inpatient care and emergency conditions [1–7]. The Helios hospital group operates acute care hospitals, outpatient clinics, and prevention centers across Germany (https://www.helios-gesundheit.de/) and patients have free choice of healthcare providers. [...]in-hospital mortality was somewhat higher in cardiovascular and oncology cases and this finding may also contribute to the observed excess mortality in Germany that was not associated with During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting. Using claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the "protection" stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06-1.15], P<0.01) and in oncology cases (4.5 vs. 4.3%, OR 1.06 [95% CI 1.01-1.11], P<0.01), it was similar in surgical (0.9 vs. 0.8%, OR 1.06 [95% CI 1.00-1.13], P = 0.07) and in psychiatry cases (0.4 vs. 0.5%, OR 1.01 [95% CI 0.78-1.31], P<0.95). There have been varying changes in care pathways and in-hospital mortality in different disciplines during the Covid-19 pandemic in Germany. Despite all the inherent and well-known limitations of claims data use, this data may be used for health care surveillance as the pandemic continues worldwide. While this study provides an up-to-date analysis of utilization of hospital care in the largest German hospital network, short- and long-term consequences are unknown and deserve further studies. |
| Author | Reichardt, Peter Stengler, Katharina Bollmann, Andreas Thiele, Holger Hohenstein, Sven Meier-Hellmann, Andreas Pellissier, Vincent Ritz, Jörg-Peter Borger, Michael A. Hindricks, Gerhard Kuhlen, Ralf |
| AuthorAffiliation | 3 Oncology Center Berlin-Buch, Helios Hospital Berlin-Buch and Berlin Cancer Institute, Berlin, Germany 6 Helios Health, Berlin, Germany 1 Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany 2 Department of Psychiatry, Psychotherapy and Psychosomatics, Helios Park Hospital, Leipzig, Germany 5 Helios Kliniken, Berlin, Germany 4 Department of Surgery, Helios Hospital Schwerin, Schwerin, Germany King’s College London, UNITED KINGDOM |
| AuthorAffiliation_xml | – name: 4 Department of Surgery, Helios Hospital Schwerin, Schwerin, Germany – name: King’s College London, UNITED KINGDOM – name: 1 Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany – name: 2 Department of Psychiatry, Psychotherapy and Psychosomatics, Helios Park Hospital, Leipzig, Germany – name: 3 Oncology Center Berlin-Buch, Helios Hospital Berlin-Buch and Berlin Cancer Institute, Berlin, Germany – name: 5 Helios Kliniken, Berlin, Germany – name: 6 Helios Health, Berlin, Germany |
| Author_xml | – sequence: 1 givenname: Andreas orcidid: 0000-0002-5441-3906 surname: Bollmann fullname: Bollmann, Andreas – sequence: 2 givenname: Sven orcidid: 0000-0002-9708-1593 surname: Hohenstein fullname: Hohenstein, Sven – sequence: 3 givenname: Vincent surname: Pellissier fullname: Pellissier, Vincent – sequence: 4 givenname: Katharina surname: Stengler fullname: Stengler, Katharina – sequence: 5 givenname: Peter surname: Reichardt fullname: Reichardt, Peter – sequence: 6 givenname: Jörg-Peter surname: Ritz fullname: Ritz, Jörg-Peter – sequence: 7 givenname: Holger surname: Thiele fullname: Thiele, Holger – sequence: 8 givenname: Michael A. surname: Borger fullname: Borger, Michael A. – sequence: 9 givenname: Gerhard surname: Hindricks fullname: Hindricks, Gerhard – sequence: 10 givenname: Andreas surname: Meier-Hellmann fullname: Meier-Hellmann, Andreas – sequence: 11 givenname: Ralf surname: Kuhlen fullname: Kuhlen, Ralf |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33765096$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1055_a_1592_2234 crossref_primary_10_1093_eurheartj_ehac227 crossref_primary_10_1007_s00432_023_05063_9 crossref_primary_10_2196_38600 crossref_primary_10_1093_nop_npad015 crossref_primary_10_32895_UMP_MPR_6_4_7 crossref_primary_10_1016_S2215_0366_23_00113_X crossref_primary_10_2196_50938 crossref_primary_10_4081_ecj_2023_11000 crossref_primary_10_1007_s00104_022_01684_x crossref_primary_10_1016_j_vaccine_2024_126354 crossref_primary_10_1186_s12875_022_01792_x crossref_primary_10_1007_s11605_022_05318_9 crossref_primary_10_1016_j_jacc_2022_06_008 crossref_primary_10_1371_journal_pone_0276123 crossref_primary_10_3389_fpsyt_2023_1198632 |
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| ContentType | Journal Article |
| Copyright | 2021 Bollmann et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2021 Bollmann et al 2021 Bollmann et al |
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| DOI | 10.1371/journal.pone.0249251 |
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| DocumentTitleAlternate | In- and outpatient hospital care in Germany during the Covid-19 pandemic |
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| References | S Singh (pone.0249251.ref009) 2020; 156 C Maringe (pone.0249251.ref012) 2020; 21 S König (pone.0249251.ref014) 2020 TS Anderson (pone.0249251.ref003) 2020 S König (pone.0249251.ref011) A Bollmann (pone.0249251.ref005) 2020 MM Mafham (pone.0249251.ref006) 2020; 396 AS Oseran (pone.0249251.ref004) 2020; 26 A Bollmann (pone.0249251.ref001) 2020; 6 S König (pone.0249251.ref008) 2018; 39 TJ Gluckman (pone.0249251.ref007) 2020 A Baum (pone.0249251.ref002) 2020; 324 A Stang (pone.0249251.ref010) 2020 M Cozad (pone.0249251.ref013) 2019; 109 |
| References_xml | – volume: 26 start-page: 327 issue: 8 year: 2020 ident: pone.0249251.ref004 article-title: Changes in hospital admissions for urgent conditions during COVID-19 pandemic publication-title: Am J Manag Care doi: 10.37765/ajmc.2020.43837 – volume: 156 start-page: 164 year: 2020 ident: pone.0249251.ref009 article-title: COVID-19 and out-of-hospital cardiac arrest: a systematic review and meta-analysis publication-title: Resuscitation. doi: 10.1016/j.resuscitation.2020.08.133 – volume: 21 start-page: 1023 issue: 8 year: 2020 ident: pone.0249251.ref012 article-title: The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study publication-title: Lancet Oncol. doi: 10.1016/S1470-2045(20)30388-0 – volume: 6 start-page: 221 issue: 3 year: 2020 ident: pone.0249251.ref001 article-title: Emergency hospital admissions and interventional treatments for heart failure and cardiac arrhythmias in Germany during the Covid-19 outbreak: insights from the German-wide Helios hospital network publication-title: Eur Heart J Qual Care Clin Outcomes doi: 10.1093/ehjqcco/qcaa049 – volume: 109 start-page: 1584 issue: 11 year: 2019 ident: pone.0249251.ref013 article-title: Debunking myths about health insurance claims data for public health research and practice publication-title: Am J Public Health doi: 10.2105/AJPH.2019.305317 – volume: 324 start-page: 96 issue: 1 year: 2020 ident: pone.0249251.ref002 article-title: Admissions to Veterans Affairs hospitals for emergency conditions during the COVID-19 pandemic publication-title: JAMA doi: 10.1001/jama.2020.9972 – start-page: 1 year: 2020 ident: pone.0249251.ref003 article-title: Hospitalizations for emergent medical, surgical, and obstetric conditions in Boston during the COVID-19 pandemic publication-title: J Gen Intern Med – start-page: qcaa071 year: 2020 ident: pone.0249251.ref005 article-title: Cumulative hospitalization deficit for cardiovascular disorders in Germany during the Covid-19 pandemic publication-title: Eur Heart J Qual Care Clin Outcomes doi: 10.1093/ehjqcco/qcaa071 – volume: 39 start-page: 3947 year: 2018 ident: pone.0249251.ref008 article-title: In-hospital mortality of patients with atrial arrhythmias: insights from the German-wide Helios hospital network of 161 502 patients and 34 025 arrhythmia-related procedures publication-title: Eur Heart J doi: 10.1093/eurheartj/ehy528 – volume: 396 start-page: 381 issue: 10248 year: 2020 ident: pone.0249251.ref006 article-title: COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England publication-title: Lancet doi: 10.1016/S0140-6736(20)31356-8 – year: 2020 ident: pone.0249251.ref007 article-title: Case rates, treatment approaches, and outcomes in acute myocardial infarction during the Coronavirus Disease 2019 pandemic publication-title: JAMA Cardiol – ident: pone.0249251.ref011 article-title: Regional and temporal disparities of excess all-cause mortality for Germany in 2020: Is there more than just Covid-19?2020 publication-title: J Infect. – year: 2020 ident: pone.0249251.ref014 article-title: In-hospital care in acute heart failure during the COVID-19 pandemic: insights from the German-wide Helios hospital network publication-title: Eur J Heart Fail. – year: 2020 ident: pone.0249251.ref010 article-title: Excess mortality due to COVID-19 in Germany publication-title: J Infect. |
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| Snippet | During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and... BackgroundDuring the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical... About the Authors: Andreas Bollmann Roles Conceptualization, Supervision, Writing – original draft, Writing – review & editing * E-mail:... |
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| SubjectTerms | Ambulatory Care - trends Cardiovascular Diseases - mortality Cardiovascular Diseases - pathology Coronaviruses COVID-19 COVID-19 - epidemiology COVID-19 - pathology COVID-19 - virology Databases, Factual Editing Emergency medical services Germany - epidemiology Heart Hospital Mortality Hospitalization Hospitalization - trends Hospitals Humans Medicine and Health Sciences Mortality Neoplasms - mortality Neoplasms - pathology Odds Ratio Oncology Pandemics Patient Admission - trends Patient admissions Psychiatry Psychosomatics Psychotherapy SARS-CoV-2 - isolation & purification Severe acute respiratory syndrome coronavirus 2 Surgery Trends Visualization |
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| Title | Utilization of in- and outpatient hospital care in Germany during the Covid-19 pandemic insights from the German-wide Helios hospital network |
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