At the close of 2019, the COVID-19 pandemic caught the world off guard, promptly becoming the most severe health crisis of the past 100 years. The rapid surge in cases worldwide has impacted health systems, which, together with restriction measures such as lockdowns, has caused substantial disruptions in the provision of care for non-COVID-19 patients. To understand the extent of this indirect impact on the provision of hospital care for other conditions, this research investigated hospital and emergency department admissions during the pandemic period (up to June 2021) in the areas of Bergamo and Brescia, two densely populated provinces in northern Italy which were hardly hit during the first epidemic wave in February-April 2020. Longitudinal retrospective analyses were conducted using time-series data to model variations in hospitalizations and emergency department visits over the study period, using 2017–2019 as a reference. The indirect impact of COVID-19 on hospital care pathways was also evaluated by fitting time-series of their proxies (i.e., hospital access, hospitalization and mortality) of high-volume, non-deferrable clinical conditions. Furthermore, data on COVID-19-attributable excess of health events (hospital admissions and emergency department visits) were analysed through epidemic surveillance systems to learn whether there was evidence of SARS-CoV-2 transmission in Bergamo and Brescia provinces in the period preceding the recognized epidemic outbreak in late February 2020 using healthcare administrative database. This dissertation provides complete estimates of hospital activity during the pandemic period and accurately details the impact that COVID-19 has had on the health services in Bergamo and Brescia, as well as on the Lombardy Regional Health Service in general. The results provide population-based evidence that expands our understanding of the disruptions caused by the COVID-19 pandemic; findings could also be used to inform policy and management decisions to ensure that the most appropriate health service responses and preparedness are implemented.

La pandemia da COVID-19, sviluppatasi in Cina alla fine del 2019, ha subito rappresentato la più devastante crisi sanitaria dagli inizi del XX secolo. La rapida trasmissione di SARS-CoV-2 e le restrizioni imposte per tenere sotto controllo il contagio hanno causato interruzioni e ritardi nell’assistenza a condizioni cliniche diverse dal COVID-19 stesso. Al fine di meglio comprendere l’impatto della pandemia sull’assistenza ospedaliera, questa ricerca è andata ad esaminare gli accessi ospedalieri e in pronto soccorso dagli inizi della pandemia (e fino a giugno 2021) nelle province di Bergamo e Brescia, due aree primariamente e duramente colpite durante la prima ondata pandemica tra febbraio e aprile 2020. Sono state condotte analisi longitudinali retrospettive sulle serie storiche degli accessi in ospedale e pronto soccorso, usando il triennio 2017-2019 come riferimento. L’impatto indiretto del COVID-19 sui percorsi assistenziali ospedalieri è stato ulteriormente esaminato attraverso proxy di cura (accessi in ospedale, ricoveri e mortalità) di condizioni cliniche caratterizzate da alti volumi e necessità di assistenza in emergenza-urgenza. Infine, i flussi amministrativi degli eventi che hanno mostrato un eccesso dovuto alla pandemia sono stati analizzati con strumenti di sorveglianza epidemica per stabilire se fosse possibile tracciare eventuali cluster epidemici nei territori bergamaschi e bresciani prima del riconoscimento dei primi casi di infezione alla fine di febbraio 2020. Nel complesso, questa tesi offre stime esaustive dei cambi nell’attività ospedaliera nel periodo pandemico, descrivendo accuratamente l’impatto che il COVID-19 ha avuto sul sistema sanitario nelle province di Bergamo e Brescia e, più ampiamente, sul Servizio Sanitario Regionale lombardo. I risultati forniscono, quindi, un’evidenza basata su dati di popolazione che aiuta a comprendere i disagi causati a pazienti e utenti dei servizi di salute. Le conclusioni di questo lavoro possono, quindi, servire da riferimento per orientare decisioni strategiche nella futura organizzazione dei servizi sanitari—non solo ospedalieri—nonché per sviluppare elementi di preparazione e risposta a COVID-19 e ad altri possibili eventi a carattere epidemico.

(2023). Analysis of hospital activity during the COVID-19 pandemic: population-based evidence from highly impacted provinces in northern Italy. (Tesi di dottorato, Università degli Studi di Milano-Bicocca, 2023).

Analysis of hospital activity during the COVID-19 pandemic: population-based evidence from highly impacted provinces in northern Italy

FERRARA, PIETRO
2023

Abstract

At the close of 2019, the COVID-19 pandemic caught the world off guard, promptly becoming the most severe health crisis of the past 100 years. The rapid surge in cases worldwide has impacted health systems, which, together with restriction measures such as lockdowns, has caused substantial disruptions in the provision of care for non-COVID-19 patients. To understand the extent of this indirect impact on the provision of hospital care for other conditions, this research investigated hospital and emergency department admissions during the pandemic period (up to June 2021) in the areas of Bergamo and Brescia, two densely populated provinces in northern Italy which were hardly hit during the first epidemic wave in February-April 2020. Longitudinal retrospective analyses were conducted using time-series data to model variations in hospitalizations and emergency department visits over the study period, using 2017–2019 as a reference. The indirect impact of COVID-19 on hospital care pathways was also evaluated by fitting time-series of their proxies (i.e., hospital access, hospitalization and mortality) of high-volume, non-deferrable clinical conditions. Furthermore, data on COVID-19-attributable excess of health events (hospital admissions and emergency department visits) were analysed through epidemic surveillance systems to learn whether there was evidence of SARS-CoV-2 transmission in Bergamo and Brescia provinces in the period preceding the recognized epidemic outbreak in late February 2020 using healthcare administrative database. This dissertation provides complete estimates of hospital activity during the pandemic period and accurately details the impact that COVID-19 has had on the health services in Bergamo and Brescia, as well as on the Lombardy Regional Health Service in general. The results provide population-based evidence that expands our understanding of the disruptions caused by the COVID-19 pandemic; findings could also be used to inform policy and management decisions to ensure that the most appropriate health service responses and preparedness are implemented.
MANTOVANI, LORENZO GIOVANNI
COVID-19; SARS-CoV-2; Ospedali; Pronto Soccorso; Italia
COVID-19; SARS-CoV-2; Hospital activity; Emergency department; Italy
MED/42 - IGIENE GENERALE E APPLICATA
English
21-feb-2023
SANITA' PUBBLICA
35
2021/2022
open
(2023). Analysis of hospital activity during the COVID-19 pandemic: population-based evidence from highly impacted provinces in northern Italy. (Tesi di dottorato, Università degli Studi di Milano-Bicocca, 2023).
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/404613
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