Indirect impact of Covid-19 on hospital care pathways in Italy
Teresa Spadea, Chiara Di Girolamo, Tania Landriscina, Olivia Leoni, Silvia Forni, Paola Colais, Caterina Fanizza, Alessandra Allotta, Roberta Onorati, Roberto Gnavi, the Mimico-19 working group, Teresa Spadea, Roberto Gnavi, Tania Landriscina, Roberta Onorati, Alessandro Migliardi, Giuseppe Costa, Olivia Leoni, Michele Ercolanoni, Chiara Di Girolamo, Elena Berti, Nicola Caranci, Maria Luisa Moro, Silvia Forni, Valeria Di Fabrizio, Sara D’Arienzo, Fabrizio Gemmi, Paola Colais, Luigi Pinnarelli, Mariangela D’Ovidio, M Balducci, Marina Davoli, Caterina Fanizza, Vito Petrarolo, Giulia Piepoli, Lucia Bisceglia, Alessandra Allotta, Achille Cernigliaro, Salvatore Scondotto
Abstract
Earlier in 2020, seven Italian regions, which cover 62% of the Italian population, set up the Mimico-19 network to monitor the side effects of the restrictive measures against Covid-19 on volumes and quality of care. To this aim, we retrospectively analysed hospital discharges data, computing twelve indicators of volume and performance in three clinical areas: cardiology, oncology, and orthopaedics. Weekly indicators for the period January-July 2020 were compared with the corresponding average for 2018-2019; comparisons were performed within 3 sub-periods: pre-lockdown, lockdown, and post-lockdown. The weekly trend of hospitalisations for ST-segment elevation myocardial infarction (STEMI) showed a 40% reduction, but the proportion of STEMI patients with a primary PTCA did not significantly change from previous years. Malignant neoplasms surgery volumes differed substantially by site, with a limited reduction for lung cancer (< 20%) and greater declines (30-40%) for breast and prostate cancers. The percentage of timely surgery for femoral neck in the elderly remained constantly higher than the previous 2 years whereas hip and knee replacements fell dramatically. Hospitalisations have generally decreased, but the capacity of a timely and effective response in time-dependent pathways of care was not jeopardized throughout the period. General trends did not show important differences across regions, regardless of the different burden of Covid-19. Preventive and primary care services should adopt a pro-active approach, moving towards the identification of at-risk conditions that were neglected during the pandemic and timely addressing patients to the secondary care system.