Indirect impact of Covid-19 on hospital care pathways in Italy

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.

Figure 1

Impact of Covid-19 on cardiological hospital care in Italy: volumes and performance by sub-period*. Weekly trend of indicators (left axis) with 95% CI and % variations (right axis)—January–July 2020 versus 2018–2019 average. *Pre-lockdown, lockdown (9/3–17/5), post-lockdown—W values and p-values from the paired-sample Wilcoxon test for comparisons within each sub-period.

Figure 2

Impact of Covid-19 on oncological hospital care in Italy: surgery volumes by sub-period*. Weekly trend of indicators (left axis) with 95% CI and % variations (right axis)—January–July 2020 versus 2018–2019 average. *Pre-lockdown, lockdown (9/3–17/5), post-lockdown—W values and p-values from the paired-sample Wilcoxon test for comparisons within each sub-period.

Figure 3

Impact of Covid-19 on orthopaedic hospital care in Italy: volumes and performance by sub-period*. Weekly trend of indicators (left axis) with 95% CI and % variations (right axis)—January–July 2020 versus 2018–2019 average. *Pre-lockdown, lockdown (9/3–17/5), post-lockdown—W values and p-values from the paired-sample Wilcoxon test for comparisons within each sub-period.