Quantifying activity reduction during the COVID-19 pandemic

It has been observed that fewer patients are presenting to hospital with acute coronary syndromes (ACS) during the coronavirus pandemic. As a result they are not started on the necessary medical treatment (i.e. statins, antihypertensives and anticoagulants in the case of the missed STEMI and NSTEMI patients), nor will they have received any interventional treatment, which will have longer term impacts on health outcomes for these patients.

13 May 2020 | 1 min read

Summary

Dr Foster is analysing data during the COVID-19 pandemic aiming to explore how the increases in demand from COVID-19 patients and changes to supply of elective procedures will have a knock-on effect on volumes of patients in the wider population receiving both routine and urgent care.

We will look at patients presenting with acute medical conditions and undergoing procedures where there is a clear intervention/treatment that is known to impact health outcomes in the long term.

  1. Calculate the percentage change in activity between expected volumes of spells for April 2020
  2. Volumes of expected and actual admissions in April 2020 for all diagnosis and all procedure groups relating to the dominant diagnosis/procedure of a spell.
  3. Calculate the difference between the expected and actual number of admissions for all procedure groups and all diagnosis groups relating to the dominant diagnosis/procedure of a spell
  4. Plot the trend of the volume of spells in the month of April over the last 5 years (including April 2020) for any key diagnosis or procedure groups of interest identified in the above analysis

Quantifying activity reduction: planning for higher levels of acuity

This phenomenon could be applied to a range of other medical and surgical conditions and it’s possible that during the pandemic patients have a higher threshold to report the signs and symptoms of underlying health conditions – possibly due to a fear of contracting the virus whilst hospitalised or patients not wishing to put any additional strain on the NHS – and therefore there could be a sizeable proportion of the population with undiagnosed health conditions.

This analysis aims to help providers to plan their response to the higher levels of acuity they are likely to be faced with after the pandemic is under control. In addition a reduction in the number of elective diagnostic procedures could have impacts on the timing of cancer diagnosis and it would be useful to quantify this reduction in order to assist planning of future activity in the recovery period.

What risk factors can we analyse?

In the first instance Dr Foster proposes to look across all diagnostics and procedure groups to see which groups show the largest percentage reduction (or increase) in admissions. We will also group specific sets of ICD10 codes to focus on specific R codes (signs and symptoms) and cardiology conditions (on separate graphs) with significant long-term benefits to timely diagnosis and management.

Admissions with R codes will often lead to the request of further investigations and referral to other services therefore a reduction in these could have a significant impact on diagnosis and treatment further down the line.

Further analysis

  • Acute coronary syndromes (emergency admissions only)
  • Other cardiology diagnoses of interest (emergency admissions only)
  • Cardiology procedures
  • Common procedures
  • Diagnostic procedures

 

The analyses proposed above can be delivered as a Tableau dashboard available to be read using Tableau Reader or as a static PDF report. The data accompanying Tableau can also be provided separately in Excel as required.