Background Nationwide, unbiased, and unselected data of hospitalised patients with COVID-19 are scarce. Our aim was to provide a detailed account of case characteristics, resource use, and outcomes of hospitalised patients with COVID-19 in Germany, where the health-care system has not been overwhelmed by the pandemic. Methods In this observational study, adult patients with a confirmed COVID-19 diagnosis, who were admitted to hospital in Germany between Feb 26 and April 19, 2020, and for whom a complete hospital course was available (ie, the patient was discharged or died in hospital) were included in the study cohort. Claims data from the German Local Health Care Funds were analysed. The data set included detailed information on patient characteristics, duration of hospital stay, type and duration of ventilation, and survival status. Patients with adjacent completed hospital stays were grouped into one case. Patients were grouped according to whether or not they had received any form of mechanical ventilation. To account for comorbidities, we used the Charlson comorbidity index. Findings Of 10 021 hospitalised patients being treated in 920 different hospitals, 1727 (17%) received mechanical ventilation (of whom 422 [24%] were aged 18–59 years, 382 [22%] were aged 60–69 years, 535 [31%] were aged 70–79 years, and 388 [23%] were aged ≥80 years). The median age was 72 years (IQR 57–82). Men and women were equally represented in the non-ventilated group, whereas twice as many men than women were in the ventilated group. The likelihood of being ventilated was 12% for women (580 of 4822) and 22% for men (1147 of 5199). The most common comorbidities were hypertension (5575 [56%] of 10 021), diabetes (2791 [28%]), cardiac arrhythmia (2699 [27%]), renal failure (2287 [23%]), heart failure (1963 [20%]), and chronic pulmonary disease (1358 [14%]). Dialysis was required in 599 (6%) of all patients and in 469 (27%) of 1727 ventilated patients. The Charlson comorbidity index was 0 for 3237 (39%) of 8294 patients without ventilation, but only 374 (22%) of 1727 ventilated patients. The mean duration of ventilation was 13·5 days (SD 12·1). In-hospital mortality was 22% overall (2229 of 10 021), with wide variation between patients without ventilation (1323 [16%] of 8294) and with ventilation (906 [53%] of 1727; 65 [45%] of 145 for non-invasive ventilation only, 70 [50%] of 141 for non-invasive ventilation failure, and 696 [53%] of 1318 for invasive mechanical ventilation). In-hospital mortality in ventilated patients requiring dialysis was 73% (342 of 469). In-hospital mortality for patients with ventilation by age ranged from 28% (117 of 422) in patients aged 18–59 years to 72% (280 of 388) in patients aged 80 years or older. Interpretation In the German health-care system, in which hospital capacities have not been overwhelmed by the COVID-19 pandemic, mortality has been high for patients receiving mechanical ventilation, p...

Background The role of non-invasive ventilation (NIV) in severe COVID-19 remains a matter of debate. Therefore, the utilization and outcome of NIV in COVID-19 in an unbiased cohort was determined. Aim The aim was to provide a detailed account of hospitalized COVID-19 patients requiring non-invasive ventilation during their hospital stay. Furthermore, differences of patients treated with NIV between the first and second wave are explored. Methods Confirmed COVID-19 cases of claims data of the Local Health Care Funds with non-invasive and/or invasive mechanical ventilation (MV) in the spring and autumn pandemic period in 2020 were comparable analysed. Results Nationwide cohort of 17.023 cases (median/IQR age 71/61–80 years, 64% male) 7235 (42.5%) patients primarily received IMV without NIV, 4469 (26.3%) patients received NIV without subsequent intubation, and 3472 (20.4%) patients had NIV failure (NIV-F), defined by subsequent endotracheal intubation. The proportion of patients who received invasive MV decreased from 75% to 37% during the second period. Accordingly, the proportion of patients with NIV exclusively increased from 9% to 30%, and those failing NIV increased from 9% to 23%. Median length of hospital stay decreased from 26 to 21 days, and duration of MV decreased from 11.9 to 7.3 days. The NIV failure rate decreased from 49% to 43%. Overall mortality increased from 51% versus 54%. Mortality was 44% with NIV-only, 54% with IMV and 66% with NIV-F with mortality rates steadily increasing from 62% in early NIV-F (day 1) to 72% in late NIV-F (>4 days). Conclusions Utilization of NIV rapidly increased during the autumn period, which was associated with a reduced duration of MV, but not with overall mortality. High NIV-F rates are associated with increased mortality, particularly in late NIV-F.

Zusammenfassung Zusammenfassung Die Covid-19-Pandemie hat das stationäre Versorgungsgeschehen stark verändert. Der Beitrag beschreibt wesentliche durch die Pandemie bedingte Leistungsveränderungen. Des Weiteren werden die Charakteristika und Versorgungsstrukturen von Covid-19-Patienten dargestellt. Es zeigt sich ein deutlicher Rückgang der Krankenhausaufnahmen im Jahr 2020 im Vergleich zum Vorjahr, der in der ersten Pandemiewelle (März bis Mai) stärker ausfiel als in der zweiten Pandemiewelle (Oktober bis Dezember). Dies ging mit einer Verschiebung des Leistungsspektrums hin zu Fällen mit einer höheren Fallschwere einher. Bei den operativen Leistungen ist ein geringerer Rückgang zu verzeichnen als bei den übrigen Leistungen. Auch bei ausgewählten dringlichen Behandlungsanlässen kam es zu Fallzahlrückgängen. Noch stärkere Rückgänge wiesen die überwiegend verschiebbaren Behandlungsanlässe auf, bei denen sich auch während der Sommermonate keine Nachholeffekte abzeichneten. Dass es sich bei Covid-19 um eine sehr schwere Erkrankung handelt, verdeutlichen die hohen Sterblichkeitsraten der stationären Patienten sowie deren lange Verweil- und Beatmungsdauer.

This article analyses the changes in the annually agreed budgets for 2016 and 2017 on the basis of 1 230 somatic hospitals. The budgets of these hospitals increased by 3.0 % after adjustment, which corresponds to an increase in funds of around 1.8 billion euros. This budget increase rate in the first year of implementation of the Hospital Structure Act is the lowest since 2011. The adjusted price effect of 2.2 %, however, is in line with the average of previous years; the reason for the low rate of budget change is rather an agreed volume development of only 0.9 % after a record value in the previous year, which affects almost all service areas. It is still too early to assess to what extent this is also a direct consequence of the changed budget mechanisms for the financing of additional volumes or whether it has even initiated a trend reversal in the volume development in inpatient care. Nevertheless, it is a fact that the new, complex and controversial regulations have led to much later negotiations and implementation dates. For the first time since 2009, less than half of the total budget volume was implemented within the budget year, with the corresponding consequences for the planning and calculation security of hospitals and payers.

Background The role of non invasive ventilation (NIV) in severe COVID-19 requiring mechanical ventilation (MV) remains a matter of debate. Methods In this observational study of confirmed COVID-19 cases claims data of the Local Health Care Funds of MV patients were comparably analysed: spring period of 2020 (February to May) versus autumn period (October/November). Findings In a nationwide cohort 7,490 cases were included: median age 70 (IQR 60to79) years, 66% male, hypertension 67%, diabetes 42%, cardiac arrhythmia 43%, congestive heart failure 34%, renal failure 27%. Overall, 3,851 (51%) patients primarily received invasive MV without NIV, 1,614 (22%) patients received NIV without having been escalated to intubation, and 1,247 (17%) patients had NIV failure (NIVF), defined by endotracheal intubation following NIV. Comparing cases of the first and second period, the proportion of patients who received invasive MV decreased from 74% to 39%. Accordingly, the proportion of patients with NIV without subsequent intubation increased from 10% to 28%, and those failing NIV increased from 9% to 21%. The overall median length of hospital stay decreased from 26 to 22 days, and the overall duration of MV decreased from 11.6 to 7.6 days. The NIV failure rate decreased from 49% (219/449) to 42% (927/2,185). Overall mortality remained unchanged (51% and 53% respectively). Mortality was 39% with NIV only, 52% with invasive MV and 66% with NIVF with mortality rates steadily increasing from 58% in early NIVF (day 1) to 75% in late NIV-F (>5 days). Interpretation The utilization of NIV rapidly increased during the autumn period compared to the spring period 2020, which was associated with a reduced duration of MV and hospital stay, but not with overall mortality. NIVF rates are high and are associated with increased mortality rates, particularly in late NIVF. In contrast, NIV success is associated with the lowest mortality rates.