Regional differences in COVID-19 ICU admission rates in the Kingdom of Saudi Arabia: A simulation of the new model of care under vision 2030

Abstract

Objective Saudi Arabia has succeeded in having one of the lowest rates of COVID-19 worldwide due to the government’s initiatives in taking swift action to control both the spread and severity of the virus. However, Covid-19 can serve as a test case of the expected response of the new healthcare system under Vision 2030. This study used data from the thirteen present administrative regions of KSA to simulate the variations in ICU admission as a quality indicator in the five business units proposed by a new Model of Care. Methods We determined the rates of ICU admission for patients with confirmed SARS-CoV-2 (COVID-19) from March to mid-July 2020. The final sample included 1743 inpatients with moderate to severe COVID-19. Patient characteristics, including demographics, pre-existing chronic conditions, and COVID-19 complications, were collected. Business units (BUs) were compared with respect to the relative odds of ICU admission by using multiple logistic regression. Results After keeping patient and clinical characteristics constant, clear BU differences were observed in the relative odds of ICU admission of COVID-19 patients. Inpatient admission to ICU in our total sample was almost 50%. Compared to the Central BU, the Northern and Western BUs showed significantly higher odds of ICU admission while the Eastern & Southern BUs had significantly lower odds. Conclusion ICU use for COVID-19 patients differed significantly in KSA healthcare BUs, consistent with variations in care for other non-COVID-19-related conditions. These differences cannot be explained by patient or clinical characteristics, suggesting quality-of-care differences. We believe that privatization and the shift to fewer administrative BUs will help lessen or eliminate altogether the present variations in healthcare service provision.

Regional Differences in COVID-19 Mortality Rates in the Kingdom of Saudi Arabia: A Simulation of the New Model of Care

“…Geriatric patients may have increased mortality risks as their pre-existing conditions increase and have higher requirements for interventions such as oxygen, ICU, mechanical ventilation, and longer hospital stays [ 13 - 16 ]. A study of ICU admissions for COVID-19 inpatients in the KSA revealed age, sex, and comorbidities as risk factors similar to international studies [ 17 ]. Based on the aforementioned study and a review of international studies it is reasonable to expect that the elderly in Saudi Arabia would also be at higher risk for mortality [ 18 - 21 ].…”

“…After controlling for patient and disease factors, compared to the central BU, the northern BU had the highest mortality rate followed by the western, whose rates were 9.90 and 1.55 times higher, respectively, showing statistically significant increases, whereas the rates in the southern and eastern BUs were lowest, with rates 0.60 and 0.23 times lower, respectively, also showing statistically significant decreases. Disparities in the quality of care between BUs have been observed in ICU admissions indicating similar results with the northern and western BUs being highest and southern and eastern BUs being lowest revealing a concerning trend [ 17 ].…”

Characteristics of Hospitalized COVID-19 Patients in the Four Southern Regions Under the Proposed Southern Business Unit of Saudi Arabia

“…Complications linked to COVID-19 include bacterial pneumonia, sepsis, acute respiratory distress syndrome (ARDS), acute kidney injury, multi-organ failure, thromboembolism, and others. 8 , 9 As previously reported by several studies, health care resources throughout the world faced multiple challenges in meeting the surge in COVID-19 patients, including demand for intensive care units (ICUs) and other critical care services, the wide range of symptoms, complications, and outcomes requiring continual upgrading of treatment modalities, severe and persistent shortages of equipment and staff, and efficient distribution of the burden, among others. 9–11 Along with the toll on health care systems around the world, the COVID-19 pandemic has significantly disrupted socio-economic systems globally including food production and distribution, the supply chain, and the survival of many enterprises.…”

“…15 The pandemic has disrupted the healthcare system just as the transition of the healthcare system under Vision 2030 has begun, providing an opportunity to measure many quality factors using this rare occurrence. 8 , 16 …”

“…A 2021 systematic review of 80 studies to analyze COVID-19 risk factors based on patient continent of residence revealed many differences between continents, while a recent study in the KSA also revealed regional differences among the 13 regions. 8 , 26 Along with the global health crisis posed by COVID-19, there has been massive social and economic upheaval with schools closing, travel severely restricted, and job loss. 12 , 13…”