US Health Care Workforce Changes During the First and Second Years of the COVID-19 Pandemic

Cantor, Jonathan; Whaley, Christopher; Simon, Kosali; Nguyễn, Thủy

doi:10.1001/jamahealthforum.2021.5217

Cited by 31 publications

(32 citation statements)

References 5 publications

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“…Such increases in health care use will occur in the context of greater need for longterm care (further compounding pressure for hospital beds), as well as substantial care backlogs, critical staffing shortages and a shrinking health care workforce. [34][35][36][37][38][39][40][41] Although most people with SARS-CoV-2 infection will not need more health care, they will be competing for scarce health care resources with the subset of people whose use increases considerably. Such increased demand will require substantial population-level restructuring and investment of resources.…”

Section: Discussionmentioning

confidence: 99%

Post-acute health care burden after SARS-CoV-2 infection: a retrospective cohort study

McNaughton

Austin

Sivaswamy

et al. 2022

CMAJ

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The public health effects of the COVID-19 pandemic are difficult to overstate. 1 More than 600 million SARS-CoV-2 infections and 6.5 million deaths have been reported worldwide as of September 2022, 2 which are likely gross undercounts as many infections go undetected. 3 Long-term morbidity can be caused by SARS-CoV-2 infection. [4][5][6][7][8][9] In the first pandedmic wave, as many as 27% of people admitted to hospital died or were readmitted within 60 days, and as many as 70% of people who were not admitted to hospital reported at least 1 symptom 4 months after infection. 10,11 By the World Health Organization (WHO) definition, about 10%-20% of those infected acquire a post-COVID-19 condition (long COVID). 12,13 Analysis of 10 prospective surveys and the medical records of 1.1 million patients with COVID-19 diagnosis codes before the emergence of the Omicron variant showed similar find-ings: 7.8%-17% had symptoms 12 weeks after self-reported COVID-19, with 1.2%-4.8% reporting debilitating symptoms. 14 Estimates of long COVID vary by methodology (e.g., definitions of initial infection and timing of symptoms, timing of data collection), but risk is thought to be influenced by infection severity, type of variant, patient characteristics, vaccination 15 and, potentially, previous infection. 16 Because each new SARS-CoV-2 infection carries some risk of long COVID, everyone remains at risk for developing the condition.Health care funders, policy-makers and clinicians need a clear understanding of the impact of long COVID on use of health care resources to allocate resources equitably now and plan for future needs. 17 We sought to quantify the post-acute burden of health care use after SARS-CoV-2 infection among community-dwelling adults in Ontario.

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Section: Discussionmentioning

confidence: 99%

Post-acute health care burden after SARS-CoV-2 infection: a retrospective cohort study

McNaughton

Austin

Sivaswamy

et al. 2022

CMAJ

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“…Increases of this magnitude will require significant restructuring, innovation, and investment of resources, particularly in the context of existing prolonged wait times to access care, insufficient supply of acute and long-term care beds, and projected loss of health care workers. [30][31][32][33][34][35][36][37] Patterns of health care use differed by sex, adding to known differences by sex related to COVID-19. [38][39][40][41][42][43][44][45] Among women with a positive SARS-CoV-2 PCR test, increase in total health care utilization was larger than for men (at the 95% percentile, 4 additional health care encounters per person-year versus no difference for men; at the 99 th percentile, 76 additional health care encounters per person-year for women, compared to 37 encounters per person-year for men), and women used more of all types of health care.…”

Section: Discussionmentioning

confidence: 99%

Post-acute health care burden after SARS-CoV-2 infection: A retrospective cohort study of long COVID among 530,892 adults

McNaughton

Austin

Sivaswamy

et al. 2022

Preprint

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ImportanceThe SARS-CoV-2 pandemic portends a significant increase in health care use related to post-acute COVID sequelae, but the magnitude is not known.ObjectiveTo assess the burden of post-acute health care use after a positive versus negative polymerase chain reaction (PCR) test for SARS-CoV-2.Design, Setting, and ParticipantsRetrospective cohort study of community-dwelling adults January 1, 2020 to March 31, 2021 in Ontario, Canada, using linked population-based health data. Follow-up began 56 days after PCR testing.ExposuresIndividuals with a positive SARS-CoV-2 PCR test were matched 1:1 to individuals who tested negative based on hospitalization, test date, public health unit, sex, and a propensity score of socio-demographic and clinical characteristics.Main Outcomes and MeasuresThe health care utilization rate was the number of outpatient clinical encounters, homecare encounters, emergency department visits, days hospitalized, and days in long-term care per person-year. Mean health care utilization for test-positive versus negative individuals was compared using negative binomial regression, and rates at 95th and 99th percentiles were compared. Outcomes were also stratified by sex.ResultsAmong 530,232 unique, matched individuals, mean age was 44 years (sd 17), 51% were female, and 0.6% had received ≥1 COVID-19 vaccine dose. The mean rate of health care utilization was 11% higher in test-positive individuals (RR 1.11, 95% confidence interval [CI] 1.10-1.13). At the 95th percentile, test-positive individuals had 2.1 (95% CI 1.5-2.6) more health care encounters per person-year, and at the 99th percentile 71.9 (95% CI 57.6-83.2) more health care encounters per person-year. At the 95th percentile, test-positive women had 3.8 (95% CI 2.8-4.8) more health care encounters per person-year while there was no difference for men. At the 99th percentile, test-positive women had 76.7 (95% CI 56.3-89.6) more encounters per person-year, compared to 37.6 (95% CI 16.7-64.3) per person-year for men.Conclusions and RelevancePost-acute health care utilization after a positive SARS-CoV-2 PCR test is significantly higher compared to matched test-negative individuals. Given the number of infections worldwide, this translates to a tremendous increase in use of health care resources. Stakeholders can use these findings to prepare for health care demand associated with long COVID.Key PointsQuestionHow does the burden of health care use ≥56 days after a positive SARS-CoV-2 polymerase chain reaction (PCR) test compare to matched individuals who tested negative?FindingsAfter accounting for multiple factors, the mean burden of post-acute health care use was 11% higher among those who tested positive, with higher rates of outpatient encounters, days hospitalized, and days in long-term care. Rates of homecare use were higher for test-positive women but lower for men.For perspective, for every day in January 2022 with 100,000 or more infections, this translates to an estimated 72,000 additional post-acute health care encounters per year for the 1% of people who experienced the most severe complications of SARS-CoV-2; among those in the top 50% of health care use, this translates to 245,000 additional health care encounters per year. This increase will occur in the context of an ongoing pandemic and, in many health care systems, a depleted workforce and backlogs of care. Unless addressed, this increase is likely to exacerbate existing health inequities.MeaningGiven the large number of people infected, stakeholders can use these findings to plan for health care use associated with long COVID.

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“…Healthcare worker fatigue and burnout are major issues in healthcare 4 . Routinely, healthcare systems are experiencing high levels of personnel turnover, temporary staffing solutions, and changing workforce dynamics 5 . Much effort has been made to preserve inpatient capacity, but our data illustrates that the immediate perioperative workforce at NM has not experienced a decrease in overall workload in terms of overall time in the OR.…”

Section: Discussionmentioning

confidence: 99%

Operating room utilization – How the pandemic affected resulting case volume

Ringenberg¹,

Fremming²,

Berky³

et al. 2022

Perioperative Care and Operating Room Management

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US Health Care Workforce Changes During the First and Second Years of the COVID-19 Pandemic

Cited by 31 publications

References 5 publications

Post-acute health care burden after SARS-CoV-2 infection: a retrospective cohort study

Post-acute health care burden after SARS-CoV-2 infection: a retrospective cohort study

Post-acute health care burden after SARS-CoV-2 infection: A retrospective cohort study of long COVID among 530,892 adults

Operating room utilization – How the pandemic affected resulting case volume

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