The quality of care can degrade during COVID, experts warn

The quality of patient care for non-COVID-19 patients during the pandemic is unclear, mainly due to a lack of data. Early in the response to the pandemic, CMS announced that it would suspend reporting for quality programs for the first two quarters of 2020, which means understanding patient safety in the early stages of the pandemic may be uncertain. Even before the pandemic, the quality data published publicly by CMS were on average two years and older.

The Centers for Disease Control and Prevention, for their part, publish raw mortality data on what they call excessive deaths. This is the number of deaths higher than expected based on previous years.

According to a study in JAMA, from March 1 to August 1, 2020, there were 225,530 more deaths and about a third were directly attributed to COVID-19. The remaining deaths can be explained by the increase in deaths from other medical conditions such as heart disease, diabetes and Alzheimer's. Some conditions, such as sepsis, were relatively stable during the pandemic.

The CDC data has some limitations, said Dr. Steven Woolf, professor of family medicine and population health at Virginia Commonwealth University Medical School and lead author of the JAMA study of excessive deaths during COVID. The data is based on information from death certificates, which may mislead the cause of death, he said.

While there isn't hard data to explain these excessive deaths, individual reports from people delaying care may partially explain the increase, Woolf said. He added that healthcare circumstances are also likely to lead to excessive deaths. For example, a hospital experiencing an increase in COVID cases may delay treating a patient with recent stroke because resources are drained.

"You can imagine that the flooding of the healthcare system is getting in the way of these people from getting the care they need," he said.

CMS data released during COVID is the hospital inspection reports, but it doesn't paint a clear picture of the quality of care. Overall, CMS reported fewer hospital inspection reports in 2020. As of November 2020, 1,090 events have been reported which can be viewed on the Association of Health Care Journalists' website, where the data is compiled and published. 4,423 reports were published in 2019. CMS postponed routine inspections for the first few months of COVID, but immediate inspections of hazards and abuse never stopped. The decline in inspection reports can be explained in part by the disruption in electoral processes and the decline in hospital volume during the pandemic.

The American Hospital Association argues that hospitals have done everything possible to adapt to the challenges of the pandemic while maintaining quality of care. Nancy Foster, AHA's vice president of quality and patient safety, said in a statement that as the pandemic response began, hospitals faced unknowns about how best to treat the virus. In addition, the stress on resources was a major concern. In the months since then, Foster said, "We have learned more about the transmission of the virus (and) we have fine-tuned and improved these measures to keep patients and staff safe more effectively."

“America's hospitals and health systems take their mission to care for their patients and communities very seriously. The American public can be assured that we will take all necessary precautions to protect you and your loved ones when you join us, ”added Foster.

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