Quality of care may be slipping during COVID, experts warn

Quality of care may be slipping during COVID, experts warn

The quality of patient care for non-COVID-19 patients during the pandemic is unclear , mainly because of a lack of data. Early on in the pandemic response, CMS announced it would suspend for the first two quarters of 2020 reporting for quality programs, which means understanding of patient safety during the initial stages of the pandemic may be uncertain. Even before the pandemic, quality data publicly posted from CMS was about two years and older on average.
For its part, the Centers for Disease Control and Prevention is releasing raw mortality data on what they call excess deaths, which are the number of deaths that are greater than what would be expected based on previous years.
There were 225,530 excess deaths from March 1 to Aug. 1, 2020, and about one-third were directly attributed to COVID-19, according to a study in JAMA. The remaining deaths can be explained by increases in deaths from other conditions like heart disease, diabetes and Alzheimer’s disease. Some conditions like sepsis were relatively stable throughout the pandemic.
The CDC data has some limitations, said Dr. Steven Woolf, professor of family medicine and population health at the Virginia Commonwealth University School of Medicine and lead author of the JAMA study on excess deaths during COVID. The data relies on information from death certificates, which may incorrectly attribute the cause of death, he said.
Although there isn’t hard data to explain these excess deaths, anecdotal reports of people delaying care can in part explain the rise, Woolf said. He added circumstances in healthcare settings are also likely contributing to excess deaths. For instance, a hospital experiencing a surge of COVID cases may be delayed in treating an emergent stroke patient because resources are strained.
“You can imagine the flooding of the healthcare system getting in the way of these folks getting the care they need,” he said.
CMS data that has still been released during COVID is its hospital inspection reports, but they don’t paint a clear picture of care quality. Overall, CMS reported fewer hospital inspection reports in 2020. Through November 2020 there were 1,090 events reported and available to view on the Association of Health Care Journalists website, which compiles and posts the data. In 2019, 4,423 reports were posted. CMS did postpone routine inspections for the first few months of COVID but immediate jeopardy and abuse inspections never stopped. The drop in inspection reports can partly be explained by pausing of elective procedures and declines in hospital volumes throughout the pandemic.
The American Hospital Association argues hospitals have done all they can to adapt to the challenges brought on by the pandemic while maintaining quality of care. Nancy Foster, AHA’s vice president of quality and patient safety policy, said in a statement that early in the pandemic response, hospitals faced unknowns in terms of how to best treat the virus. Additionally, strains on resources were a major concern. But in the months since, Foster said “we’ve learned more about how the virus is transmitted, (and) we’ve been able to refine and improve these actions to be even more effective in keeping patients and staff safe.”
“America’s hospitals and health systems take very seriously their mission to care for their patients and communities. The American public can rest assured that we are taking every precaution necessary to protect you and your loved ones when you come to us,” Foster added.

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