Healthcare utilization and clinical outcomes between remodeled and conventional respiratory departments in treating COVID-19 patients during omicron period in China: a propensity score-matched study

Abstract

Purpose This study aims to compare the clinical outcomes and healthcare costs of COVID-19 patients treated in either conventional or remodeled respiratory departments at a large medical center in China. Methods Using propensity score matching, we selected COVID-19 patients treated between December 2022 and February 2023. We compared all-cause in-hospital mortality as the primary outcome, along with secondary outcomes including length of hospitalization, rates of patients with critical illness complications, COVID-19 related treatments, and healthcare costs. Results Among the 5,102 COVID-19 patients treated during the study period, 4,553 (89.24%) were in the remodeled respiratory department, and 549 (10.76%) were in the conventional department. The final analysis included 1,633 propensity score-matched patients from the remodeled department and 549 from the conventional department at a ratio of 1:3. There were no significant differences in all-cause in-hospital mortality or length of hospitalization between the two groups. However, patients in the remodeled department had significantly higher rates of cerebrovascular complications (13.65% vs 8.74%, p = 0.003), higher rates of critical illnesses (3.61% vs 1.50% vs, p = 0.017), higher healthcare costs (7,400 vs 4,300, p < 0.001), while lower rates of respiratory complications (86.22% vs 99.63%, p < 0.001) and non-critical illnesses (45.19% vs 58.83%, p < 0.001). Patients in remodeled department received more invasive oxgen treatment than their counterpart while there was no difference regarding medication administering between the two groups. Conclusions During the COVID-19 pandemic, treatment in the remodeled respiratory department was associated with a higher incidence of critical illness and increased healthcare costs, but similar all-cause in-hospital mortality and length of hospitalization compared to the conventional department. Temporarily remodeling hospital infrastructure to expand respiratory care capacity can be a safe and effective strategy to manage surges in COVID-19 cases or other respiratory disorders at the expense of higer cost.