How Data Analytics Helped Providence St. Joseph Address Care Delays

Since the start of the pandemic last year, hospital data has shown lower rates of unplanned hospital visits and higher rates of in-hospital mortality. According to Dr. Ari Robicsek, who is the chief medical analytics officer at Providence St. Joseph Health Center, this could be due to patients delaying care because of the pandemic.

According to Robicsek, hospitals and providers have the unique opportunity to make use of the data within their systems to help communities.

“We've collected an enormous amount of data in the context of caring for our patients. One of the things that I was routinely doing early in the pandemic was just tracking data on among other things, patient volumes,” Robicsek told HealthITAnalytics.

“What I noticed was that not only had the volumes of patients coming into our hospital for elective procedures dropped early in the pandemic, which was totally expected, but we also saw this substantial drop in the volume of patients coming to us for emergency type of reasons, strokes, heart attacks, and gastrointestinal bleeds and other things.”

This decline in hospital visits was not only reported in the Providence hospital system but in a variety of other locations as well. According to Robicsek, Providence saw about a 48 percent decrease in people coming to the hospital for acute reasons.

After witnessing this trend at Providence, Robicsek and a team of scientists began looking into why patient visits were down by analyzing pre-pandemic hospital data versus pandemic data from the year 2020. 

Through the study, the team discovered that not only were fewer people coming into the hospitals, but patients without COVID-19 were showing high in-hospital mortality rates. Robicsek and the team focused the study on why there was a decreased rate of people coming to the hospital, but a higher mortality rate when people did.

The researchers examined unplanned hospitalization data from January 2019 to December 2020 across six states in the Providence St. Joseph Health system. The states were Alaska, Washington, Montana, Oregon, California, and Texas. The team categorized a visit as unplanned if an “urgent” or “emergency” service was recorded.

The data showed three specific pandemic periods with different trends in hospitalization. These included the ten weeks corresponding to the spring COVID-19 surge (March 4 to May 13, 2020), an intervening period during the summer and early fall (May 14 to October 19, 2020), and a second ten-week period that corresponded to the fall COVID-19 surge (October 20 to December 31, 2020).

The data was compared to a pre-pandemic baseline period from January 1, 2019, to March 3, 2020. The researchers showed that fewer patients were coming into the hospital, and those that did were seeing higher mortality rates.

Robicsek suggested this could be due to patients delaying care due to the pandemic. Patients could be actively avoiding taking trips to the hospital out of fear of becoming infected by COVID-19. For that reason, those that were less sick were staying home, while those with more severe illnesses were continuing to visit the hospital.

While evidence suggests that patients were delaying care due to a fear of COVID-19 infection at the hospital, Robicsek released a separate study last year determining that individuals are no more likely to contract COVID-19 in an emergency department (ED) than in any other place. The study highlighted the fact that hospitals are safe, and patients should not delay care.

Delaying care can present providers challenges and is dangerous for patients. As patients become sicker, there are fewer options for medical professions in terms of treatment.

“If you have a severe pneumonia, it's harder to treat than a moderately severe pneumonia. You need more antibiotics, you need them for longer, they're less likely to work. Same thing with a stroke,” Robicsek said.

Not only does delaying care create problems for providers and patients but also population health. Robicsek highlighted the importance of communicating with patient communities and ensuring them that hospitals are safe.

“What I would say is this adds another facet to the sort of pandemic learnings about population health, which is that we need to do a good job as health systems of reassuring our communities, that hospitals are safe places to come, if you're feeling sick, even during a pandemic.”

With cases of COVID-19 rising once again, Robicsek identified some strategies that hospitals can pursue to ensure patients that hospitals are a safe place to be. Providence launched a campaign based on the study’s findings conveying to their patient population that despite the COVID-19 pandemic, it’s safe to come to the hospital.

Additionally, Providence is developing relationships between clinicians and patients to get the message out that way.

“I believe what critical health systems can do is reassure the physicians that they can be reassuring their patients that you start having chest pain, come to the ED. Don't hesitate just because there's a pandemic,” Robicsek said.

Robicsek explained patients should not be afraid to come to the hospital if they need assistance.

“The answer that comes from the mortality part of our study is, in some cases, [patients are] staying home or they're waiting way too long to come to the hospital. So those are the critical findings, and combined with our other work, the message is don't delay. It's safe to come to the hospital, it's dangerous to stay home if you're sick,” Robicsek concluded.