The untold story of COVID-19’s impact on healthcare quality: Part one

The pre-pandemic world feels like a distant memory when it comes to healthcare. Before COVID-19, hospitals hummed with a steady rhythm of admissions, procedures and discharges. Quality metrics (the numbers we use to track how well healthcare systems perform) were steadily improving. But then, in late 2019, the emergence of COVID-19 sent shockwaves throughout the world leaving a trail of devastation across social, economic and healthcare landscapes.

When COVID-19 hit, the U.S. healthcare system faced an unprecedented challenge as hospitals became overwhelmed by critically ill patients grappling with a novel and highly contagious virus. Inpatient care underwent a dramatic metamorphosis to accommodate the surge of sick people. What did this do to quality metrics? Did they all come tumbling down? Or, did they start to unfold a more nuanced story? In this two-part series, we’ll take a look.

The pre-pandemic era

The pre-pandemic era was characterized by a rigorous focus on delivering high quality care to every patient, regardless of their medical condition or background.

• Healthcare systems and providers engaged in a relentless pursuit of excellence, striving to meet (and exceed) various quality benchmarks set by regulatory agencies, accreditation bodies and quality reporting programs.
• Key initiatives underscored the industry's commitment to improving patient outcomes, enhancing patient safety and optimizing resources. To achieve these objectives, hospitals invested significant resources in infection control protocols, care coordination efforts and quality improvement initiatives.
• Staff training, performance monitoring and data analytics drove continuous improvement and fostered a culture of accountability and excellence.

Quality metrics report card

Quality metrics were looking pretty good before COVID-19 became an unwelcomed houseguest. The 2024 National Impact Assessment of the Centers for Medicare & Medicaid Services (CMS) Quality Measures Report provides valuable insight into the state of quality measures before and after the pandemic. For example:

• Chronic conditions: Healthcare organizations invested substantial resources into chronic disease management programs to address the growing prevalence of conditions such as diabetes, hypertension and heart disease. According to the report, quality metrics related to chronic disease management revealed steady improvement in performance. For example, the number of diabetic patients achieving target HbA1c levels increased by 10% over the past five years, reflecting improvements in glycemic control adherence to treatment guidelines. The report also highlights progress in other chronic conditions, such as blood pressure control for patients with hypertension and cholesterol management for individuals at risk of cardiovascular disease. Overall, metrics show fewer hospital readmissions and better medication adherence – signs that people with chronic conditions are getting better at-home management thanks to improved care coordination and patient education.
• Safety: Healthcare quality metrics in safety encompass a wide range of indicators, including hospital acquired infections such as methicillin-resistant staphylococcus aureus (MRSA), central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). To help mitigate risk and enhance patient safety, healthcare systems implemented robust protocols and quality safety improvement initiatives. Before COVID-19, fever healthcare-associated infections were reported in acute care settings. The estimate of avoided costs ranged widely from $93.8 million to $1.3 billion, reflecting successful infection control efforts and adherence to best practices in healthcare-associated infection prevention. Similarly, medication error rates decreased by 3% annually, indicating improvements in medication safety protocols.

Scrambling for survival

When COVID-19 struck, it ripped through the healthcare system and fundamentally altered the way it operates. The influx of COVID-19 patients strained hospitals, disrupted routine operations and challenged existing care delivery models. Hospitals were bursting at the seams, making it impossible to maintain the same level of infection control vigilance. According to the CMS quality measures report, standardized infection ratios for CLABSI, CAUTI and MRSA were worse than expected in acute care settings during 2020 and 2021. This reversed any improvement that occurred prior to COVID-19, demonstrating the dramatic impact COVID-19 has had on our ability to maintain pre-pandemic quality levels.

The unexpected positives

The negative impact COVID-19 has had on our world can still be seen (and felt). But it isn’t all doom and gloom. In part two of this post, we’ll examine some of the positives that have emerged from the pandemic. Stay tuned!

Javier Ortiz is a clinical development analyst for the Health Information Systems business at Solventum.