Impact of the Fall 2009 Influenza A(H1N1)pdm09 Pandemic on U.S. Hospitals

*Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC †Agency for Healthcare Research and Quality, Rockville, MD ‡Fogarty International Center, National Institutes of Health, Bethesda, MD §Weill Cornell Medical Center, New York, NY ∥National Center for Immunization and Respiratory Diseases ¶National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA #Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI **Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA ††Social and Scientific Systems Inc., Silver Spring, MD.
Medical care (Impact Factor: 3.23). 01/2013; 51(3). DOI: 10.1097/MLR.0b013e31827da8ea
Source: PubMed


Understanding how hospitals functioned during the 2009 influenza A(H1N1)pdm09 pandemic may improve future public health emergency response, but information about its impact on US hospitals remains largely unknown.

Research design:
We matched hospital and emergency department (ED) discharge data from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project with community-level influenza-like illness activity during each hospital's pandemic period in fall 2009 compared with a corresponding calendar baseline period. We compared inpatient mortality for sentinel conditions at high-surge versus nonsurge hospitals.

US hospitals experienced a doubling of pneumonia and influenza ED visits during fall 2009 compared with prior years, along with an 18% increase in overall ED visits. Although no significant increase in total inpatient admissions occurred overall, approximately 10% of all study hospitals experienced high surge, associated with higher acute myocardial infarction and stroke case fatality rates. These hospitals had similar characteristics to other US hospitals except that they had higher mortality for acute cardiac illnesses before the pandemic. After adjusting for 2008 case fatality rates, the association between high-surge hospitals and increased mortality for acute myocardial infarction and stroke patients persisted.

The fall 2009 pandemic period substantially impacted US hospitals, mostly through increased ED visits. For a small proportion of hospitals that experienced a high surge in inpatient admissions, increased mortality from selected clinical conditions was associated with both prepandemic outcomes and surge, highlighting the linkage between daily hospital operations and disaster preparedness.

Download full-text


Available from: Lyn Finelli,
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Microsimulation was used to assess the financial impact on hospitals of a surge in influenza admissions in advance of the H1N1 pandemic in the fall of 2009. The goal was to estimate net income and losses (nationally, and by hospital type) of a response of filling unused hospital bed capacity proportionately and postponing elective admissions (a "passive" supply response). Methods: Epidemiologic assumptions were combined with assumptions from other literature (e.g., staff absenteeism, profitability by payer class), Census data on age groups by region, and baseline hospital utilization data. Hospital discharge records were available from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). Hospital bed capacity and staffing were measured with the American Hospital Association's (AHA) Annual Survey. Results: Nationwide, in a scenario of relatively severe epidemiologic assumptions, we estimated aggregate net income of $119 million for about 1 million additional influenza-related admissions, and a net loss of $37 million for 52,000 postponed elective admissions. Implications: Aggregate and distributional results did not suggest that a policy of promising additional financial compensation to hospitals in anticipation of the surge in flu cases was necessary. The analysis identified needs for better information of several types to improve simulations of hospital behavior and impacts during demand surges.
    Health Services Research 02/2013; 48(2). DOI:10.1111/1475-6773.12041 · 2.78 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The impact of a severe influenza pandemic could be overwhelming to hospital emergency departments, clinics, and medical offices if large numbers of ill people were to simultaneously seek care. While current planning guidance to reduce surge on hospitals and other medical facilities during a pandemic largely focuses on improving the "supply" of medical care services, attention on reducing "demand" for such services is needed by better matching patient needs with alternative types and sites of care. Based on lessons learned during the 2009 H1N1 pandemic, the Centers for Disease Control and Prevention and its partners are currently exploring the acceptability and feasibility of using a coordinated network of nurse triage telephone lines during a pandemic to assess the health status of callers, help callers determine the most appropriate site for care (eg, hospital ED, outpatient center, home), disseminate information, provide clinical advice, and provide access to antiviral medications for ill people, if appropriate. As part of this effort, the integration and coordination of poison control centers, existing nurse advice lines, 2-1-1 information lines, and other hotlines are being investigated.
    Biosecurity and bioterrorism: biodefense strategy, practice, and science 03/2013; 11(1). DOI:10.1089/bsp.2013.0012 · 1.64 Impact Factor

  • Annals of emergency medicine 07/2013; 63(5). DOI:10.1016/j.annemergmed.2013.06.021 · 4.68 Impact Factor
Show more