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.

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