The COVID-19 pandemic substantially disrupted healthcare delivery internationally, forcing institutions to balance COVID-19 care and maintenance of routine clinical services. The relationship between institutional attributes and changes in clinical practice during pandemic emergency periods was uncertain. This study evaluated how hospital characteristics influenced implementation of percutaneous coronary intervention (PCI) during state of emergency periods declared for COVID-19, using national administrative data.
Analyses used Diagnosis Procedure Combination (DPC) data covering the period from April 2018 through December 2021. The dataset provided hospital-level counts of procedures and allowed longitudinal assessment across multiple state of emergency periods during the COVID-19 pandemic.
A total of 634 hospitals were classified along two independent stratification schemes: historical PCI volume (High, Middle, Low) and institutional COVID-19 response level (High, Middle, Low). To quantify changes in PCI delivery associated with state of emergency periods, the authors employed autoregressive integrated moving average (ARIMA) time-series models with exogenous variables (ARIMAX), enabling estimation of percent changes in both emergency and elective PCI attributable to the emergency declarations.
When hospitals were grouped by historical PCI volume, the study found statistically significant decreases in both emergency and elective procedures among higher-volume centers. Specifically, high-volume facilities showed a 5.0% reduction in emergency PCI and a 9.6% reduction in elective PCI. Middle-volume facilities had comparable declines: 5.1% for emergency PCI and 10.8% for elective PCI. The abstract reports these reductions as significant; exact p-values and confidence intervals were not reported in the abstract.
Stratifying hospitals by COVID-19 response level revealed larger decreases in elective procedures at facilities classified as high-response. High-response facilities experienced a 17.7% reduction in elective PCI, compared with reductions of 8.5% at medium-response facilities and 6.4% at low-response facilities. The study thus identifies differential impacts on elective care that correlate with institutional COVID-19 response intensity.
The authors characterized differences in institutional types across COVID-19 response strata. Facilities with a high COVID-19 response had a greater proportion of public hospitals (62.1%) and a much lower share of advanced treatment hospitals (4.9%) compared with low-response facilities, which were 43.0% public and 21.2% advanced treatment hospitals. These distributions suggest that hospital ownership and advanced-care designation were associated with the degree of institutional engagement in COVID-19 response activities.
The observed patterns are interpreted as evidence of functional differentiation among medical institutions during the pandemic: hospitals assumed distinct roles that affected their ability to deliver PCI. According to the authors, these differences arose from complex interactions among historical institutional roles (for example, prior PCI volume and advanced-care status), management constraints imposed during emergency response, and institutional priorities such as allocation of beds and staff toward COVID-19 care versus routine cardiovascular services.
Based on the findings, the authors emphasize the importance of explicit planning for role allocation across medical institutions in future infectious disease outbreaks. They highlight the need for management support systems that enable institutions to maintain essential non-COVID services—such as PCI—while responding to surges in infectious disease caseloads. The results imply that policymakers should consider institutional characteristics (ownership, advanced treatment designation, historical procedure volume) when organizing regional or national response frameworks to preserve critical cardiovascular services.
The abstract summarizes design, methods, and principal findings but does not provide details on several elements commonly reported in full manuscripts. Specifically, the abstract does not report model diagnostics (for example, ARIMA model fit statistics), exact p-values or confidence intervals for the percent changes, patient-level characteristics, or any sensitivity analyses. If these details are needed for appraisal, they would require consulting the full text.
Using nationwide DPC data and time-series ARIMAX models, the study found that reductions in emergency and elective PCI during COVID-19 state of emergency periods varied by hospital PCI volume and by institutional COVID-19 response level. High- and middle-volume PCI centers showed significant declines in both emergency and elective interventions, while high-response COVID-19 facilities had the largest decrease in elective PCI and differed in ownership and advanced-care status from low-response facilities. The authors conclude that functional differentiation among institutions during the pandemic reflected historical roles, management constraints, and institutional priorities, and they recommend planned role allocation and improved management support to sustain essential services during future outbreaks.