@Article{info:doi/10.2196/54355,
author="Huang, Jiaoling
and Qian, Ying
and Yan, Yuge
and Liang, Hong
and Zhao, Laijun",
title="Addressing Hospital Overwhelm During the COVID-19 Pandemic by Using a Primary Health Care--Based Integrated Health System: Modeling Study",
journal="JMIR Med Inform",
year="2024",
month="Jun",
day="3",
volume="12",
pages="e54355",
keywords="hospital overwhelm; primary health care; modeling study; policy mix; pandemic; model; simulation; simulations; integrated; health system; hospital; hospitals; management; service; services; health systems; develop; development; bed; beds; overwhelm; death; deaths; mortality; primary care",
abstract="Background: After strict COVID-19--related restrictions were lifted, health systems globally were overwhelmed. Much has been discussed about how health systems could better prepare for future pandemics; however, primary health care (PHC) has been largely ignored. Objective: We aimed to investigate what combined policies PHC could apply to strengthen the health care system via a bottom-up approach, so as to better respond to a public health emergency. Methods: We developed a system dynamics model to replicate Shanghai's response when COVID-19--related restrictions were lifted. We then simulated an alternative PHC-based integrated health system and tested the following three interventions: first contact in PHC with telemedicine services, recommendation to secondary care, and return to PHC for recovery. Results: The simulation results showed that each selected intervention could alleviate hospital overwhelm. Increasing the rate of first contact in PHC with telemedicine increased hospital bed availability by 6{\%} to 12{\%} and reduced the cumulative number of deaths by 35{\%}. More precise recommendations had a limited impact on hospital overwhelm (<1{\%}), but the simulation results showed that underrecommendation (rate: 80{\%}) would result in a 19{\%} increase in cumulative deaths. Increasing the rate of return to PHC from 5{\%} to 20{\%} improved hospital bed availability by 6{\%} to 16{\%} and reduced the cumulative number of deaths by 46{\%}. Moreover, combining all 3 interventions had a multiplier effect; bed availability increased by 683{\%}, and the cumulative number of deaths dropped by 75{\%}. Conclusions: Rather than focusing on the allocation of medical resources in secondary care, we determined that an optimal PHC-based integrated strategy would be to have a 60{\%} rate of first contact in PHC, a 110{\%} recommendation rate, and a 20{\%} rate of return to PHC. This could increase health system resilience during public health emergencies. ",
issn="2291-9694",
doi="10.2196/54355",
url="https://medinform.jmir.org/2024/1/e54355",
url="https://doi.org/10.2196/54355"
}