TY  - JOUR
AU  - Huang, Jiaoling
AU  - Qian, Ying
AU  - Yan, Yuge
AU  - Liang, Hong
AU  - Zhao, Laijun
PY  - 2024
DA  - 2024/6/3
TI  - Addressing Hospital Overwhelm During the COVID-19 Pandemic by Using a Primary Health Care–Based Integrated Health System: Modeling Study
JO  - JMIR Med Inform
SP  - e54355
VL  - 12
KW  - hospital overwhelm
KW  - primary health care
KW  - modeling study
KW  - policy mix
KW  - pandemic
KW  - model
KW  - simulation
KW  - simulations
KW  - integrated
KW  - health system
KW  - hospital
KW  - hospitals
KW  - management
KW  - service
KW  - services
KW  - health systems
KW  - develop
KW  - development
KW  - bed
KW  - beds
KW  - overwhelm
KW  - death
KW  - deaths
KW  - mortality
KW  - primary care
AB  - 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. 
SN  - 2291-9694
UR  - https://medinform.jmir.org/2024/1/e54355
UR  - https://doi.org/10.2196/54355
DO  - 10.2196/54355
ID  - info:doi/10.2196/54355
ER  -