Investigation of the cost of COVID-19 patients applying to the emergency department during their stay in the emergency department and the factors affecting this cost

Objective: The aim of this thesis is to examine the costs incurred during the time patients spend in the emergency department during the Covid-19 pandemic and the various factors that affect these costs. Since the beginning of the pandemic, health systems worldwide have entered an unprecedented mode of operation. Emergency departments have become one of the most intense points of this mode of operation and have taken on a critical role in the treatment of Covid-19 patients. The focus of the research is to calculate emergency department costs and identify variables that affect these costs. These variables include the patient's age, gender, whether a SARS-CoV 2 PCR test was performed, additional health problems, the presence of medical procedures performed, and factors such as clinical outcome. The research will analyze the effects of these variables on cost using quantitative methods. This analysis can help hospitals and health policy makers manage emergency department resources more effectively during and after the pandemic. This study aims to evaluate the cost of the initial responses of emergency departments, one of the most accessible and responsive units of health systems when a pandemic emerges. Therefore, this analysis aims to examine in detail how emergency departments responded to this extraordinary situation and the financial impacts of these responses. Another important aspect of this study is the development of the methodology used in cost calculations. Hence, the study aims to calculate emergency department costs more accurately using various statistical methods and cost modeling techniques. This will provide both an academic and practical contribution and will help improve the methods used in calculating health service costs. In addition, by providing a detailed analysis of the variables that affect the cost of emergency services during the pandemic, it aims to provide information that will guide health service providers and policy makers for more effective use of resources. This information can be used to make health systems more resilient and effective in crisis situations like a pandemic. One more last aim is to increase the scientific and practical knowledge necessary to understand the cost and management of health services and to contribute to the existing literature in this field. This contribution will play an important role in increasing the efficiency and effectiveness of health services by providing a better understanding of the factors that affect the cost of health services. In this way, this research can help health services better prepare for future pandemics and other crises. Materials And Methods: This research covers patients who applied to the Covid-19 Emergency Medicine Clinic of Süleyman Demirel University Medical School Hospital between August 1, 2020, and October 31, 2020. Our study examined the files of 1976 patients, particularly those with Z03 (Medical observation and evaluation of suspected cases) and U07.3 (Covid-19, virus not identified) diagnosis codes. Using the hospital information system, the medical records of these patients were scanned in detail. 1960 patients with complete cost information and other medical information were included in the study. In this study, patients' demographic information (age, gender), comorbid diseases, laboratory test needs, HRCT requests, consultation requests, medical treatment status needs, and SARS-CoV-2 PCR test results were examined according to patients' clinical outcomes. After the patient data were recorded, this information was collected in a worksheet in the Microsoft Excel program. Later, this worksheet was analyzed using IBM SPSS (Statistical Package for the Social Sciences) version 29.0. The statistical significance of the data was determined through both non-parametric and parametric tests. In addition, relationships between variables were examined with random forest importance analysis and multiple linear regression analysis. Findings: The study included 1960 patients. Among all, no statistical significance was found between the costs of women and men (p=0.057). In the non parametric tests performed, it was observed that age, the presence of comorbid diseases (diabetes mellitus, hypertension, cardiovascular diseases, asthma-COPD, malignancy, and other group diseases), and the positive result of SARS-CoV-2 PCR test have increased the cost. It was also notable that laboratory requests, HRCT requests, consultations, and applying treatment in the emergency department directly affect the cost. Although there was no significant difference between patient costs in terms of clinical outcome, the cost of patients hospitalized in non-covid-19 services was marginally higher than discharged patients (p=0.053). Conclusion: The pandemic has changed the way hospitals operate, restricting some services and dedicating many departments to Covid-19 treatment. This academic study is working on a cost analysis of a university hospital's emergency department during the Covid-19 pandemic. The research analyzes the effects of patients' characteristics on cost based on Covid-19 emergency department patient applications. Despite the higher number of male applications, no significant cost difference has been detected based on gender. While the applications of patients in the 25-49 age range were found to be high, it was observed that the costs of the group aged 75 and over were higher. This finding shows that age significantly affects the cost. Due to patients' needs for additional health services such as comorbid diseases, additional laboratory tests, imaging, and additional treatments, costs have increased. Factors such as laboratory tests, imaging, treatment, and consultation directly affect patient costs. According to the cost analysis of the SARS-CoV-2 PCR test, it was observed that the costs of patients who are PCR positive are higher than those who are negative. It is thought that the cost of positive cases has increased due to the higher examination and treatment costs. In clinical outcomes, no general difference was seen among Covid-19 emergency service costs. This situation can be explained by the fact that patients suspected of Covid-19 during the pandemic process are generally examined and imaged. The aim of the research is to determine the costs of Covid-19 emergency services and to use the results to contribute the development of health services and health policies. The results obtained aimed to provide a basis for presenting new ideas for health processes and preparing better for pandemics. It also aims to be prepared for potential pandemics that may be encountered in the future.