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The Regional Impact of COVID-19 on U.S. Academic Medical Centers: Lessons for Public Health Emergency Preparedness and Response

Published online by Cambridge University Press:  13 October 2025

Thad Wilkins ,
David Walsh ,
Ding Xie ,
Jennifer Waller ,
Phillip Coule  and
Dean Seehusen
Thad Wilkins*
Affiliation:
Department of Family and Community Medicine, Medical College of Georgia at Augusta University , Augusta, GA, USA
David Walsh
Affiliation:
Department of Medicine: Division of Hospital Medicine, Medical College of Georgia at Augusta University , Augusta, GA, USA
Ding Xie
Affiliation:
Department of Medicine: Division of Hospital Medicine, Medical College of Georgia at Augusta University , Augusta, GA, USA
Jennifer Waller
Affiliation:
Department of Family and Community Medicine, Medical College of Georgia at Augusta University , Augusta, GA, USA
Phillip Coule
Affiliation:
Department of Emergency Medicine, Medical College of Georgia at Augusta University , Augusta, GA, USA
Dean Seehusen
Affiliation:
Department of Family and Community Medicine, Medical College of Georgia at Augusta University , Augusta, GA, USA
*
Corresponding author: Thad Wilkins; Email: jwilkins@augusta.edu
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Abstract

Objective

To evaluate the hospital-level impact of the COVID-19 pandemic on U.S. academic medical centers (AMCs) and assess regional variation in care delivery to inform public health emergency preparedness strategies.

Methods

We retrospectively analyzed adult inpatient discharges from 106 AMCs using Vizient® Clinical Data Base from October 2019 to December 2023. The study period was divided into pre-COVID (Oct 2019-Mar 2020), early-COVID (Apr 2020-Dec 2020), late-COVD (Jan 2021-May 2023), and post-COVID (Jun-Dec 2023). Outcomes included hospital encounters, length of stay (LOS), ICU admissions, ICU LOS, mortality, and case mix index (CMI). Mixed models assessed temporal and regional variation.

Results

Among 13.5 million discharges, monthly encounters declined during early COVID and rebounded post-COVID (P < 0.0001). Observed LOS increased from 6.2 to 6.7 days during the pandemic and remained elevated post-COVID (P < 0.0001). ICU LOS rose during early and late COVID (P < 0.0001), while ICU admission rates declined slightly over time (P = 0.0112). Mortality peaked at 3.4% during early COVID and returned to 2.8% post-COVID (P < 0.0001).

Conclusions

The COVID-19 pandemic significantly disrupted inpatient operations at U.S. AMCs, with increased LOS, ICU burden, and case complexity. By segmenting the pandemic into phases, we identified patterns in hospital performance that reflect evolving public health challenges.

Keywords

COVID-19academic medical centersdisaster preparednesshealth system resilienceICU utilizationcase mix indexsurge capacitylength of staymortalityregional variation

Information

Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 19 , 2025 , e292
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

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