Author: Remus Iulian Nica

Quality of Care and Post-COVID Disability in Romania: A Patient-Reported, Hospital-Wide Study

Background: COVID-19, declared a Public Health Emergency of International Concern, affected hospital operations by increasing the number of patients presenting to hospitals, the necessity to control infections, and the shortage of staff. Through our study, we evaluated the quality and quantity of care and how these changes affected patient experience and outcomes, and we identified actionable methods in order to prepare for the future. Methods: We analyzed data between 2020 and the first half of 2023 from a Romanian tertiary military hospital using patient-reported experience surveys and operational indicators (readmissions, postoperative complications). Associations were assessed using Pearson and Spearman correlation coefficients. We then benchmarked against an ideal surge-ready hospital using a 0-1 Composite Risk Index (CRI) that integrates occupancy, adverse-event density, flow reliability, and readmissions. Results: Overall satisfaction was strongly influenced by satisfaction with medical care (p < 0.001). Higher overall satisfaction was associated with fewer readmissions. Benchmarking showed the highest risk in the ICU, intermediate in Surgery and Internal Medicine, moderate in the ED, and the lowest in the Ambulatory. Satisfaction was highest in the initial period of the COVID-19 pandemic, dropped in 2022, and showed partial recovery at the end of this period. Conclusions: Quality of care is a critical measure of hospital performance, especially in the context of the COVID-19 pandemic. Patient feedback revealed areas of good practice and also the limits of the system, influenced by the burden of multisystem disease and limited resources. Post-COVID-19 disability outcomes are strongly influenced by the quality and continuity of care. Systematic use of patient- reported outcomes, standardized evaluation, and adaptive rehabilitation is essential to preserve the quality of care and reduce long- term functional impairment.