PONE-D-24-06438Quality of Hospital Care for WHO's Three Disease Groups Pre-, During, and Post-COVID-19 Pandemic Peak in ThailandPLOS ONE

Dear Dr. Chongsuvivatwong,

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Additional Editor Comments:

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ACADEMIC EDITOR: Major Revision

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The study is not novel and similar papers were published before.

Reviewer #2: The article titled "Quality of Hospital Care for WHO's Three Disease Groups Pre-, During, and Post-COVID-19 Pandemic Peak in Thailand," submitted to the scientific journal Plos One, delves into the critical examination of hospital care quality across different disease groups during various phases of the COVID-19 pandemic. Through analyzing trends in hospital admission data from the Thai Health Information Portal (THIP) database, the study aims to shed light on how the pandemic has affected the quality of care for poverty-related, noncommunicable, and injury-related diseases in Thailand.

Positive Points:

Relevance and Timeliness: The study addresses a timely and significant issue, providing insights into how the COVID-19 pandemic has impacted the quality of hospital care across different disease groups. This research is particularly valuable given the ongoing global healthcare crisis and the need to understand its implications on healthcare delivery systems.

Comprehensive Methodology: The utilization of existing hospital admission data from the THIP database covering a substantial period from 2017 to 2022 lends credibility to the study. Categorizing disease groups using the International Classification of Diseases (ICD)-10 and analyzing outcomes such as prolonged length of stay (LOS), hospital mortality, and readmission pre-, during, and post-COVID-19 pandemic peak offers a comprehensive view of the situation.

Insightful Findings: The study's findings provide valuable insights into the impact of the pandemic on different disease groups. By examining metrics such as prolonged LOS, hospital mortality rates, and readmissions, the research highlights the varying degrees of impact across poverty-related, noncommunicable, and injury-related diseases, contributing to a deeper understanding of healthcare dynamics during the pandemic.

Opportunities for Improvement:

Clarity in Data Presentation: While the study presents extensive data on outcomes across disease groups, there is a need for clearer presentation and interpretation of results. Providing visual aids such as tables or graphs could enhance the readability and accessibility of the findings for readers.

Discussion of Methodological Limitations: The article lacks a comprehensive discussion of the limitations inherent in the methodology employed. Addressing potential biases, data limitations, and other methodological constraints would strengthen the study's validity and assist readers in interpreting the results accurately.

Contextual Analysis: While the study identifies the impact of COVID-19 on hospital care quality, it could benefit from a deeper contextual analysis of the underlying factors influencing these trends. Exploring socioeconomic determinants, healthcare infrastructure, and public health interventions could enrich the interpretation of findings and provide actionable insights for policymakers and healthcare practitioners.

Future Research Directions: The article would benefit from a section dedicated to suggesting avenues for future research. Identifying gaps in knowledge, proposing alternative methodologies, or recommending areas for further investigation would enhance the scholarly contribution of the study and guide future research efforts in this area.

In conclusion, the article "Quality of Hospital Care for WHO's Three Disease Groups Pre-, During, and Post-COVID-19 Pandemic Peak in Thailand" presents a valuable contribution to understanding healthcare quality dynamics during the COVID-19 pandemic. While the study demonstrates strengths in relevance, methodology, and findings, there are opportunities for improvement in data presentation, discussion of methodological limitations, contextual analysis, and identification of future research directions. Addressing these areas would enhance the overall quality and impact of the research.

Reviewer #3: Dear Authors,

The manuscript described hospital quality variables in different periods of COVID-19 pandemic.

I have some comments as follows:

1. Please modify the title to be more precise and attractive, i.e., include some information about diseases in focus and which hospital quality's parameter were measured and reported.

2. Introduction:

- please include more relevant references, esp. profound healthcare disruption from the pandemic (ref.1), and ref. 2. For example, information from CDC or WHO.

- Moreover, there were a lot of published articles about the impact of the pandemics on healthcare quality, including those variables focused on this manuscript. Please elaborate on how would this manuscript benefit the scientific society?

3. Method:

- please use weighted data to analyse the regression, since the sample size of post pandemic period was much smaller than other period.

- what are the effect size of each primary outcome

4. Results:

- please add more information on demographic data in each period. For example, numbers of poverty-related/non-communicable cases in each period.

- regression table: it was interesting that there were significance differences among periods; however, they did not show which period differ from which. From the analytic results presented, it can be that pre-pandemic period gave differences in outcomes than post-pandemic period without the relation to pandemic period.

- 'DM' and 'CVD' are covariate, having both of them in the model can induce bias.

5. Discussion:

- some analysis demonstrated similar levels and trends in during and post-COVID-19 periods.

The authors discussed only the differences during the pandemic, and seemed to neglect the post pandemic's data.

- second page of discussion, line 12-14 -> please reference the statement:

11 Lockdowns may limit people's ability

12 to seek timely healthcare for various conditions, leading to more severe presentations when they

13 eventually seek treatment. More severe cases often require longer hospital stays or hospital

14 mortality.

-second page of discussion,line 26; indicating potential challenges in managing these conditions -> please elaborate on this statement.

- second page of discussion,line 28-29:' The findings for CVD and DM exhibited mixed directions, highlighting the complexity of the pandemic's influence on hospital care across various health issues.' since these diseases can be covariate , it is possible that they manifested similar issues.

- Please revise Academic written English language, particularly in discussion part'

- please add results' implications into the last part of the discussion or in conclusion.

Best regards,

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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COVID-19’s Impact on Hospital Stays, Mortality, and Readmissions for Poverty-related Diseases, Noncommunicable Diseases, and Injury Groups

in Thailand

PONE-D-24-06438R1

Dear Dr. Chongsuvivatwong,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Worradorn Phairuang, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: The authors have performed the suggested suggestions. The manuscript can be accepted for publication. Congratulations!

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If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

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