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Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study.
J Med Internet Res. 2021 04 29; 23(4):e26558.JM

Abstract

BACKGROUND

The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care, accompanied by a corresponding surge in the use of telehealth services. However, the extent and nature of changes in health care utilization during the pandemic may differ by care setting. Knowledge of the impact of the pandemic on health care utilization is important to health care organizations and policy makers.

OBJECTIVE

The aims of this study are (1) to evaluate changes in in-person health care utilization and telehealth visits during the COVID-19 pandemic and (2) to assess the difference in changes in health care utilization between the pandemic year 2020 and the prepandemic year 2019.

METHODS

We retrospectively assembled a cohort consisting of members of a large integrated health care organization, who were enrolled between January 6 and November 2, 2019 (prepandemic year), and between January 5 and October 31, 2020 (pandemic year). The rates of visits were calculated weekly for four settings: inpatient, emergency department (ED), outpatient, and telehealth. Using Poisson models, we assessed the impact of the pandemic on health care utilization during the early days of the pandemic and conducted difference-in-deference (DID) analyses to measure the changes in health care utilization, adjusting for the trend of health care utilization in the prepandemic year.

RESULTS

In the early days of the pandemic, we observed significant reductions in inpatient, ED, and outpatient utilization (by 30.2%, 37.0%, and 80.9%, respectively). By contrast, there was a 4-fold increase in telehealth visits between weeks 8 (February 23) and 12 (March 22) in 2020. DID analyses revealed that after adjusting for prepandemic secular trends, the reductions in inpatient, ED, and outpatient visit rates in the early days of the pandemic were 1.6, 8.9, and 367.2 visits per 100 person-years (P<.001), respectively, while the increase in telehealth visits was 272.9 visits per 100 person-years (P<.001). Further analyses suggested that the increase in telehealth visits offset the reduction in outpatient visits by week 26 (June 28, 2020).

CONCLUSIONS

In-person health care utilization decreased drastically during the early period of the pandemic, but there was a corresponding increase in telehealth visits during the same period. By end-June 2020, the combined outpatient and telehealth visits had recovered to prepandemic levels.

Authors+Show Affiliations

Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33882020

Citation

Xu, Stanley, et al. "Impact of the COVID-19 Pandemic On Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study." Journal of Medical Internet Research, vol. 23, no. 4, 2021, pp. e26558.
Xu S, Glenn S, Sy L, et al. Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study. J Med Internet Res. 2021;23(4):e26558.
Xu, S., Glenn, S., Sy, L., Qian, L., Hong, V., Ryan, D. S., & Jacobsen, S. (2021). Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study. Journal of Medical Internet Research, 23(4), e26558. https://doi.org/10.2196/26558
Xu S, et al. Impact of the COVID-19 Pandemic On Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study. J Med Internet Res. 2021 04 29;23(4):e26558. PubMed PMID: 33882020.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study. AU - Xu,Stanley, AU - Glenn,Sungching, AU - Sy,Lina, AU - Qian,Lei, AU - Hong,Vennis, AU - Ryan,Denison S, AU - Jacobsen,Steven, Y1 - 2021/04/29/ PY - 2020/12/16/received PY - 2021/04/17/accepted PY - 2021/01/23/revised PY - 2021/4/22/pubmed PY - 2021/5/19/medline PY - 2021/4/21/entrez KW - COVID-19 KW - cohort KW - difference-in-difference analysis KW - health care utilization KW - health care worker KW - impact KW - knowledge KW - pandemic KW - policy KW - retrospective KW - telehealth KW - telemedicine KW - usage KW - utilization SP - e26558 EP - e26558 JF - Journal of medical Internet research JO - J Med Internet Res VL - 23 IS - 4 N2 - BACKGROUND: The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care, accompanied by a corresponding surge in the use of telehealth services. However, the extent and nature of changes in health care utilization during the pandemic may differ by care setting. Knowledge of the impact of the pandemic on health care utilization is important to health care organizations and policy makers. OBJECTIVE: The aims of this study are (1) to evaluate changes in in-person health care utilization and telehealth visits during the COVID-19 pandemic and (2) to assess the difference in changes in health care utilization between the pandemic year 2020 and the prepandemic year 2019. METHODS: We retrospectively assembled a cohort consisting of members of a large integrated health care organization, who were enrolled between January 6 and November 2, 2019 (prepandemic year), and between January 5 and October 31, 2020 (pandemic year). The rates of visits were calculated weekly for four settings: inpatient, emergency department (ED), outpatient, and telehealth. Using Poisson models, we assessed the impact of the pandemic on health care utilization during the early days of the pandemic and conducted difference-in-deference (DID) analyses to measure the changes in health care utilization, adjusting for the trend of health care utilization in the prepandemic year. RESULTS: In the early days of the pandemic, we observed significant reductions in inpatient, ED, and outpatient utilization (by 30.2%, 37.0%, and 80.9%, respectively). By contrast, there was a 4-fold increase in telehealth visits between weeks 8 (February 23) and 12 (March 22) in 2020. DID analyses revealed that after adjusting for prepandemic secular trends, the reductions in inpatient, ED, and outpatient visit rates in the early days of the pandemic were 1.6, 8.9, and 367.2 visits per 100 person-years (P<.001), respectively, while the increase in telehealth visits was 272.9 visits per 100 person-years (P<.001). Further analyses suggested that the increase in telehealth visits offset the reduction in outpatient visits by week 26 (June 28, 2020). CONCLUSIONS: In-person health care utilization decreased drastically during the early period of the pandemic, but there was a corresponding increase in telehealth visits during the same period. By end-June 2020, the combined outpatient and telehealth visits had recovered to prepandemic levels. SN - 1438-8871 UR - https://www.unboundmedicine.com/medline/citation/33882020/Impact_of_the_COVID_19_Pandemic_on_Health_Care_Utilization_in_a_Large_Integrated_Health_Care_System:_Retrospective_Cohort_Study_ L2 - https://www.jmir.org/2021/4/e26558/ DB - PRIME DP - Unbound Medicine ER -