Changes in Health Services Use Among Commercially Insured US Populations During the COVID-19 Pandemic.
Changes in Health Services Use Among Commercially Insured US Populations During the COVID-19 Pandemic.
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DOI：
10.1001/jamanetworkopen.2020.24984
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发表时间：
2020-11-02
影响因子：
13.8
通讯作者：
Bravata DM
中科院分区：
文献类型：
--
作者：
Whaley CM;Pera MF;Cantor J;Chang J;Velasco J;Hagg HK;Sood N;Bravata DM
在美国2019冠状病毒病（COVID-19）大流行的初始阶段，商业保险人群的医疗服务使用情况发生了怎样的变化？这项横断面研究对680万名商业保险个人进行了基于索赔的分析，发现在2020年3月和4月的COVID-19疫情初期，患者显著减少了预防和选择性护理的使用，增加了远程医疗的使用，但不足以抵消现场护理的减少。在使用现场护理和远程医疗方面的变化中可以看到种族/族裔和收入差距。在这项研究中，COVID-19大流行的最初两个月与卫生服务使用的大幅减少有关;未来的政策措施应确保这些减少不会对患者健康产生不利影响。这项横断面研究分析了商业保险个人的医疗保险索赔，以评估美国在COVID-19大流行初期使用医疗服务的变化。2019冠状病毒病（COVID-19）大流行给患者、医疗保健专业人员和机构带来了前所未有的压力，但该大流行与使用预防性、选择性和非选择性护理的关系，以及使用医疗保健的潜在差异，仍然未知。检查2020年3月和4月COVID-19大流行的前两个月相对于2019年和2018年3月和4月的医疗保健使用变化，并检查使用变化是否因患者的邮政编码级别种族/民族或收入而异。这项横断面研究分析了来自美国所有50个州的患者的医疗保险索赔，这些患者通过雇主获得医疗保险。与2019年和2018年的现有趋势相比，我们检查了2020年COVID-19大流行前2个月预防服务、非选择性护理、选择性手术、处方药、面对面办公室就诊和远程医疗就诊的使用变化。还研究了基于患者的邮政编码级别种族和收入的大流行与卫生保健使用之间的差异。分析了2018年、2019年和2020年分别有560万、640万和680万美国人参加雇主赞助保险的数据。所有3年的患者人口统计学特征相似（平均[SD]年龄，2018年为34.3 [18.6]岁，2019年为34.3 [18.5]岁，2020年为34.5 [18.5]岁; 2018年为50.0%的女性，2019年为49.5%的女性，2020年为49.5%的女性）。2020年3月和4月，每万人的回归调整使用率变化了-28.2（95% CI，−30.5至−25.9）和−64.5（95% CI，−66.8至−62.2）结肠镜检查; −149.1（95% CI，−162.0至−16.2）和−342.1（95% CI，−355.0至−329.2）对于乳房X线照片; −60.0（95% CI，−63.3至−54.7）和−118.1（95% CI，−112.4至−113.9）血红蛋白A1 c检测; −300.5（95% CI，−346.5至−254.5）和−369.0（95% CI，−414.7至−323.4）儿童疫苗; −4.6（95% CI，−5.3至−3.9）和−10.9（95% CI，−11.6至−10.2）肌肉骨骼手术; −1.1（95% CI，−1.4至−0.7）和−3.4（95% CI，−3.8至−3.0）白内障手术; −13.4（95% CI，−14.6至−12.2）和−31.4（95% CI，−32.6至−30.2）;和−581.1（95% CI，−612.9至−549.3）和−1465（95% CI，−1496至−1433）的亲自办公室访问。使用远程医疗服务的人数增加了每万人227.9人（95% CI，221.7至234.1人）和每万人641.6人（95% CI，635.5至647.8人）。居住在邮政编码较低或大多数种族/少数民族人群中的患者的亲自就诊减少幅度较小（≥80%种族/少数民族邮政编码：200.0/10000 [95% CI，128.9-270.1]; 79%-21%种族/少数民族邮政编码：54.2/10 000 [95% CI，33.6-74.9]），但采用远程医疗的比率也较低（≥80%的种族/少数民族邮政编码：-71.6/10000 [95%CI，-87.6至-55.5]; 79%-21%的种族/少数民族邮政编码：-15.1/10 000 [95% CI，-19.8至-10.4]）。在这项针对美国大量雇主赞助保险人群的横断面研究中，COVID-19大流行的前两个月与预防性和选择性护理的使用大幅减少有关。远程医疗的使用迅速增加，但不足以解释亲自初级保健访问的减少。在使用远程医疗方面，邮政编码一级存在种族和收入差距。
How did health services use among commercially insured populations change during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic in the United States? This cross-sectional study with a claims-based analysis of 6.8 million commercially insured individuals found that during the initial phase of the COVID-19 epidemic in March and April of 2020, patients significantly reduced use of preventive and elective care and increased use of telemedicine but not enough to offset reductions in in-person care. Racial/ethnic and income disparities were seen in changes in use of in-person care and telemedicine. In this study, the initial 2 months of the COVID-19 pandemic were associated with large reductions in use of health services; future policy initiatives should ensure that these reductions do not adversely affect patient health. This cross-sectional study analyzes health insurance claims among commercially-insured individuals to asess changes in the use of health services in the Unted States during the initial phase of the COVID-19 pandemic. The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented strain on patients and health care professionals and institutions, but the association of the pandemic with use of preventive, elective, and nonelective care, as well as potential disparities in use of health care, remain unknown. To examine changes in health care use during the first 2 months of the COVID-19 pandemic in March and April of 2020 relative to March and April of 2019 and 2018, and to examine whether changes in use differ by patient’s zip code–level race/ethnicity or income. This cross-sectional study analyzed health insurance claims for patients from all 50 US states who receive health insurance through their employers. Changes in use of preventive services, nonelective care, elective procedures, prescription drugs, in-person office visits, and telemedicine visits were examined during the first 2 months of the COVID-19 pandemic in 2020 relative to existing trends in 2019 and 2018. Disparities in the association of the pandemic with health care use based on patient’s zip code–level race and income were also examined. Data from 5.6, 6.4, and 6.8 million US individuals with employer-sponsored insurance in 2018, 2019, and 2020, respectively, were analyzed. Patient demographics were similar in all 3 years (mean [SD] age, 34.3 [18.6] years in 2018, 34.3 [18.5] years in 2019, and 34.5 [18.5] years in 2020); 50.0% women in 2018, 49.5% women in 2019, and 49.5% women in 2020). In March and April 2020, regression-adjusted use rate per 10 000 persons changed by −28.2 (95% CI, −30.5 to −25.9) and −64.5 (95% CI, −66.8 to −62.2) for colonoscopies; −149.1 (95% CI, −162.0 to −16.2) and −342.1 (95% CI, −355.0 to −329.2) for mammograms; −60.0 (95% CI, −63.3 to −54.7) and −118.1 (95% CI, −112.4 to −113.9) for hemoglobin A1c tests; −300.5 (95% CI, −346.5 to −254.5) and −369.0 (95% CI, −414.7 to −323.4) for child vaccines; −4.6 (95% CI, −5.3 to −3.9) and −10.9 (95% CI, −11.6 to −10.2) for musculoskeletal surgery; −1.1 (95% CI, −1.4 to −0.7) and −3.4 (95% CI, −3.8 to −3.0) for cataract surgery; −13.4 (95% CI, −14.6 to −12.2) and −31.4 (95% CI, −32.6 to −30.2) for magnetic resonance imaging; and −581.1 (95% CI, −612.9 to −549.3) and −1465 (95% CI, −1496 to −1433) for in-person office visits. Use of telemedicine services increased by 227.9 (95% CI, 221.7 to 234.1) per 10 000 persons and 641.6 (95% CI, 635.5 to 647.8) per 10 000 persons. Patients living in zip codes with lower-income or majority racial/ethnic minority populations experienced smaller reductions in in-person visits (≥80% racial/ethnic minority zip code: 200.0 per 10 000 [95% CI, 128.9-270.1]; 79%-21% racial/ethnic minority zip code: 54.2 per 10 000 [95% CI, 33.6-74.9]) but also had lower rates of adoption of telemedicine (≥80% racial/ethnic minority zip code: −71.6 per 10 000 [95% CI, −87.6 to −55.5]; 79%-21% racial/ethnic minority zip code: −15.1 per 10 000 [95% CI, −19.8 to −10.4]). In this cross-sectional study of a large US population with employer-sponsored insurance, the first 2 months of the COVID-19 pandemic were associated with dramatic reductions in the use of preventive and elective care. Use of telemedicine increased rapidly but not enough to account for reductions in in-person primary care visits. Race and income disparities at the zip code level exist in use of telemedicine.
影响因子：
9.7
作者：
Lau, Jen;Knudsen, Janine;Chokshi, Dave A.
通讯作者：
Chokshi, Dave A.
影响因子：
9.7
作者：
Courtemanche, Charles;Garuccio, Joseph;Yelowitz, Aaron
通讯作者：
Yelowitz, Aaron
影响因子：
33.9
作者：
Hartnett, Kathleen P.;Kite-Powell, Aaron;Gundlapalli, Adi, V
通讯作者：
Gundlapalli, Adi, V