Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study.
Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study.
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DOI：
10.2196/26558
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发表时间：
2021-04-29
影响因子：
7.4
通讯作者：
Jacobsen S
中科院分区：
文献类型：
--
作者：
Xu S;Glenn S;Sy L;Qian L;Hong V;Ryan DS;Jacobsen S
COVID-19 大流行导致现场医疗保健的使用突然减少，同时远程医疗服务的使用也相应激增。然而，大流行期间医疗保健利用变化的程度和性质可能因护理环境而异。了解大流行对医疗保健利用的影响对于医疗保健组织和政策制定者来说非常重要。本研究的目的是 (1) 评估 COVID-19 大流行期间现场医疗保健利用率和远程医疗就诊的变化，以及 (2) 评估 2020 年大流行年和 2019 年大流行前年之间医疗保健利用率变化的差异。我们回顾性地收集了一个由大型综合医疗保健组织的成员组成的队列，这些成员于 2019 年 1 月 6 日至 11 月 2 日（大流行前年）以及 1 月 5 日至 10 月期间入组2020年（大流行年）31日。每周计算四种情况的就诊率：住院部、急诊室 (ED)、门诊部和远程医疗。使用泊松模型，我们评估了疫情对大流行初期医疗保健利用率的影响，并进行了服从差异（DID）分析来衡量医疗保健利用率的变化，并根据大流行前一年的医疗保健利用率趋势进行了调整。在大流行初期，我们观察到住院患者、急诊室和门诊患者的使用率显着下降（分别下降了 30.2%、37.0% 和 80.9%）。相比之下，2020 年第 8 周（2 月 23 日）至第 12 周（3 月 22 日）期间，远程医疗就诊次数增加了 4 倍。DID 分析显示，在调整大流行前的长期趋势后，大流行初期住院患者、急诊室和门诊患者就诊率分别减少为每 100 人年 1.6、8.9 和 367.2 次(P<.001)，而远程医疗就诊次数的增加为每 100 人年 272.9 次 (P<.001)。进一步分析表明，到第 26 周（2020 年 6 月 28 日），远程医疗就诊次数的增加抵消了门诊就诊次数的减少。在大流行初期，现场医疗保健利用率大幅下降，但同期远程医疗就诊次数相应增加。截至 2020 年 6 月底，门诊和远程医疗就诊次数已恢复至大流行前的水平。
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. 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. 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. 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). 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.
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