Assessing the Impact of COVID-19 on IBD Outcomes Among Vulnerable Patient Populations in a Large Metropolitan Center.
Assessing the Impact of COVID-19 on IBD Outcomes Among Vulnerable Patient Populations in a Large Metropolitan Center.
复制标题
DOI：
10.1093/ibd/izad041
复制
发表时间：
2023-03
影响因子：
4.9
通讯作者：
F. Odufalu;Justin L Sewell;Vivek A. Rudrapatna;M. Somsouk;U. Mahadevan
中科院分区：
文献类型：
--
作者：
F. Odufalu;Justin L Sewell;Vivek A. Rudrapatna;M. Somsouk;U. Mahadevan
背景随着COVID-19的爆发，随着远程访问成为常态，医疗保健服务发生了迅速变化。本研究的目的是确定COVID-19大流行期间医疗保健服务的变化对资源充足和弱势人群中炎症性肠病（IBD）患者的影响。方法采用混合方法，观察性研究设计，通过电子健康记录识别在大学或安全网医院接受IBD治疗的患者。从电子健康记录中获取患者人口统计学资料、IBD病史和疾病活动。IBD相关的结果是从美国疫情爆发至2020年12月（COVID-19大流行第一年），并与上一年的结果进行比较。一部分参与者通过标准化问卷和半结构化访谈，就医疗服务和金融稳定性的变化如何影响他们的IBD提供了他们的观点。结果：共收集了1449名参与者的数据，其中1324名来自三级保健大学医院，125名来自安全网医院。于COVID-19期间，两个地点的医疗服务使用率均有所下降。人种/种族和主要语言与IBD相关住院或入院无关。在大学和安全网医院，有工作和有保险的患者有更多的IBD相关急诊就诊次数（分别为P = .03和P = .01）。不会说英语的患者更有可能报告使用远程医疗技术的挑战和难以联系IBD提供者。对于IBD人群，在COVID-19期间，在两种医院环境中，急诊科就诊、住院、门诊手术和门诊就诊与前一年相比都有所减少。社会经济地位较低和英语水平有限的患者报告说，随着医疗服务、医疗服务获得和IBD活动变化的传达，他们面临更多挑战。这些结果强调了支付者和提供者需要特别关注那些最容易受到这些系统性和持久性变化影响的人群，并促进医疗保健的公平性。
BACKGROUND With the onset of COVID-19, there were rapid changes in healthcare delivery as remote access became the norm. The aim of this study was to determine the impact of changes in healthcare delivery during the COVID-19 pandemic on patients with inflammatory bowel disease (IBD), in both well-resourced and vulnerable populations. METHODS Using a mixed methods, observational study design, patients receiving IBD care at a university or a safety-net hospital were identified by the electronic health record. Patient demographics, IBD history, and disease activity were acquired from the electronic health record. IBD-related outcomes were compared from the onset of the pandemic in the United States until December 2020 (COVID-19 pandemic year 1) and compared with outcomes in the previous year. A subset of participants provided their perspective on how changes in healthcare delivery and financial stability impacted their IBD through a standardized questionnaire and semi-structured interview. RESULTS Data from a total of 1449 participants were captured, 1324 at the tertiary care university hospital and 125 at the safety-net hospital. During COVID-19, there was a decrease in healthcare utilization at both sites. Race/ethnicity and primary language were not associated with IBD-related hospitalizations or admissions. Patients that were employed and those with insurance had a higher number of IBD-related emergency department visits at both the university and safety-net hospitals (P = .03 and P = .01, respectively). Patients who did not speak English were more likely to report challenges using technology with telehealth and difficulty contacting IBD providers. CONCLUSIONS For IBD populations, during COVID-19, in both hospital settings, emergency department visits, hospitalizations, outpatient surgery, and clinic visits were reduced compared with the year prior. Patients with lower socioeconomic status and limited English proficiency reported facing more challenges with changes to healthcare delivery, healthcare access, and conveying changes in IBD activity. These results highlight the need for payors and providers to specifically attend to those populations most susceptible to these systemic and lasting changes in care delivery and promote greater equity in healthcare.