In-Person and Telehealth Ambulatory Contacts and Costs in a Large US Insured Cohort Before and During the COVID-19 Pandemic.
In-Person and Telehealth Ambulatory Contacts and Costs in a Large US Insured Cohort Before and During the COVID-19 Pandemic.
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DOI：
10.1001/jamanetworkopen.2021.2618
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发表时间：
2021-03-01
影响因子：
13.8
通讯作者：
Lemke KW
中科院分区：
文献类型：
--
作者：
Weiner JP;Bandeian S;Hatef E;Lans D;Liu A;Lemke KW
美国首次出现 COVID-19 病例激增后，门诊护理模式发生了怎样的变化？远程医疗发挥了什么作用？在这项针对 36 568 010 名美国人的队列研究中，2019 年 3 月至 6 月期间，流动接触者减少了 18%，远程医疗使用量从 2019 年接触者总数的 0.3% 增加到 2020 年所有接触者的 23.6%。疾病负担增加、COVID-19 患病率和社会资源增加与远程医疗使用率增加有关。这些发现表明，虚拟护理采用的巨大转变对大流行期间和之后的卫生服务提供产生了许多影响。这项队列研究调查了美国在 COVID-19 大流行之前和初期阶段的门诊护理模式和成本，并评估了患者、医生、社区和 COVID-19 相关因素与远程医疗采用之间的关系。本研究评估了 COVID-19 大流行初期远程医疗在提供护理方面的作用。记录大流行之前和初期阶段美国门诊护理的模式和成本，并评估患者、医生、社区和 COVID-19 相关因素与远程医疗采用之间的关系。这是一项针对从 2019 年 3 月至 2020 年 6 月连续参加私人健康计划的工作年龄人士的队列研究。比较期为 2019 年和 2020 年 3 月至 6 月。索赔数据文件由 Blue Cross and Blue Shield Association 的独立持牌人 Blue Health Intelligence 提供。数据分析于 2020 年 6 月至 10 月期间进行。流动就诊（面对面和远程医疗）和允许的收费，根据登记文件、从业者索赔以及与登记者邮政编码相关的社区特征得出的特征进行分层。分析中总共包括 36 568 010 人（平均 [SD] 年龄，35.71 [18.77] 岁；18 466 557 名女性 [50.5%]）。从 2019 年到 2020 年，面对面接触减少了 37%（从每位登记者 1.63 次接触减少到 1.02 次接触）。2020 年期间，远程医疗就诊（每人 0.32 次就诊）占所有互动的 23.6%，而 2019 年为 0.3%。添加这些虚拟接触后，COVID-19 时代患者和医生的总体就诊率比 2019 年低 18% 2019 年（每人 1.34 次与 1.64 次访问）。行为健康接触比虚拟医疗接触更有可能发生（46.1% vs 22.1%）。某个地区的 COVID-19 流行率与远程医疗的较高使用率相关；与来自最低五分之一地区（参考类别）的患者相比，来自 COVID-19 患病率最高五分之一地区的患者在感染一周内进行远程医疗就诊的可能性高出 1.34 倍。生活在社会资源有限地区的人们不太可能使用远程医疗（社会优势最大的社区与最不发达的社区，使用率分别为 27.4% 和 19.9%）。 2019 年至 2020 年间，每位参保者的医疗费用下降了 15%（从每人每月 358.32 美元降至 306.04 美元）。 2020 年期间，那些拥有 1 项或多项 COVID-19 相关服务的人（1 470 721 名会员）的医疗费用是那些没有 COVID-19 相关服务的人的 3 倍以上（每位会员每月 1701 美元 vs 544 美元）。 2020 年进行 1 次或多次远程医疗就诊的人比仅进行面对面流动接触的人的费用要高得多（COVID-19 相关亚组为 2214.10 美元 vs 1337.78 美元，非 COVID-19 亚组为 735.87 美元 vs 456.41 美元）。这项针对参加美国健康计划的大量患者的研究记录了 COVID-19 发病时的护理模式。研究结果与政策制定者、付款人和从业者相关，因为他们在大流行期间和之后管理远程医疗的使用。
How did ambulatory care patterns change after the initial COVID-19 surge in the US and what role did telehealth play? In this cohort study of 36 568 010 US individuals, ambulatory contacts decreased by 18% between the 2019 and 2020 March to June periods, and telehealth use increased from 0.3% of contacts in 2019 to 23.6% of all contacts in 2020. Increased disease burden, COVID-19 prevalence, and greater social resources were associated with higher telehealth use. These findings suggest that the dramatic shift in the adoption of virtual care has many implications for health services provision both during and after the pandemic. This cohort study examines the patterns and costs of ambulatory care in the US before and during the initial stage of the COVID-19 pandemic and assesses how patient, practitioner, community, and COVID-19–related factors are associated with telehealth adoption. This study assesses the role of telehealth in the delivery of care at the start of the COVID-19 pandemic. To document patterns and costs of ambulatory care in the US before and during the initial stage of the pandemic and to assess how patient, practitioner, community, and COVID-19–related factors are associated with telehealth adoption. This is a cohort study of working-age persons continuously enrolled in private health plans from March 2019 through June 2020. The comparison periods were March to June in 2019 and 2020. Claims data files were provided by Blue Health Intelligence, an independent licensee of the Blue Cross and Blue Shield Association. Data analysis was performed from June to October 2020. Ambulatory encounters (in-person and telehealth) and allowed charges, stratified by characteristics derived from enrollment files, practitioner claims, and community characteristics linked to the enrollee’s zip code. A total of 36 568 010 individuals (mean [SD] age, 35.71 [18.77] years; 18 466 557 female individuals [50.5%]) were included in the analysis. In-person contacts decreased by 37% (from 1.63 to 1.02 contacts per enrollee) from 2019 to 2020. During 2020, telehealth visits (0.32 visit per person) accounted for 23.6% of all interactions compared with 0.3% of contacts in 2019. When these virtual contacts were added, the overall COVID-19 era patient and practitioner visit rate was 18% lower than that in 2019 (1.34 vs 1.64 visits per person). Behavioral health encounters were far more likely than medical contacts to take place virtually (46.1% vs 22.1%). COVID-19 prevalence in an area was associated with higher use of telehealth; patients from areas within the top quintile of COVID-19 prevalence during the week of their encounter were 1.34 times more likely to have a telehealth visit compared with those in the lowest quintile (the reference category). Persons living in areas with limited social resources were less likely to use telehealth (most vs least socially advantaged neighborhoods, 27.4% vs 19.9% usage rates). Per enrollee medical care costs decreased by 15% between 2019 and 2020 (from $358.32 to $306.04 per person per month). During 2020, those with 1 or more COVID-19–related service (1 470 721 members) had more than 3 times the medical costs ($1701 vs $544 per member per month) than those without COVID-19–related services. Persons with 1 or more telehealth visits in 2020 had considerably higher costs than persons having only in-person ambulatory contacts ($2214.10 vs $1337.78 for the COVID-19–related subgroup and $735.87 vs $456.41 for the non–COVID-19 subgroup). This study of a large cohort of patients enrolled in US health plans documented patterns of care at the onset of COVID-19. The findings are relevant to policy makers, payers, and practitioners as they manage the use of telehealth during the pandemic and afterward.
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影响因子：
9.7
作者：
Lau, Jen;Knudsen, Janine;Chokshi, Dave A.
通讯作者：
Chokshi, Dave A.
DOI：
10.1093/jamia/ocaa072
发表时间：
2020-07-01
影响因子：
6.4
作者：
Mann, Devin M.;Chen, Ji;Nov, Oded
通讯作者：
Nov, Oded
DOI：
10.1093/jamia/ocaa284
发表时间：
2021-03-01
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Ferguson JM;Jacobs J;Yefimova M;Greene L;Heyworth L;Zulman DM
通讯作者：
Zulman DM
影响因子：
4.7
作者：
Punia, Vineet;Nasr, Gaelle;Najm, Imad
通讯作者：
Najm, Imad
影响因子：
13.8
作者：
Alexander GC;Tajanlangit M;Heyward J;Mansour O;Qato DM;Stafford RS
通讯作者：
Stafford RS