COVID-19 Mitigation Efforts and Disparities in Access to Routine Preventive Care and Chronic Disease Management

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PROJECT SUMMARY As a result of mitigation policy and behavioral changes, the COVID-19 pandemic significantly reduced access to primary care, which is likely to have lasting effects on chronic disease management and health outcomes, particularly for medically and socially vulnerable populations with existing chronic conditions. Newly available longitudinal individual-level data allows us to rigorously examine these effects for the first time. Although there is a large and growing literature quantifying disparities in outcomes related to COVID-19, relatively less is known about how the pandemic has affected access to primary and preventive care as well as associated health outcomes among medically and socially vulnerable populations. Understanding how the pandemic affected the utilization of preventive health care and management of chronic conditions, such as diabetes mellitus (DM) and hypertension (HTN), as well as the downstream outcomes, is critical to addressing resultant health disparities and mitigating the impact of future disruptions to the healthcare system and advancing interventions and policies to reduce health disparities We will leverage this newly available and timely data to examine changes in receipt of healthcare during the pandemic. Our data will include commercial health insurance claims in addition to a unique dataset containing billing data for a large, urban safety-net county health system serving a low-income, largely minority patient population. Within those populations, we will include a special focus examining individuals with DM or HTN. Using a mixed-methods design, we will examine changes in health care utilization and the predictors of disruptions over time. To more comprehensively understand contextual influences related to disruptions in care, we will obtain complementary qualitative data through interviews with patients, providers and clinic staff, and health systems leaders from the second largest municipal health system in the United States that will explore the drivers of underutilization of primary and preventive care during and after the pandemic. Our specific aims are to: (1) quantify the impact of the pandemic on racial/ethnic disparities in receipt of appropriate primary care, chronic disease management, and downstream health outcomes; (2) compare the differential effect of pandemic mitigation efforts between a commercially insured population and a safety net population; and (3) contextualize the secondary health effects of the pandemic using qualitative interviews with health systems stakeholders. Using established and novel data sets, supplemented by qualitative interviews we will be able to shed light on the changes in patterns of care management both during and after the pandemic for medically and socially vulnerable patients. Such information is crucial to determining how we should direct health care resources during national crises. However, these results are equally important in a post-pandemic landscape, in which the way patients seek care and health systems offer care is permanently altered.