Health Services Utilization During the COVID-19 Pandemic

项目总结/摘要 COVID-19大流行对美国医疗保健系统和医疗保健造成了前所未有的冲击。 为患者提供服务。正如研究小组所记录的那样，COVID-19大流行突然而戏剧性地 改变了卫生保健利用模式，包括远程保健服务的使用迅速增加， 当面服务减少，大量延期服务。目前还不清楚这些护理模式将如何 在大流行的过程中演变（例如，延迟服务将在以后发生的程度，远程医疗 将取代面对面的服务，并将维持新水平的远程保健服务），更不用说在 2019冠状病毒病大流行后的几年，以及持续护理模式在社会和临床方面将如何不同 弱势患者群体。医生组织（PO）在快速采用 远程医疗和PO的障碍，远程医疗采用可能反映在患者的结果， 这些PO亲自护理的减少给许多PO带来了财务压力，导致人们担心， 许多PO可能停业或合并。减少护理、采用远程医疗的影响 作为一种新的护理提供方式，获得PO可能会对弱势患者产生更大的影响 人群，包括低收入、农村和种族/少数民族人群，以及多个 慢性病了解患者和提供者对COVID-19公共卫生危机的反应以及 患者，特别是那些在医疗和社会方面处于弱势的患者， 旨在帮助卫生服务系统应对新冠肺炎的短期和长期政策制定- 19.我们建议进行一系列分析，以1）估计卫生服务在2000年期间的变化情况。 COVID-19大流行，与卫生服务使用变化相关的因素，如果医疗延迟护理仍然存在 一旦COVID-19大流行消退，如何应对政策（社交距离政策和COVID-19） 19疫苗接种）影响了护理提供，以及这些模式在医学和社会方面的差异 弱势患者群体; 2）评估PO采用远程医疗的障碍，并评估PO采用 远程医疗减少了不利的健康后果，特别是在弱势患者群体中;以及3） 检查因COVID-19导致的PO关闭或整合是否会导致患者护理连续性或访问的缺口 弱势患者群体之间的障碍。为此，我们将利用现有的数据资产， 兰德U19卓越中心的专业知识，研究团队已经建立了过去5年。我们 将使用100%的医疗保险按服务收费索赔数据。这项研究的结果将有助于为一系列 短期和长期政策和监管变化，包括支付政策、使用的变化 技术，向提供者提供财政援助，以确保他们的生存，并提高保健能力， 新冠肺炎疫情如何重塑了美国的医疗体系。

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic has created an unprecedented shock to the U.S. health care system and to care delivery for patients. As documented by the study team, the COVID-19 pandemic suddenly and dramatically changed health care utilization patterns, including a rapid escalation in use of telehealth services, an abrupt decline in in-person services, and a large volume of deferred services. It is unclear how these care patterns will evolve over the course of the pandemic (e.g., the degree to which deferred services will occur later, telehealth will substitute for in-person services, and new levels of telehealth services will be sustained), much less in the years following the COVID-19 pandemic, and how continuing care patterns will differ for socially and clinically vulnerable patient populations. Physician organizations (POs) face differing burdens in rapidly adopting telemedicine, and PO barriers to telemedicine adoption may be reflected in the outcomes of patients treated by these POs. The reduction in in-person care has placed financial stress on many POs, leading to concerns that many POs may go out of business or consolidate. The impacts of care reductions, the adoption of telemedicine as a new care delivery modality, and access to POs are likely to have larger effects among vulnerable patient populations, including lower-income, rural, and racial/ethnic minority populations, and patients with multiple chronic conditions. Understanding patient and provider responses to the COVID-19 public health crisis and the care patients receive, particularly those who are medically and socially vulnerable, is essential to inform immediate-term and longer-term policymaking intended to help the health delivery system respond to COVID- 19. We propose to conduct a set of analyses to 1) Estimate how health services have changed during the COVID-19 pandemic, the factors associated with changes in health service use, if health delayed care remains unmet once the COVID-19 pandemic subsides, how policy responses (social distancing policies and COVID- 19 vaccination) have impacted care delivery, and how these patterns differ for medically and socially vulnerable patient populations; 2) Asses PO barriers to adopting telemedicine and assess if PO adoption of telemedicine lessens adverse health outcomes, particularly among vulnerable patient populations; and 3) Examine if PO closure or consolidation due to COVID-19 leads to gaps in patient care continuity or access barriers among vulnerable patient populations. To do so, we will leverage the existing data assets and expertise of the RAND U19 Center of Excellence that the research team has built over the past 5 years. We will use 100% Medicare fee-for-service claims data. Findings from this study will help inform an array of immediate-term and longer-term policies and regulatory changes, including changes to payment policies, use of technology, financial assistance to providers to ensure their survival, and improving the ability of health systems to respond to how the COVID-19 pandemic has reshaped the US health care system.