Background and Aim This study quantifies how changes in healthcare utilization and delivery during the first months of the COVID‐19 pandemic have altered the presentation, treatment, and management of patients with gastrointestinal (GI) malignancies within an academic health system. Methods and results Patients diagnosed with a GI malignancy (ICD10: C15‐C26) who received medical care within the health system during the observation period (first 44 weeks of 2019 and 2020) were identified for a retrospective cohort study. Deidentified patient encounter parameters were collected for this observation period and separated into pre‐pandemic (weeks 1–10) and early pandemic (weeks 11–20) study periods. Difference‐in‐difference analyses adjusted for week‐specific and year‐specific effects quantified the impact of the COVID‐19 pandemic on care delivery between pre‐pandemic and early pandemic study periods in 2020. Across all GI malignancies, the COVID‐19 pandemic has been associated with a significant decline in the number of patients with new patient visits (NPVs) ( p = 1.2 × 10 −4 ), Radiology encounters ( p = 1.9 × 10 −7 ), Surgery encounters ( p = 1.6 × 10 −3 ), Radiation Oncology encounters ( p = 4.1 × 10 −3 ), and infusion visits (6.1 × 10 −5 ). Subgroup analyses revealed cancer‐specific variations in changes to delivery. Patients with colorectal cancer (CRC) had the most significant decrease in NPVs ( p = 7.1 × 10 −5 ), which was significantly associated with a concomitant decrease in colonoscopies performed during the early pandemic period (r 2 = 0.722, p = 2.1 × 10 −10 ). Conclusions The COVID‐19 pandemic has been associated with significant disruptions to care delivery. While these effects were appreciated broadly across GI malignancies, CRC, diagnosed and managed by periodic screening, has been affected most acutely.

30 Background: Changes in healthcare utilization and delivery during the first months of the COVID-19 pandemic have altered the presentation, treatment, and management of patients with gastrointestinal (GI) malignancies. We hypothesize this has contributed to diagnostic and treatment delays that will increase disease morbidity and mortality. Methods: We performed a retrospective cohort study comparing healthcare utilization of patients with diagnosed GI malignancy (ICD10:C15-C26) during and prior to the COVID-19 pandemic within our health system. Deidentified patient encounter parameters were collected for the first 20 weeks of both 2019 and 2020, including the number of: new patient visits (NPVs), hospital admissions, and specialty encounters. Difference-in-difference analyses adjusted for week-specific and year-specific effects quantified the impact of the COVID-19 pandemic on care delivery, with week 11 of 2020 marking the start of the pandemic period. Results: The 2019 and 2020 cohorts of patients had similar demographic compositions on the basis of sex and ethnicity (2019: n = 23,536, 56.8% M, 70.4/16.3/1.9% White/Black/Hispanic; 2020: n = 25,773, 57.0% M, 70.3/16.3/2.0% White/Black/Hispanic). Across all GI malignancies, the COVID-19 pandemic period was associated with a significant decrease in NPVs (-50.0/week, -45% from 2019, p < 1e-3). Colorectal cancer (CRC) had the largest decrease in NPVs among GI malignancies (-25.3/week, -53% from 2019, p < 1e-4). Of note, there was a parallel decrease in colonoscopies during this time (-682/week, -91% from 2019, p < 1e-11). For patients with diagnosed GI malignancies, the COVID-19 pandemic was associated with statistically significant declines in hospital admissions (-31.7/week, -37% from 2019, p < 1e-5), radiology encounters (-177/week, -38% from 2019, p < 1e-6), radiation oncology encounters (-18.2/week, -12% from 2019, p < 0.01), chemotherapy infusion visits (-62.2/week, -17% from 2019, p < 1e-4), and surgery encounters (-71.1/week, -15.7% from 2019, p < 0.01). Subgroup analyses revealed these reductions were most significant in patients with CRC (radiology encounters, surgery encounters, hospital admissions), anal cancer (radiation oncology encounters), and pancreatic cancer (chemotherapy infusion visits). Conclusions: These data demonstrate that the COVID-19 pandemic is associated with significant disruptions to care delivery. While these effects were appreciated broadly across GI malignancies, CRC—diagnosed and managed by periodic screening—has been affected most acutely. The precipitous drop in screening colonoscopies likely contributed to the decline in NPVs, specialty encounters and hospital admissions. These findings underscore the importance of reinstating regular GI cancer screening and management. Future work will assess the impact of these and other changes to cancer care delivery on long term morbidity and mortality.

Background: The advent of learning healthcare systems requires physicians to not only manage individual patients, but also use data to manage their patient population as a whole. Improving care using data has been facilitated via the adoption of the EHR and its ability to collate data for populations of patients. While incorporation of population health into residency curricula has become more common, there have been few educational initiatives for fellows despite the requirements of the ACGME that fellowship programs provide trainees with practice habit data relevant to their patient population. We aimed to create and evaluate an ambulatory cardiovascular disease fellowship population health dashboard and curriculum incorporating actionable, relevant metrics. Methods: In 2018 we developed a curriculum that taught principles of population health through didactics and videos that CVM fellows in our program could access asynchronously. In parallel, we developed a novel fellow-specific population health dashboard embedded in our EHR. The dashboard included demographic information relating to the fellow’s clinic patient population such as race/ethnicity, healthcare utilization information like percentage of no-show visits, and specialty specific quality metrics such as beta-blocker use in patients with CHF. CVM fellows (PGY4-7) participated in the effort. Fellows were encouraged to review their practices then coached by a CVM faculty member in one-to-one sessions to develop strategies to improve one or more quality metrics of their choice. Pre and post surveys were administered to determine baseline and post-curriculum knowledge, attitudes, and experience with the topic of population health. We tracked fellow engagement through measured dashboard utilization. Results: Pre and post survey response rate was 81% and 46% respectively. At baseline, 23.5% (8) of fellows reported never receiving any education in population health and 67.6% (23) of fellows reported previous experience with population health tools such as EHR dashboards. Only 14.7% (5) of fellows had baseline knowledge of how quality metrics affect health care reimbursement. After the initial year of the curriculum and dashboard implementation, 100% (11) of fellows responding believed that it was important to learn about population health management and planned to utilize the skills they learned in practice. Further, 72% (8) of fellows changed one or more aspects of their practice after utilizing the dashboard coupled with one-on-one coaching. Since EHR dashboard implementation, fellows have accessed the dashboard 560 times. Discussion: Integrating population health education utilizing a fellow-specific EHR dashboard in a CVM fellowship is both feasible and highly rated. This method of population health education is scalable across other cardiovascular disease fellowship programs and other subspecialties.