Changes in Primary Care Visits in the 24 Weeks After COVID-19 Stay-at-Home Orders Relative to the Comparable Time Period in 2019 in Metropolitan Chicago and Northern Illinois

Abstract

Objective In this brief report, we characterize pediatric primary care service utilization in metropolitan Chicago over the first 24 weeks of the COVID-19 pandemic response in relation to the comparable time period in 2019. Methods We examined retrospective visit and billing data, regardless of payer, from 16 independent pediatric practices that utilize a common electronic medical record platform within an Accountable Care Organization of 252 pediatricians in 71 offices throughout metropolitan Chicago. We categorized visits as Well-Child and Immunization-Only (WC-IO) or Other types and identified visits with a telemedicine billing modifier. Diagnoses for Other visits were tallied and categorized using the Agency for Healthcare Research and Quality Clinical Classification System. We summarized counts of visits and the proportion of visits with a telemedicine billing modifier in one-week epochs for 2020 compared with 2019. Results There were 102 942 total visits (72 030 WC-IO; 30 912 Other) in 2020 and 144 672 visits (80 578 WC-IO; 64 094 Other) in 2019. WC-IO visits in 2020 were half of 2019 visits at the start of the Illinois Stay-at-Home Order and returned greater than 90% of 2019 visits in 8 weeks. Other visit types have remained below 70% of 2019 visits. A telemedicine billing modifier peaked in mid-April (21% of all visits) and declined to <10% of all visits in June (Phase 2 reopening). The top 10 most common diagnoses differed between years. Conclusions Recovery of well child and immunization visits suggests that practice-level efforts and policy change can ensure children receive recommended care as the pandemic evolves.

Impact of COVID-19 on Pediatric Primary Care Visits at Four Academic Institutions in the Carolinas

“…[ 8 , 9 , 10 , 11 ]. However, our study adds to the sparse literature, by evaluating 79 clinics across four large, academic institutions in the Southeastern US, indicating decreased utilization of pediatric primary care [ 12 , 19 ]. Reasons for decreased primary care visits include patients’ fear of contracting the SARS-CoV-2 infection [ 11 , 18 ], practices deferring elective visits [ 21 ], governmental stay at home orders [ 9 ], and decreased infection-related visits [ 22 ].…”

“…[ 8 , 9 , 10 , 11 ]. There has also been a decrease in pediatric primary care visits due to concerns about children becoming infected with SARS-CoV-2, or in order to comply with stay-at-home orders [ 12 ]. During March and April 2020, restaurants, bars, public schools, and nonessential businesses were closed for in-person services and large gatherings were prohibited.…”

“…Telehealth has emerged as a tool for patients to access primary care during the pandemic, although how much impact telehealth has had on closing the gap in pediatric primary care is still unclear. While there has been growing literature about the impact of the COVID-19 pandemic on pediatric healthcare utilization [ 8 , 12 , 17 , 18 , 19 , 20 ], there are still limited data on the effect of the pandemic on the volume of pediatric primary care visits and the characteristics of patients who did and did not attend a visit during the pandemic.…”

Parent‐reported hesitancy to seek emergency care for children at the crest of the first wave of COVID‐19 in Chicago

“…In March, the Governor of Illinois issued a stay‐at‐home executive order limiting health care seeking to emergencies and COVID‐19 care, closing schools to in‐person instruction, and restricting daycare to groups of 10 or fewer children of essential workers. The stay‐at‐home order was associated with substantial reductions in health care utilization by children in metropolitan Chicago and northern Illinois; well‐child examinations recovered to prepandemic levels by June while other visit types remained suppressed through summer 2020 5 …”

“…During the first wave of COVID‐19 in metropolitan Chicago, we found that nearly one in four caregivers were hesitant to seek ED care for their child with a hypothetical emergency condition. Prior to declines in acute health care utilization associated with the COVID‐19 pandemic, 3‐5 higher ED utilization has been observed among children who are African American/Black or Latinx and publicly insured 7 . Researchers focused attention on low‐acuity ED visits for children 7,8 …”