Impact of COVID-19 on Trends in Outpatient Clinic Utilization

Gander, Jennifer C.; McDonald, Bennett; Goodrich, Glenn K.; Tavel, Heather M.; Basra, Sundeep; Weinfield, Nancy S.; Ritzwoller, Debra P.; Roblin, Douglas W.; Davis, Teaniese L.

doi:10.1097/mlr.0000000000001812

Cited by 9 publications

(10 citation statements)

References 22 publications

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“…Eligible participants were identified from our study’s common data model (CDM) implemented at 3 KP Regions: Kaiser Permanente Colorado (KPCO), Georgia (KPGA), and Mid-Atlantic States (KPMAS). All 3 KP Regions are primarily group-model integrated delivery systems but differ in important patient population demographic characteristics and mode and timing of virtual visit implementation 39–41…”

Section: Methodsmentioning

confidence: 99%

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Management of Neck or Back Pain in Ambulatory Care

et al. 2023

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Background/Objective: In recent years, 2 circumstances have changed provider-patient interactions in ambulatory care: (1) the replacement of virtual for in-person visits and (2) the COVID-19 pandemic. We studied the potential impact of each event on provider practice and patient adherence by comparing the frequency of the association of provider orders, and patient fulfillment of those orders, by visit mode and pandemic period, for incident neck or back pain (NBP) visits in ambulatory care. Methods: Data were extracted from the electronic health records of 3 Kaiser Permanente regions (Colorado, Georgia, and Mid-Atlantic States) from January 2017 to June 2021. Incident NBP visits were defined from ICD-10 coded as primary or first listed diagnoses on adult, family medicine, or urgent care visits separated by at least 180 days. Visit modes were classified as virtual or in-person. Periods were classified as prepandemic (before April 2020 or the beginning of the national emergency) or recovery (after June 2020). Percentages of provider orders for, and patient fulfillment of orders, were measured for 5 service classes and compared on: virtual versus in-person visits, and prepandemic versus recovery periods. Comparisons were balanced on patient case-mix using inverse probability of treatment weighting. Results: Ancillary services in all 5 categories at each of the 3 Kaiser Permanente regions were substantially ordered less frequently on virtual compared with in-person visits in both the prepandemic and recovery periods (both P ≤ 0.001). Conditional on an order, patient fulfillment within 30 days was high (typically ≥70%) and not likely meaningfully different between visit modes or pandemic periods. Conclusions: Ancillary services for incident NBP visits were ordered less frequently during virtual than in-person visits in both prepandemic and recovery periods. Patient fulfillment of orders was high, and not significantly different by mode or period.

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Section: Methodsmentioning

confidence: 99%

“…All 3 KP Regions are primarily group-model integrated delivery systems but differ in important patient population demographic characteristics and mode and timing of virtual visit implementation. [39][40][41] Under a ceding arrangement, the IRBs of KPCO, KPGA, and KPMAS collectively reviewed and approved the study protocol.…”

Section: Study Settingsmentioning

confidence: 99%

Management of Neck or Back Pain in Ambulatory Care

et al. 2023

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“…Six of the research studies examine the implementation and impact of telemedicine across 3 KP regions. The findings of the KP research highlight that, by Spring 2021, all 3 KP regions saw a resumption of in-person adult primary care visits to prepandemic levels, while behavioral health continued to be delivered predominantly through telemedicine 5. Racial-ethnic disparities in telemedicine use were found within KP; adults identifying as Black, Asian, or Hispanic were less likely to use virtual care 6.…”

Section: Commentarymentioning

confidence: 97%

“…The findings of the KP research highlight that, by Spring 2021, all 3 KP regions saw a resumption of in-person adult primary care visits to prepandemic levels, while behavioral health continued to be delivered predominantly through telemedicine. 5 Racial-ethnic disparities in telemedicine use were found within KP; adults identifying as Black, Asian, or Hispanic were less likely to use virtual care. 6 The KP research studies also tackle new areas in telemedicine research by comparing the impact of telemedicine and in-person visits on ancillary services utilization, including medication, laboratories, and imaging, for urinary tract infections 7 neck and back pain, 8 and depression.…”

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confidence: 99%

Assessing the Impact of Telemedicine Implementation in Diverse Health Care Systems

Rodríguez

2023

Medical Care

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Health care organizations and systems can have a large impact on how extensively telemedicine and virtual visits are used by medical practices and individual clinicians. This supplemental issue of medical care aims to advance evidence about how health care organizations and systems can best support telemedicine and virtual visit implementation. This issue includes 10 empirical studies examining the impact of telemedicine on quality of care, utilization, and/or patient care experiences, of which 6 are studies of Kaiser Permanente patients; 3 are studies of Medicaid, Medicare, and community health center patients; and 1 is a study of PCORnet primary care practices. The Kaiser Permanente studies find that ancillary service orders resulting from telemedicine encounters were not placed as often as in-person encounters for urinary tract infections, neck, and back pain, but there were no significant changes in patient fulfillment of ordered antidepressant medications. Studies focused on diabetes care quality among community health center patients and Medicare and Medicaid beneficiaries highlight that telemedicine helped maintain continuity of primary care and diabetes care quality during the COVID-19 pandemic. The research findings collectively demonstrate high variation in telemedicine implementation across systems and the important role that telemedicine had in maintaining the quality of care and utilization for adults with chronic conditions when in-person care was less accessible.

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“…All 3 regions transitioned rapidly to a virtual-care-first model in March 2020 at the time of the declaration of a national emergency and associated state-level shutdowns due to the COVID-19 pandemic. 17 Although adult primary care gradually returned to a balance of in-person and virtual care encounters once the shutdown periods ended, behavioral health care remained almost entirely virtual, and visit volume remained steady or increased slightly throughout the remainder of the study period, 18 providing an opportunity to examine practice variation in medication orders, patient fulfillment of orders, and completion of mental health symptom trackers over time within the behavioral health virtual care setting, as virtual care became the predominant mode of care.…”

Section: Settingmentioning

confidence: 99%

Health-care–Related Practices in Virtual Behavioral Health Treatment for Major Depression Before and During the COVID-19 Pandemic

et al. 2023

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Background: The abrupt shift to virtual care at the onset of the COVID-19 pandemic had the potential to disrupt care practices in virtual behavioral health encounters. We examined changes over time in virtual behavioral health-care-related practices for patient encounters with diagnoses of major depression. Methods: This retrospective cohort study utilized electronic health record data from 3 integrated health care systems. Inverse probability of treatment weighting was used to adjust for covariates across 3 time periods, prepandemic (January 2019–March 2020), peak-pandemic shift to virtual care (April 2020–June 2020), and recovery of health care operations (July 2020–June 2021). First virtual follow-up behavioral health department encounters after an incident diagnostic encounter were examined for differences across the time periods in rates of antidepressant medication orders and fulfillments, and completion of patient-reported symptoms screeners in service of measurement-based care. Results: Antidepressant medication orders declined modestly but significantly in 2 of the 3 systems during the peak-pandemic period but rebounded during the recovery period. There were no significant changes in patient fulfillment of ordered antidepressant medications. Completion of symptom screeners increased significantly in all 3 systems during the peak-pandemic period and continued to increase significantly in the subsequent period. Conclusions: A rapid shift to virtual behavioral health care was possible without compromising health-care-related practices. The transition and subsequent adjustment period have instead been marked by improved adherence to measurement-based care practices in virtual visits, signaling a potential new capacity for virtual health care delivery.

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Impact of COVID-19 on Trends in Outpatient Clinic Utilization

Cited by 9 publications

References 22 publications

Management of Neck or Back Pain in Ambulatory Care

Management of Neck or Back Pain in Ambulatory Care

Assessing the Impact of Telemedicine Implementation in Diverse Health Care Systems

Health-care–Related Practices in Virtual Behavioral Health Treatment for Major Depression Before and During the COVID-19 Pandemic

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