Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System (Preprint)

BACKGROUND COVID-19 has caused an abrupt drop in the use of in-person health care, accompanied by a corresponding surge in usage of telehealth services. However, the extent and nature of changes in health care utilization during the pandemic may differ by care setting. Knowledge of the impact of the pandemic on health care utilization is important to health care organizations and policy makers. OBJECTIVE The aims of this study are 1) to describe changes in in-person health care utilization and telehealth visits during the COVID-19 pandemic, and 2) to measure the difference in changes of health care utilization between the pandemic year 2020 and the pre-pandemic year 2019. METHODS We retrospectively assembled a cohort consisting of members of a large integrated health care organization who were enrolled between January 6, 2019-November 2, 2019 (pre-pandemic year) and between January 5, 2020-October 31, 2020 (pandemic year). The rates of visits were calculated weekly for four settings: inpatient, emergency department (ED), outpatient and telehealth. Using Poisson models, we assessed the impact of the pandemic on health care utilization during the early days of the pandemic and conducted difference in deference (DID) analyses to measure the changes in health care utilization adjusting for the trend of health care utilization in the pre-pandemic year. RESULTS In the early days of the pandemic, we observed significant reductions in inpatient, ED, and outpatient utilization (by 30.2%, 51.1%, and 85.5%, respectively). By contrast, there was a 4-fold increase in telehealth visits between week 8 (February 23) and week 13 (March 29) of year 2020. DID analyses showed that after adjusting for pre-pandemic secular trends, the decreases in inpatient, ED, and outpatient visit rates in the early days of the pandemic were 1.6, 12.1, and 415.0 visits per 100 person-years (p-value<0.0001), respectively, while the increase in telehealth visits was 272.9 visits per 100 person-years (p-value<0.0001). Further analyses suggested that the increase in telehealth visits offset the decrease in outpatient visits by week 26 (June 28). CONCLUSIONS Conclusions: In-person health care utilization dropped dramatically during the early period of the pandemic, but there was a corresponding increase in telehealth visits during the same period. By the end of June 2020, the combined outpatient and telehealth visits had recovered to pre-pandemic levels.