COVID-19 Impacts on Primary Care Clinic Care Management Processes.

PURPOSE: To learn whether the COVID-19 pandemic's disruptions and associated reduced health outcomes for people with chronic conditions might have been caused by a decrease in care management processes (CMPs) in primary care clinics METHODS: Longitudinal cohort design with repeated survey-based measures of CMPs from 2017, 2019, and 2021 in 269 primary care clinics in Minnesota. RESULTS: There were only small differences in organizational characteristics and no differences in overall CMPs between the 269 clinics analyzed and the 287 that only completed surveys in 1 or 2 years. Overall CMP scores rose by similar amounts (1.6% and 2.1%) from 2017 to 2019 and from 2019 to 2021. In 2021, CMP scores were lower in small medical groups than in large medical groups in 2017 (66.1% vs 78.5%, P <.001), a similar difference to that in 2017. Care management process scores were also lower in clinics in urban areas compared with rural areas (73.9% vs 79.0%, P <.001), but overall scores in all subgroups were higher in 2021 than in 2017. This improvement occurred despite reports from 55% of clinic leaders that the pandemic had been very or extremely disruptive. CONCLUSIONS: Although quite disrupted by the pandemic, care management processes for chronic disease care in these resilient primary care clinics actually increased from 2019 to 2021, at least in clinics that were part of large organizations. However, that was not true for clinics from smaller groups and perhaps for other areas of care.

Risk of Thromboembolic Events Following COVID-19 Diagnosis Without Hospitalization.

INTRODUCTION: Current research shows no increased risk of thromboembolic events with mild COVID-19 but does not account for comorbidities. The aim of this study was to examine the incidence of thromboembolic events, including pulmonary embolism, cerebral infarction, and deep vein thrombosis, in nonhospitalized patients diagnosed with COVID-19 while accounting for comorbidities such as diabetes, asthma, COPD and cancer. METHODS: We completed a large retrospective observational analysis of adult patients within a large urban health system. RESULTS: Using a logit framework (with and without propensity score weighting), there was no increased risk of thromboembolic events among patients positive for SARS-CoV-2 who did not require hospitalization for COVID-19. CONCLUSION: This data suggest prophylactic anticoagulation is likely not warranted in the outpatient setting.

Care Management Practices for Diabetes and Other Chronic Conditions during COVID

Background: Diabetes outcomes in primary care settings depend on specific care management processes (CMPs) provided by practices. CMPs have been tracked in Minnesota since 2017 using a practice survey that measures the presence of 1CMPs in primary care, including CMPs focused on patients with diabetes. Method: Secondary data analysis of CMP data collected in 2017, 2019, and 2021, with a COVID supplement in 2021. The 2021 survey was conducted in February and March, between the peaks in COVID cases observed in Minnesota. Results: Response rates for the three waves were 71%, 72% and 69%, respectively. Our analysis focuses on the 269/556 practices participating in all three waves. Overall prevalence of CMPs for this subset was not significantly different (p=0.069) than for practices that participated in only one or two waves. Among continuously participating practices, overall prevalence of CMPs increased significantly (p=0.005) in 2021. This increase was driven by CMPs focusing on chronic disease management (p=0.011) , patient self-management (p=0.013) , and development of care plans (p=0.004) . Diabetes-specific CMPs had the highest prevalence in all years relative to CMPs focused on cardiovascular disease, depression or asthma. Nearly 90% of respondent practices described moderate to extreme disruption in disease management practices during the pandemic peak. Prior to the pandemic in 2019, virtual visits (phone, video) comprised less than 20% of the total visits for almost all practices. During the 2020 peak, 29% of practices conducted 60% or more of their visits virtually, and an additional 50% of practices conducted 20%-59% of visits virtually. By early 2021, nearly all practices reported less than 40% of visits being conducted virtually. Conclusions: Despite significant practice disruption due to the pandemic, primary care practices in Minnesota reported continued increase in CMPs supporting care for patients with diabetes and other chronic conditions.