ABSTRACT
INTRODUCTION AND OBJECTIVE: We determined the national impact over time of the COVID-19 pandemic on outpatient urology visits and procedural volume. METHODS: We examined temporal changes in urologic care delivery in the United States from February 2020 to July 2020 based on patient, practice, and local/regional demographic and pandemic response features using real-world data from the American Urological Association Quality (AQUA) Registry, which is a Qualified Clinical Data Registry. Data are collected via automated extraction from practices' electronic health record systems. RESULTS: There were 2,750,001 unique patients represented in our study cohort, accounting for 8,953,832 total outpatient visits and 1,570,161 procedures;data represented 157 outpatient urologic practices and 3,165 providers across 48 US states and territories. We found large (>40%) declines in outpatient visits from March 2020 to April 2020 across all patient demographic groups and across states, regardless of timing of state stay-at-home orders. Visits recovered through May and early June, but began falling again by early July. Non-urgent outpatient visits decreased more across various non-urgent procedures (39e47%) than for procedures performed for urgent diagnoses (29e43%);surgical procedures for non-urgent conditions also decreased more (37e53%) than those for potentially urgent conditions (13e21%) (Table). African American and Hispanic patients had smaller decreases in outpatient visits compared with Asian and Caucasian patients, but also slower recoveries back to baseline. Medicare-insured patients had the steepest declines (50%) while those on Medicaid had among the lowest percentage of recovery to baseline (84.4%). Practices in zip codes with lower median incomes, higher poverty levels, and lower urologist to population ratios had smaller decreases in outpatient visits. CONCLUSIONS: This study provides timely, real-world evidence on the magnitude of decline in the provision of specialty care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urologic health services by sociodemographic strata and specific diagnoses.
ABSTRACT
INTRODUCTION AND OBJECTIVE: We used data from a specialty-wide, community-based urology registry to determine trends in outpatient prostate cancer (PCa) care during the COVID-19 pandemic. METHODS: 3,165 (w 25%) of US urology providers, representing 48 states and territories, participate in the American Urological Association Quality (AQUA) Registry, which collects data via automated extraction from electronic health record systems. We analyzed trends in PCa care delivery from 156 practices contributing data in 2019 and 2020. Risk stratification was based on prostate-specific antigen (PSA) at diagnosis, biopsy Gleason, and clinical T-stage, and we used a natural language processing algorithm to determine Gleason and Tstage from unstructured clinical notes. The primary outcome was mean weekly visit volume by PCa patients per practice (visits defined as all MD and mid-level visits, telehealth and face-to-face), and we compared each week in 2020 through week 44 (November 1) to the corresponding week in 2019. RESULTS: There were 267,691 PCa patients in AQUA who received care between 2019 and 2020. From mid-March to early November, 2020 (week 10 - week 44) the magnitude of the decline and recovery varied by risk stratum, with the steepest drops for lowrisk PCa (Table). For 2020, overall mean visits per day (averaged weekly) were similar to 2019 for the first 9 weeks (w25). Visits declined to week 14 (18.19;a 31% drop from 2019), recovered to 2019 levels by week 23, and declined steadily to 11.89 (a 58% drop from 2019) as of week 44, the cut off of this analysis. CONCLUSIONS: Access to care for men with PCa was sharply curtailed by the COVID-19 pandemic, and while the impact was less for men with high-risk disease compared to those with low-risk disease, visits even for high-risk individuals were down nearly one-third and continued to fall through November. This study provides real-world evidence on the magnitude of decline in PCa care across risk groups. The impact of this decline on cancer outcomes should be followed closely.