Impact of the COVID-19 pandemic on urology care delivery in The United States

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.