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

ABSTRACT

Introduction & Objectives: The impact of the COVID-19 pandemic on health care access and delivery in the US has been reported for hospital admissions and in the outpatient setting for a few selected health conditions. However, the impact on specialty care has not been adequately characterized. We therefore aimed to determine trends in outpatient urologic care visit and procedural volume in 2020, using a specialty-wide, community-based registry. Materials & Methods: The American Urological Association Quality (AQUA) Registry collects data via automated extraction from electronic health record systems at 157 urology practices representing 3,165 providers (roughly one-quarter of US urologists) across 48 US states and territories. We analyzed trends in care delivery from February 2020 to July 2020 based on patient, practice, and local/regional demographic and pandemic response features. The primary outcomes were mean visit volume and procedure volume per practice per week, and we compared each week to the corresponding week in 2019. Results: There were 2,750,001 patients in our cohort, accounting for 8,953,832 outpatient visits and 1,570,161 procedures. We found large (>40%) declines in outpatient visits from March to April 2020 across all demographic groups and US states, regardless of timing of stay-at-home orders. Visits recovered through May and early June, but began falling again by early July (see Figure). Non-urgent visits and procedures decreased more (39–47%) than visits for urgent diagnoses (29–43%);surgical procedures for non-urgent conditions also decreased more (37–53%) than those for potentially urgent conditions (13–21%). African American and Hispanic patients had smaller decreases in visits compared with Asian and Caucasian patients, but also slower recoveries back to baseline. Medicare-insured patients (mostly over 65 years old) had the steepest declines (50%) while those on Medicaid (generally low-income) 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. (Figure Presented) Conclusions: This study provides timely, real-world evidence on the magnitude of decline in the provision of urological 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.