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The Association of the First Surge of the COVID-19 Pandemic with the High- and Low-Value Outpatient Care Delivered to Adults in the USA.
Levine, David M; Samal, Lipika; Neville, Bridget A; Burdick, Elisabeth; Wien, Matthew; Rodriguez, Jorge A; Ganesan, Sandya; Blitzer, Stephanie C; Yuan, Nina H; Ng, Kenney; Park, Yoonyoung; Rajmane, Amol; Jackson, Gretchen Purcell; Lipsitz, Stuart R; Bates, David W.
  • Levine DM; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA. dmlevine@bwh.harvard.edu.
  • Samal L; Harvard Medical School, Boston, MB, USA. dmlevine@bwh.harvard.edu.
  • Neville BA; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
  • Burdick E; Harvard Medical School, Boston, MB, USA.
  • Wien M; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
  • Rodriguez JA; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
  • Ganesan S; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
  • Blitzer SC; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
  • Yuan NH; Harvard Medical School, Boston, MB, USA.
  • Ng K; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
  • Park Y; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
  • Rajmane A; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
  • Jackson GP; IBM Research, Cambridge, MA, USA.
  • Lipsitz SR; IBM Research, Cambridge, MA, USA.
  • Bates DW; IBM Watson Health, Cambridge, MA, USA.
J Gen Intern Med ; 37(15): 3979-3988, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2000087
ABSTRACT

BACKGROUND:

The first surge of the COVID-19 pandemic entirely altered healthcare delivery. Whether this also altered the receipt of high- and low-value care is unknown.

OBJECTIVE:

To test the association between the April through June 2020 surge of COVID-19 and various high- and low-value care measures to determine how the delivery of care changed.

DESIGN:

Difference in differences analysis, examining the difference in quality measures between the April through June 2020 surge quarter and the January through March 2020 quarter with the same 2 quarters' difference the year prior.

PARTICIPANTS:

Adults in the MarketScan® Commercial Database and Medicare Supplemental Database. MAIN

MEASURES:

Fifteen low-value and 16 high-value quality measures aggregated into 8 clinical quality composites (4 of these low-value). KEY

RESULTS:

We analyzed 9,352,569 adults. Mean age was 44 years (SD, 15.03), 52% were female, and 75% were employed. Receipt of nearly every type of low-value care decreased during the surge. For example, low-value cancer screening decreased 0.86% (95% CI, -1.03 to -0.69). Use of opioid medications for back and neck pain (DiD +0.94 [95% CI, +0.82 to +1.07]) and use of opioid medications for headache (DiD +0.38 [95% CI, 0.07 to 0.69]) were the only two measures to increase. Nearly all high-value care measures also decreased. For example, high-value diabetes care decreased 9.75% (95% CI, -10.79 to -8.71).

CONCLUSIONS:

The first COVID-19 surge was associated with receipt of less low-value care and substantially less high-value care for most measures, with the notable exception of increases in low-value opioid use.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male Country/Region as subject: North America Language: English Journal: J Gen Intern Med Journal subject: Internal Medicine Year: 2022 Document Type: Article Affiliation country: S11606-022-07757-1

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male Country/Region as subject: North America Language: English Journal: J Gen Intern Med Journal subject: Internal Medicine Year: 2022 Document Type: Article Affiliation country: S11606-022-07757-1