RESUMO
OBJECTIVES: To describe real-time changes in medical visits (MVs), visit mode, and patient-reported visit experience associated with rapidly deployed care reorganization during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: Cross-sectional time series from September 29, 2019, through June 20, 2020. METHODS: Responding to official public health and clinical guidance, team-based systematic structural changes were implemented in a large, integrated health system to reorganize and transition delivery of care from office-based to virtual care platforms. Overall and discipline-specific weekly MVs, visit mode (office-based, telephone, or video), and associated aggregate measures of patient-reported visit experience were reported. A 38-week time-series analysis with March 8, 2020, and May 3, 2020, as the interruption dates was performed. RESULTS: After the first interruption, there was a decreased weekly visit trend for all visits (ß3 = -388.94; P < .05), an immediate decrease in office-based visits (ß2 = -25,175.16; P < .01), increase in telephone-based visits (ß2 = 17,179.60; P < .01), and increased video-based visit trend (ß3 = 282.02; P < .01). After the second interruption, there was an increased visit trend for all visits (ß5 = 565.76; P < .01), immediate increase in video-based visits (ß4 = 3523.79; P < .05), increased office-based visit trend (ß5 = 998.13; P < .01), and decreased trend in video-based visits (ß5 = -360.22; P < .01). After the second interruption, there were increased weekly long-term visit trends for the proportion of patients reporting "excellent" as to how well their visit needs were met for all visits (ß5 = 0.17; P < .01), telephone-based visits (ß5 = 0.34; P < .01), and video-based visits (ß5 = 0.32; P < .01). Video-based visits had the highest proportion of respondents rating "excellent" as to how well their scheduling and visit needs were met. CONCLUSIONS: COVID-19 required prompt organizational transformation to optimize the patient experience.
