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Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study
Journal of Medical Internet Research ( IF 5.8 ) Pub Date : 2021-04-29 , DOI: 10.2196/26558
Stanley Xu , Sungching Glenn , Lina Sy , Lei Qian , Vennis Hong , Denison S Ryan , Steven Jacobsen

Background: The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care, accompanied by a corresponding surge in the use of telehealth services. However, the extent and nature of changes in health care utilization during the pandemic may differ by care setting. Knowledge of the impact of the pandemic on health care utilization is important to health care organizations and policy makers. Objective: The aims of this study are (1) to evaluate changes in in-person health care utilization and telehealth visits during the COVID-19 pandemic and (2) to assess the difference in changes in health care utilization between the pandemic year 2020 and the prepandemic year 2019. Methods: We retrospectively assembled a cohort consisting of members of a large integrated health care organization, who were enrolled between January 6 and November 2, 2019 (prepandemic year), and between January 5 and October 31, 2020 (pandemic year). The rates of visits were calculated weekly for four settings: inpatient, emergency department (ED), outpatient, and telehealth. Using Poisson models, we assessed the impact of the pandemic on health care utilization during the early days of the pandemic and conducted difference-in-deference (DID) analyses to measure the changes in health care utilization, adjusting for the trend of health care utilization in the prepandemic year. Results: In the early days of the pandemic, we observed significant reductions in inpatient, ED, and outpatient utilization (by 30.2%, 37.0%, and 80.9%, respectively). By contrast, there was a 4-fold increase in telehealth visits between weeks 8 (February 23) and 12 (March 22) in 2020. DID analyses revealed that after adjusting for prepandemic secular trends, the reductions in inpatient, ED, and outpatient visit rates in the early days of the pandemic were 1.6, 8.9, and 367.2 visits per 100 person-years (P<.001), respectively, while the increase in telehealth visits was 272.9 visits per 100 person-years (P<.001). Further analyses suggested that the increase in telehealth visits offset the reduction in outpatient visits by week 26 (June 28, 2020). Conclusions: In-person health care utilization decreased drastically during the early period of the pandemic, but there was a corresponding increase in telehealth visits during the same period. By end-June 2020, the combined outpatient and telehealth visits had recovered to prepandemic levels.

This is the abstract only. Read the full article on the JMIR site. JMIR is the leading open access journal for eHealth and healthcare in the Internet age.


中文翻译:

大型综合卫生保健系统中COVID-19大流行对卫生保健利用的影响:回顾性队列研究

背景:COVID-19大流行导致亲自护理的使用量突然减少,同时远程医疗服务的使用量也相应增加。但是,大流行期间卫生保健利用率变化的程度和性质可能因医疗机构而异。了解大流行对医疗保健利用的影响对医疗保健组织和决策者很重要。目的:这项研究的目的是(1)评估COVID-19大流行期间个人卫生保健使用和远程医疗就诊的变化,以及(2)评估2020年大流行到2006年之间卫生保健使用变化的差异。方法:我们回顾性地组建了一个由大型综合医疗机构的成员组成的队列,该队列由2019年大流行年组成。他们在2019年1月6日至11月2日(大流行年)之间以及2020年1月5日至10月31日(大流行年)之间进行了注册。每周计算以下四个地点的就诊率:住院病人,急诊科(ED),门诊病人和远程医疗。使用Poisson模型,我们评估了大流行初期大流行对医疗保健利用的影响,并进行了差异参考(DID)分析以衡量医疗保健利用的变化,并根据医疗保健利用的趋势进行调整在大流行的一年。结果:在大流行初期,我们观察到住院,急诊和门诊使用率显着下降(分别下降了30.2%,37.0%和80.9%)。相比之下,2020年的第8周(2月23日)至12周(3月22日)之间的远程医疗就诊次数增加了4倍。DID分析显示,在调整大流行前的长期趋势后,大流行初期住院,急诊和门诊就诊率分别每100人年减少1.6、8.9和367.2次就诊(P <.001) ,而远程医疗访问的增加为每100人年272.9次访问(P <.001)。进一步的分析表明,远程医疗就诊的增加抵消了第26周(2020年6月28日)门诊就诊人数的减少。结论:在大流行初期,个人卫生保健使用率急剧下降,但在同一时期,远程医疗就诊次数也相应增加。到2020年6月底,门诊和远程医疗的合并就诊已恢复到大流行前的水平。大流行初期住院,急诊和门诊就诊率分别每100人年减少1.6、8.9和367.2(P <.001),而远程医疗就诊率每增加272.9人次100人年(P <.001)。进一步的分析表明,远程医疗就诊的增加抵消了第26周(2020年6月28日)门诊就诊人数的减少。结论:在大流行初期,个人卫生保健使用率急剧下降,但在同一时期,远程医疗就诊次数也相应增加。到2020年6月底,门诊和远程医疗的合并就诊已恢复到大流行前的水平。大流行初期住院,急诊和门诊就诊率分别每100人年减少1.6、8.9和367.2(P <.001),而远程医疗就诊率每增加272.9人次100人年(P <.001)。进一步的分析表明,远程医疗就诊的增加抵消了第26周(2020年6月28日)门诊就诊人数的减少。结论:在大流行初期,个人卫生保健使用率急剧下降,但在同一时期,远程医疗就诊次数也相应增加。到2020年6月底,门诊和远程医疗的合并就诊已恢复到大流行前的水平。而远程医疗访问的增加为每100人年272.9次访问(P <.001)。进一步的分析表明,远程医疗就诊的增加抵消了第26周(2020年6月28日)门诊就诊人数的减少。结论:在大流行初期,个人卫生保健使用率急剧下降,但在同一时期,远程医疗就诊次数也相应增加。到2020年6月底,门诊和远程医疗的合并就诊已恢复到大流行前的水平。而远程医疗访问的增加为每100人年272.9次访问(P <.001)。进一步的分析表明,远程医疗就诊的增加抵消了第26周(2020年6月28日)门诊就诊人数的减少。结论:在大流行初期,个人卫生保健使用率急剧下降,但在同一时期,远程医疗就诊次数也相应增加。到2020年6月底,门诊和远程医疗的合并就诊已恢复到大流行前的水平。但同期的远程医疗就诊次数也相应增加。到2020年6月底,门诊和远程医疗的合并就诊已恢复到大流行前的水平。但同期的远程医疗就诊次数也相应增加。到2020年6月底,门诊和远程医疗的合并就诊已恢复到大流行前的水平。

这仅仅是抽象的。阅读JMIR网站上的全文。JMIR是互联网时代电子健康和医疗保健领域领先的开放获取期刊。
更新日期:2021-04-29
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