JMIR Publications

ABSTRACT

Background:

Understanding the long-term impact of the COVID-19 pandemic on health care utilization is important to health care organizations and policy makers, as well for researchers when designing studies that use observational electronic health record data during the pandemic period.

Objective:

To evaluate changes in health care utilization across all care settings among a large diverse insured population in the United States during the COVID-19 pandemic.

Methods:

We conducted a retrospective cohort study within 8 health care organizations participating in the Vaccine Safety Datalink Project using electronic health record data from members of all ages during January 2017 - December 2021. The visit rates per person-year were calculated monthly during the study period for all health care settings combined as well as by inpatient, emergency department (ED), outpatient, and telehealth settings, both among all members and members without COVID-19. Difference-in-difference analysis and interrupted time series analysis were performed to assess the changes in visit rates from the pre-pandemic period (January 2017 to February 2020) to the early pandemic period (April 2020 to December 2020) and the later pandemic period (July 2021 to December 2021), respectively.

Results:

The study included more than 11 million members between 2017 and 2021. Compared with the pre-pandemic period, we found reductions in visit rates during the early pandemic period for all in-person care settings. During the later pandemic period, overall utilization exceeded pre-pandemic levels (adjusted percent change = 5.1%; 95% CI 0.6% to 9.9%); inpatient and ED visits returned to pre-pandemic levels, although they remained 7.5% and 8.0% lower among members without a documented history of COVID-19. Telehealth visits, which were approximately 42% of the volume of outpatient visits during the later pandemic period, were increased by 97.5% (95% CI 86.0% to 109.7%) from the pre-pandemic period.

Conclusions:

Our findings provide valuable information for longer-term strategic resource allocation for patient care in the post-pandemic period and for designing observational studies involving the pandemic period.