Presentation (CTI)

OBJECTIVES: The COVID-19 pandemic impacted healthcare systems with the postponement of emergent and elective procedures to preserve healthcare resources and attempt infection containment. Postponing needed services may have downstream effects for patients, potentially causing worsening health outcomes and increasing the burden of healthcare utilization in the subsequent years. This study aims to explore whether the COVID-19 pandemic had an initial and continued effect on trends in overall healthcare utilization.
METHODS: This retrospective observational study utilized the TriNetX Linked Network (EHR+ claims) of de-identified patients from 2016-2022. Procedures associated with an emergency, inpatient, or outpatient encounter were categorized into six groups based on overall CPT category membership: cardiovascular, respiratory, musculoskeletal, dermatological, digestive, and other. Autoregressive integrated moving average (ARIMA) time series forecasting was used to predict procedure rates from January 2020 to December 2021.
RESULTS: This study included over 371 million procedures across 11,509,684 patients with a median age of 50 (IQR: 29, 62), 47.8% White, 9.2% Hispanic, and 54.8% female. For overall procedure rates there was an initial -68% change (95% prediction interval (PI): [-70%, -66%]) in April 2020, and among the 24 months forecasted an average -22% change (95% PI: [-29%, -13%]). Outpatient averaged -24% change (95% PI: [-31%, -15]); emergency -15% (95% PI: [-25%, -2%]); and inpatient -2% (95% PI: [-7%, 4%]). Most categories followed a similar average trajectory except inpatient and emergency cardiovascular procedures (10%, 95% PI: [-1%,25%]; -14%, 95% PI: [-27%, 7%]; respectively), respiratory inpatient (-3%, 95% PI: [-11%, 7%]), and digestive inpatient (-6%, 95% PI: [13%, 1%]).
CONCLUSIONS: In this study of number of procedures surrounding the COVID-19 pandemic era, we observed a significant decrease in overall procedures from January 2020 through December 2021 versus predicted amounts. Further research is needed to determine the impact of delayed healthcare utilization on patient health outcomes.