Disparities in outpatient and telehealth visits during the COVID-19 pandemic in a large integrated health care organization (Preprint)

BACKGROUND Dramatic decreases in outpatient visits and sudden increases in telehealth visits were observed during the COVID-19 pandemic, but it was unclear whether these changes differed by patients’ demographics and socioeconomic status. OBJECTIVE To assess the impact of the pandemic on outpatient and telehealth visits by demographic characteristics and household income in a diverse population. METHODS We calculated weekly rates of outpatient and telehealth visits by age, sex, race/ethnicity, and neighborhood-level median household income among members of Kaiser Permanente Southern California (KPSC) during January 5, 2020-October 31, 2020, and the corresponding period in 2019. We estimated the change in visit rates during the early pandemic period (March 22-April 25, 2020) and the late pandemic period (October 4-October 31, 2020) from the pre-pandemic period (January 5-March 7, 2020) in Poisson regression models for each subgroup while adjusting for seasonality using 2019 data. We examined if the changes in visit rates differed by subgroups statistically by comparing their 95% confidence intervals. RESULTS Among 4.56 million KPSC members enrolled in January 2020, about 15% were aged ≥65 years, 52% were female, 39% were Hispanic, and 8% lived in an area of median household income less than $40,000. Increases in telehealth visits during the pandemic varied across subgroups, while decreases in outpatient visits were similar except for age. Among age groups, the 65 years and older population had the least increase in telehealth visits (236.6%; 95% confidence interval [CI], 228.8% to 244.5%): 4.9 per one person-year during the early pandemic period versus 1.5 per one person-year during the pre-pandemic period. During the same periods, across racial/ethnic groups, Hispanic individuals had the largest increase in telehealth visits (295.5%; 95% CI, 275.5% to 316.5%); across income levels, telehealth visits in the low-income group increased the most (313.5%; 95% CI, 294.8 to 333.1%). The rate of combined outpatient and telehealth visits in the Hispanic, Non-Hispanic Black, and low-income group returned to pre-pandemic levels by October 2020. CONCLUSIONS The Hispanic group and the low-income group had the largest increase in telehealth utilization in responding to the COVID-19 pandemic. The use of virtual care potentially mitigated the impact of the pandemic on health care utilization in these vulnerable populations.

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The Impact of i-PUSH on Maternal and Child Health Outcomes, Health Care Utilization and Financial Protection: A Cluster Randomised Controlled Trial Based on Financial and Health Diaries Data

10.21203/rs.3.rs-62882/v1 ◽

2020 ◽

Author(s):

Amanuel Abajobir ◽

Richard de Groot ◽

Caroline Wainaina ◽

Anne Njeri ◽

Daniel Maina ◽

...

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Services ◽

Low Income ◽

Health Knowledge ◽

Care Utilization ◽

Quality Health ◽

Randomised Controlled ◽

The Impact ◽

Quality Health Services

Abstract Background: Universal Health Coverage (UHC) ensures access to quality health services for all, with no financial hardship when accessing the needed services. Nevertheless, access to quality health services is marred by substantial resource shortages creating service delivery gaps in low-and middle-income countries (LMICs), including Kenya. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) program, developed by AMREF Health Africa and PharmAccess Foundation (PAF), aims to empower low-income women of reproductive age and their families through innovative digital tools. This study aims to evaluate the impact of i-PUSH on maternal and child health care utilization, women’s health including their knowledge, behavior and uptake of respective services, as well as women’s empowerment and financial protection. It also aims to evaluate the impact of the LEAP training tool on empowering and enhancing CHVs’ health literacy and to evaluate the impact of the M-TIBA health wallet on savings for health and health insurance uptake.Methods: This is a cluster randomised controlled trial (RCT) study that uses a four-pronged approach –including year-long weekly financial and health diaries interviews, baseline and endline surveys, a qualitative study and behavioral lab-in-the-field experiments–in Kakemega County, Kenya. In total, 240 households from 24 villages in Kakamega will be followed to capture their health, health knowledge, health-seeking behavior, health expenditures and enrolment in health insurance over time. A random half of the households live in villages assigned to the treatment group where i-PUSH will be implemented after the baseline, while the other half of the households live in control village where i-PUSH will not be implemented until after the endline. The study protocol was reviewed and approved by the AMREF Ethical and Scientific Review Board (AMREF-ESRC). Research permits were obtained from the National Commission for Science, Technology and Innovation (NACOSTI) agency of Kenya. Discussion: People in LMICs often suffer from high out-of-pocket healthcare expenditures, which in turn, impedes access to quality health services. Saving for healthcare as well as enrolment in health insurance can improve access to healthcare by building capacities at all levels–individuals, families and communities. Notable, i-PUSH fosters savings for health care through the mobile-phone based “health wallet”, it enhances enrolment in subsidized health insurance through the mobile platform–M-TIBA–developed by PAF, and it seeks to improve health knowledge and behavior through Community Health Volunteers (CHVs) who are trained using the LEAP tool–AMREF’s mHealth platform. The findings will inform stakeholders to formulate better strategies to ensure access to UHC in general, and for a highly vulnerable segment of the population in particular, including low-income mothers and their children. Trial registration history: Registered with Protocol Registration and Results System (Protocol ID: AfricanPHRC; Trial ID: NCT04068571: AEARCTR-0006089; Date: 29 August 2019) and The American Economic Association's registry for randomised controlled trials (Trial ID: AEARCTR-0006089; Date: 26 June 2020).

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Geriatric syndromes and subsequent health-care utilization among older community dwellers in Stockholm

European Journal of Ageing ◽

10.1007/s10433-021-00600-2 ◽

2021 ◽

Author(s):

Jette Möller ◽

Christian Rausch ◽

Lucie Laflamme ◽

Yajun Liang

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Cox Regression ◽

Baseline Survey ◽

Care Utilization ◽

Geriatric Syndromes ◽

Outpatient Visits ◽

The Impact ◽

Community Dwellers

AbstractLittle is known about the long-term effect of geriatric syndromes on health-care utilization. This study aims to determine the association between geriatric syndromes and health-care utilization during a four-year period among older community dwellers. Based on the Stockholm Public Health Cohort study, a total number of 6700 community dwellers aged ≥65 years were included. From a baseline survey in 2006, geriatric syndromes were defined as having at least one of the following: insomnia, functional decline, urinary incontinence, depressive symptoms and vision impairment. Health-care utilization was identified by linkages at individual level with register data with a four-year follow-up. Cox regression was performed to estimate the associations. Compared to those without geriatric syndromes, participants with any geriatric syndromes had a higher prevalence of frequent hospitalizations, long hospital stays, frequent outpatient visits and polypharmacy in each of the follow-up years. After controlling for covariates, having any geriatric syndromes was associated with higher levels of utilization of inpatient and outpatient care as well as polypharmacy. The association was stable over time, and the fully adjusted hazard ratio (95% confidence interval) remained stable in frequent hospitalizations (from 1.89 [1.31, 2.73] in year 1 to 1.70 [1.23, 2.35] in year 4), long hospital stay (from 1.75 [1.41, 2.16] to 1.49 [1.24, 1.78]), frequent outpatient visits (from 1.40 [1.26, 1.54] to 1.33 [1.22, 1.46]) and polypharmacy (from 1.63 [1.46, 1.83] to 1.53 [1.37, 1.71]). Having any geriatric syndromes is associated with higher levels of health-care utilization among older community dwellers, and the impact of geriatric syndromes is stable over a four-year period.

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THE IMPACT OF HEALTH SUBSIDY ON HEALTH CARE UTILIZATION IN INDONESIA

Jurnal Anggaran dan Keuangan Negara Indonesia (AKURASI) ◽

10.33827/akurasi2021.vol3.iss2.art129 ◽

2021 ◽

Vol 3 (2) ◽

pp. 16-37

Author(s):

Renosa Tosca Zamaro

Keyword(s):

Health Care ◽

Access To Health Care ◽

Insurance Premium ◽

Health Care Facilities ◽

Public Hospitals ◽

Care Utilization ◽

Poor People ◽

Outpatient Visits ◽

Care Facilities ◽

The Impact

Equal opportunity and access to health care services regardless of one’s socio-economic background is important for health equity. To achieve this, the Indonesian government introduced a national health insurance program named Jaminan Kesehatan Nasional in 2014 and provided insurance premium subsidies for poor people. The current study evaluates the health subsidy policy’s impact on the utilization of different kinds of health care facilities, both public and private. Two waves of Indonesian socio-economic surveys, namely 2013 and 2018, and two analysis methods, namely logistic regression, and difference-in-differences, were applied in this study. The results show that in first-level health care facilities, the health subsidy improves the probability of outpatient visits in public health centers and polyclinics but decreases the probability of outpatient visits in medical practices. Then, in secondary-level health care facilities, the health subsidy was found to increase the likelihood of outpatient visits in public hospitals; however, it lowers the probability of outpatient visits in private hospitals.

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Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System (Preprint)

10.2196/preprints.26558 ◽

2020 ◽

Author(s):

Stanley Xu ◽

Sungching Glenn ◽

Lina Sy ◽

Lei Qian ◽

Vennis Hong ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Early Period ◽

Fold Increase ◽

Integrated Health Care ◽

Care Utilization ◽

P Value ◽

Care Organization ◽

Integrated Health ◽

The Impact

BACKGROUND COVID-19 has caused an abrupt drop in the use of in-person health care, accompanied by a corresponding surge in usage 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 describe changes in in-person health care utilization and telehealth visits during the COVID-19 pandemic, and 2) to measure the difference in changes of health care utilization between the pandemic year 2020 and the pre-pandemic year 2019. METHODS We retrospectively assembled a cohort consisting of members of a large integrated health care organization who were enrolled between January 6, 2019-November 2, 2019 (pre-pandemic year) and between January 5, 2020-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 pre-pandemic year. RESULTS In the early days of the pandemic, we observed significant reductions in inpatient, ED, and outpatient utilization (by 30.2%, 51.1%, and 85.5%, respectively). By contrast, there was a 4-fold increase in telehealth visits between week 8 (February 23) and week 13 (March 29) of year 2020. DID analyses showed that after adjusting for pre-pandemic secular trends, the decreases in inpatient, ED, and outpatient visit rates in the early days of the pandemic were 1.6, 12.1, and 415.0 visits per 100 person-years (p-value<0.0001), respectively, while the increase in telehealth visits was 272.9 visits per 100 person-years (p-value<0.0001). Further analyses suggested that the increase in telehealth visits offset the decrease in outpatient visits by week 26 (June 28). CONCLUSIONS Conclusions: In-person health care utilization dropped dramatically during the early period of the pandemic, but there was a corresponding increase in telehealth visits during the same period. By the end of June 2020, the combined outpatient and telehealth visits had recovered to pre-pandemic levels.

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Women: Health Care

Encyclopedia of Social Work ◽

10.1093/acrefore/9780199975839.013.632 ◽

2013 ◽

Author(s):

Marian A. Aguilar

Keyword(s):

Health Care ◽

Women’S Health ◽

Women's Health ◽

Low Income ◽

Health Care Expenditures ◽

The United States ◽

Care Utilization ◽

Women Health ◽

Populations At Risk ◽

The Impact

This entry provides an abbreviated version of the status of women's health in the United States, highlighting health care utilization, health care expenditures, policy issues, barriers to health care, and the impact on populations at risk. The findings accentuate the importance of moving the women's health care agenda forward because of the persistence of health disparities not just among women of color but among women with disabilities, adolescents, women in violent relationships, women with AIDS, women who are incarcerated, women who are homeless, older low-income women, women on welfare, and lesbian women.

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Health Care Utilization and Cost among Adults with Chronic Rhinosinusitis Enrolled in a Health Maintenance Organization

Otolaryngology ◽

10.1067/mhn.2002.129815 ◽

2002 ◽

Vol 127 (5) ◽

pp. 367-376 ◽

Cited By ~ 71

Author(s):

Michael p. Murphy ◽

Paul Fishman ◽

Steven O. Short ◽

Sean D. Sullivan ◽

Bevan Yueh ◽

...

Keyword(s):

Health Care ◽

Chronic Rhinosinusitis ◽

Health Maintenance Organization ◽

The United States ◽

Care Utilization ◽

Health Maintenance ◽

Outpatient Visits ◽

Marginal Total ◽

Hospital Days ◽

The Impact

OBJECTIVE: Our goal was to measure the impact of chronic rhinosinusitis (CRS) on the use and cost of health care by adults in a health maintenance organization (HMO). SETTING AND SUBJECTS: In the setting of the Group Health Cooperative, an HMO in Washington State, we conducted a study of all 218,587 adults (≥18 years) who used services during 1994. Using automated data, 20,175 adults were identified with one or more CRS diagnoses during 1994. OUTCOME MEASURES: We identified nonurgent outpatient visits, pharmacy fills, urgent visits, hospital days, and their associated costs (per adult per year). RESULTS: The marginal utilization associated with a diagnosis of CRS was 2.0 nonurgent outpatient visits, 5.1 pharmacy fills, 0.01 urgent visit, and −0.07 hospital day. The marginal total cost of CRS was $206. CONCLUSIONS: Adults with CRS had higher costs primarily because of increased nonurgent outpatient visit and pharmacy fill utilization. The overall direct cost of CRS in the United States in 1994 is estimated to have been $4.3 billion.

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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 ◽

10.2196/26558 ◽

2021 ◽

Vol 23 (4) ◽

pp. e26558

Author(s):

Stanley Xu ◽

Sungching Glenn ◽

Lina Sy ◽

Lei Qian ◽

Vennis Hong ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Health Care Organization ◽

Early Period ◽

Fold Increase ◽

Integrated Health Care ◽

Care Utilization ◽

Care Organization ◽

Integrated Health ◽

The Impact

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.

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The Impact of Urban Recreation Environment on Residents’ Happiness—Based on a Case Study in China

Sustainability ◽

10.3390/su13105549 ◽

2021 ◽

Vol 13 (10) ◽

pp. 5549

Author(s):

Lei Kang ◽

Zhaoping Yang ◽

Fang Han

Keyword(s):

Low Income ◽

Subjective Evaluation ◽

Objective Evaluation ◽

Income Group ◽

High Income Group ◽

Rapid Urbanization ◽

Indirect Impact ◽

Negative Effect ◽

The Impact ◽

Urban Recreation

Rapid urbanization promotes the expansion of urban tourism and recreation functions, but it also brings many problems, which affect residents’ happiness. Previous studies have emphasized the direct impact of urban recreation environment on happiness, and few have explored the indirect impact of urban recreation environment on happiness through subjective evaluation. Based on the survey data of nearly 10,000 permanent residents in 40 key tourism cities in China, this paper establishes a theoretical framework of the direct and indirect impact of urban recreation environment on happiness. The objective evaluation of natural recreation environment and sociocultural recreation environment has an important influence on happiness, but the influence of natural recreation environment is greater than that of sociocultural recreation environment. Individual subjective satisfaction with urban recreation environment mediates the relationship between urban objective environment and happiness. Urban parks have a positive effect on happiness, while tourist attractions have a negative effect. The influence of urban location on happiness is nonlinear. The high-income group is more sensitive to the recreation environment, while the low-income group is less sensitive to the recreation environment. These findings provide insights for further improving citizens’ quality of life and designing urban construction in developing countries under the conditions of rapid urbanization.

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Burden of Behavioral Health Comorbidities on Outpatient Health Care Utilization by Active Duty Service Members With a First Documented mTBI

Military Medicine ◽

10.1093/milmed/usaa320 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 567-571

Author(s):

Lalon M Kasuske ◽

Peter Hoover ◽

Tim Wu ◽

Louis M French ◽

Jesus J Caban

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Behavioral Health ◽

Active Duty ◽

Service Members ◽

Care Utilization ◽

Men And Women ◽

Outpatient Visits ◽

Outpatient Utilization ◽

Health Comorbidities

ABSTRACT Objective More than 280,000 Active Duty Service Members (ADSMs) sustained a mild traumatic brain injury (mTBI) between 2000 and 2019 (Q3). Previous studies of veterans have shown higher utilization of outpatient health clinics by veterans diagnosed with mTBI. Additionally, veterans with mTBI and comorbid behavioral health (BH) conditions such as post-traumatic stress disorder, depression, and substance use disorders have significantly higher health care utilization than veterans diagnosed with mTBI alone. However, few studies of the relationship between mTBI, health care utilization, and BH conditions in the active duty military population currently exist. We examined the proportion of ADSMs with a BH diagnosis before and after a first documented mTBI and quantified outpatient utilization of the Military Health System in the year before and following injury. Materials and Methods Retrospective analysis of 4,901,840 outpatient encounters for 39,559 ADSMs with a first documented diagnosis of mTBI recorded in the Department of Defense electronic health record, subsets of who had a BH diagnosis. We examined median outpatient utilization 1 year before and 1 year after mTBI using Wilcoxon signed rank test, and the results are reported with an effect size r. Outpatient utilization is compared by BH subgroups. Results Approximately 60% of ADSMs experience a first mTBI with no associated BH condition, but 17% of men and women are newly diagnosed with a BH condition in the year following mTBI. ADSMs with a history of a BH condition before mTBI increased their median outpatient utilization from 23 to 35 visits for men and from 32 to 42 visits for women. In previously healthy ADSMs with a new BH condition following mTBI, men more than tripled median utilization from 7 to 24 outpatient visits, and women doubled utilization from 15 to 32 outpatient visits. Conclusions Behavioral health comorbidities affect approximately one-third of ADSMs following a first mTBI, and approximately 17% of previously healthy active duty men and women will be diagnosed with a new BH condition in the year following a first mTBI. Post-mTBI outpatient health care utilization is highly dependent on the presence or absence of BH condition and is markedly higher is ADSMs with a BH diagnosis in the year after a first documented mTBI.

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