Impact of COVID-19 on Primary Care Quality Measures in an Academic Integrated Health System

Abstract

Background: Access to primary care was hindered by the coronavirus disease 2019 (COVID-19) pandemic.

Objective: Evaluate changes in health screening rates before and during the pandemic.

Design: Retrospective analysis of health maintenance and disease management screening rates among primary care patients before and during the pandemic.

Participants: Over 150,000 patients of a large, academic health system.

Main measures: Six quality measures were analyzed: colon cancer, breast cancer, cervical cancer, diabetes Hgb A1C, diabetes eye, and diabetes nephropathy monitoring. Based on US Preventative Services Task Force screening guidelines, we determined which patients were due for at least one of the quality measures. We tracked completion rates during three time periods: pre-pandemic (January 1-March 3, 2020), stay-at-home (March 4-May 8, 2020), and phased reopening (May 9-July 8, 2020). Differences in quality measure completion rates were evaluated using mixed-effects logistic regression models.

Key results: Compared to pre-pandemic rates, completion of all health screenings declined during the stay-at-home period: mammograms (OR: 0.34; 95% CI: 0.31-0.37), cervical cancer (OR: 0.83; 95% CI: 0.76-0.91), colorectal cancer (OR: 0.25; 95% CI: 0.23-0.28), diabetes eye (OR: 0.34; 95% CI: 0.29-0.41), diabetes Hgb A1c (OR: 0.41; 95% CI: 0.37-0.46), and diabetes nephropathy (OR: 0.46, 95% CI: 0.41-0.53). During phased reopening, completion of all quality measures increased compared to the stay-at-home period, except for cervical cancer screening (OR: 0.83; 95% CI: 0.76-0.92). There was a persistent reduction in completion of all quality measures, except for diabetic nephropathy monitoring (OR: 0.99; 95% CI: 0.89-1.09), during phased reopening compared to pre-pandemic.

Conclusions: Healthcare screening rates were reduced during the early part of the COVID-19 pandemic and did not fully recover to pre-pandemic rates by July 2020. Future research should aim to clarify the long-term impacts of delayed health screenings. New interventions should be considered for expanding remote preventative health services.

Keywords: COVID-19; chronic disease management; preventative screening; primary care.

Fig. 1

Trends in breast, cervical, and colorectal cancer screenings by week (weeks 1–27 in 2019 vs 2020). Black line: average weekly completion rate (%) for each screening in 2019. Red line: average weekly completion rate (%) for each screening in 2020. For each graph, dashed line at 9 weeks indicates start of stay-at-home order, and dashed line at 19 weeks indicates start of phased reopening during the COVID-19 pandemic.

Fig. 2

Trends in diabetes Hgb A1c, diabetes eye, and diabetes nephropathy monitoring by week (weeks 1–27 in 2019 vs 2020). Black line: average weekly completion rate (%) for each screening in 2019. Red line: average weekly completion rate (%) for each screening in 2020. For each graph, dashed line at 9 weeks indicates start of stay-at-home order, and dashed line at 19 weeks indicates start of phased reopening during the COVID-19 pandemic.