Impact of COVID-19 on Trends in Outpatient Clinic Utilization: A Tale of 2 Departments

Abstract

Background: The COVID-19 pandemic forced many US health care organizations to shift from mostly in-person care to a hybrid of virtual visits (VV) and in-person visits (IPV). While there was an expected and immediate shift to virtual care (VC) early in the pandemic, little is known about trends in VC use after restrictions eased.

Methods: This is a retrospective study using data from 3 health care systems. All completed visits from adult primary care (APC) and behavioral health (BH) were extracted from the electronic health record of adults aged 19 years and older from January 1, 2019 to June 30, 2021. Standardized weekly visit rates were calculated by department and site and analyzed using time series analysis.

Results: There was an immediate decrease in APC visits following the onset of the pandemic. IPV were quickly replaced by VV such that VV accounted for most APC visits early in the pandemic. By 2021, VV rates declined, and VC visits accounted for <50% of all APC visits. By Spring 2021, all 3 health care systems saw a resumption of APC visits as rates neared or returned to prepandemic levels. In contrast, BH visit rates remained constant or slightly increased. By April 2020, almost all BH visits were being delivered virtually at each of the 3 sites and continue to do so without changes to utilization.

Conclusions: VC use peaked during the early pandemic period. While rates of VC are higher than prepandemic levels, IPV are the predominant visit type in APC. In contrast, VC use has sustained in BH, even after restrictions eased.

FIGURE 1

(A–C) Weekly encounter rates in adult primary care departments per 1000 enrolled adult members from January 1, 2019, to June 30, 2021, at Kaiser Permanente Colorado (KPCO) (A); Kaiser Permanente Georgia (KPGA) (B); Kaiser Permanente Mid-Atlantic States (KPMAS) (C). The red dashed line is the overall weekly encounter rate. The green solid line is the in-person visit weekly encounter rate. The blue solid line is the virtual visit weekly encounter rate. The dashed black lines define the 3 encounter eras [pre-COVID (era 1), COVID onset and recovery (era 2), and COVID vaccination (era 3)]. The first black dashed line corresponds to the national emergency on March 13, 2020. The second black line corresponds to December 26, 2020 which shortly follows the emergency authorization and distribution of the first 2 COVID-19 vaccines.

FIGURE 2

(A–C) Weekly encounter rates in behavioral health departments per 1000 enrolled adult members from January 1, 2019 to June 30, 2021 at Kaiser Permanente Colorado (KPCO) (A); Kaiser Permanente Georgia (KPGA) (B); Kaiser Permanente Mid-Atlantic States (KPMAS) (C). The red dashed line is the overall weekly encounter rate. The green solid line is the in-person visit weekly encounter rate. The blue solid line is the virtual visit weekly encounter rate. The dashed black lines define the 3 encounter eras [pre-COVID (era 1), COVID onset and recovery (era 2), and COVID vaccination (era 3)]. The first black dashed line corresponds to the national emergency on March 13, 2020. The second black line corresponds to December 26, 2020 which shortly follows the emergency authorization and distribution of the first 2 COVID-19 vaccines.