MP72-19 DECREASED UTILIZATION OF LOW-VALUE HEALTH CARE SERVICES DURING THE COVID-19 PANDEMIC

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP72-19 DECREASED UTILIZATION OF LOW-VALUE HEALTH CARE SERVICES DURING THE COVID-19 PANDEMIC Tracy X. Han, Nguyen David-Dan, Zhiyu (Jason) Qian, Benjamin V. Stone, Peter Herzog, Stuart R. Lipsitz, Alexander P. Cole, Toni K. Choueiri, and Quoc-Dien Trinh Tracy X. HanTracy X. Han More articles by this author , Nguyen David-DanNguyen David-Dan More articles by this author , Zhiyu (Jason) QianZhiyu (Jason) Qian More articles by this author , Benjamin V. StoneBenjamin V. Stone More articles by this author , Peter HerzogPeter Herzog More articles by this author , Stuart R. LipsitzStuart R. Lipsitz More articles by this author , Alexander P. ColeAlexander P. Cole More articles by this author , Toni K. ChoueiriToni K. Choueiri More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003340.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Low value health care is defined as care in which the potential to cause harm is greater than benefit. We hypothesize that rationing of health care services during the pandemic decreased the delivery of low value services. METHODS: Data was retrieved from the Mass General Brigham Research Patient Data Registry. High value care services were defined by U.S. Preventive Services Task Force guidelines, while low value care services were adapted for claims as described in the literature. Twenty-one services (4 high value and 17 low value) had adequate volume for analysis. Three month periods were considered, consisting of the pandemic period (Q4: 3/2/20 to 6/1/20) and control periods preceding the pandemic (Q1: 12/1/18 to 3/1/19; Q2: 3/2/19 to 6/1/19; and Q3: 12/1/19 to 3/1/20). Ratio measures of services per period were used to account for seasonality and differences in frequency.The 2019 high value (H) care ratio (Y0H = NHQ2/NHQ1) illustrates relative service counts during a typical year and the 2020 ratio (Y1H = NHQ4/NHQ3) represents the change due to the pandemic. Difference in ratios YH=Y1H-Y0H less than zero reflects a reduction in high value services during the pandemic. The same calculation was made for low value (L) procedures; YL=Y1L-Y0L. The difference between YL and YH is the difference in differences (DID) estimator and illustrates the differential decline in services. YH- YL greater than zero suggests that low value care declined to a greater degree than high value care. Subdivision DID in ratio analyses were performed for cancer and non-cancer care. RESULTS: Included in this analysis were 3,271,957 patients. Mean age was 51.4 years, 59.1% of patients were female, and 71.7% were non-Hispanic. Of 21 identified services, 18 had a reduction in volume during the pandemic. The YL for PSA testing in men older than 75 was -0.81. The DID in ratios of all care was 0.08 (p<0.01), suggesting a modest decline in low-value care (Figure 1). The reduction was more pronounced for cancer care with a DID in ratios of 3.39 (p<0.01). CONCLUSIONS: We observed a reduction in both low and high value care with a greater reduction in low value services, especially for cancer care. Limitations include use of data from a single health system, limited number of services, and short time periods given the rapid onset of the pandemic. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1032 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tracy X. Han More articles by this author Nguyen David-Dan More articles by this author Zhiyu (Jason) Qian More articles by this author Benjamin V. Stone More articles by this author Peter Herzog More articles by this author Stuart R. Lipsitz More articles by this author Alexander P. Cole More articles by this author Toni K. Choueiri More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement PDF downloadLoading ...