COVID-19 Public Health Emergency Research Articles

The role of increasing telehealth use during the COVID-19 pandemic on disparities in access to healthcare: A systematic review (PubMed).

Abstract The objective of this paper was to summarize the available evidence on how telehealth access and utilization changed for minority groups during the COVID-19 public health emergency. We planned to complete this objective by conducting a systematic review, with a focus on health equity. Our secondary objective was to understand which dimensions of minority status were frequently measured in telehealth studies during the COVID-19 pandemic, and how variation in the experiences of these groups contributed to health equity.

The role of increasing telehealth use during the COVID-19 pandemic on disparities in access to healthcare: A systematic review (CINAHL Plus).

Abstract The objective of this paper was to summarize the available evidence on how telehealth access and utilization changed for minority groups during the COVID-19 public health emergency. We planned to complete this objective by conducting a systematic review, with a focus on health equity. Our secondary objective was to understand which dimensions of minority status were frequently measured in telehealth studies during the COVID-19 pandemic, and how variation in the experiences of these groups contributed to health equity.

The effect of telehealth on cost of healthcare during the COVID-19 pandemic: A systematic review (PubMed).

Abstract The COVID-19 public health emergency (PHE) necessitated a profound change in the delivery of healthcare services. With a highly infectious virus, telehealth use was expanded to reduce the risk of transmission and improve access to care. The sudden uptake in telehealth provided a natural experiment to assess not only the acceptability of this technology but also the impact that telehealth can have on healthcare costs and outcomes. Due to a substantial transformation in healthcare delivery, payment policies underwent rapid changes in response. In this systematic review, we aimed to evaluate the current evidence of the impact of telehealth use on healthcare costs during the COVID-19 public health emergency across telehealth modalities and health conditions.

The role of increasing telehealth use during the COVID-19 pandemic on disparities in access to healthcare: A systematic review (Embase).

Abstract The objective of this paper was to summarize the available evidence on how telehealth access and utilization changed for minority groups during the COVID-19 public health emergency. We planned to complete this objective by conducting a systematic review, with a focus on health equity. Our secondary objective was to understand which dimensions of minority status were frequently measured in telehealth studies during the COVID-19 pandemic, and how variation in the experiences of these groups contributed to health equity.

The effect of telehealth on cost of healthcare during the COVID-19 pandemic: A systematic review (Cochrane CENTRAL).

Abstract The COVID-19 public health emergency (PHE) necessitated a profound change in the delivery of healthcare services. With a highly infectious virus, telehealth use was expanded to reduce the risk of transmission and improve access to care. The sudden uptake in telehealth provided a natural experiment to assess not only the acceptability of this technology but also the impact that telehealth can have on healthcare costs and outcomes. Due to a substantial transformation in healthcare delivery, payment policies underwent rapid changes in response. In this systematic review, we aimed to evaluate the current evidence of the impact of telehealth use on healthcare costs during the COVID-19 public health emergency across telehealth modalities and health conditions.

The effect of telehealth on cost of healthcare during the COVID-19 pandemic: A systematic review (Embase).

Abstract The COVID-19 public health emergency (PHE) necessitated a profound change in the delivery of healthcare services. With a highly infectious virus, telehealth use was expanded to reduce the risk of transmission and improve access to care. The sudden uptake in telehealth provided a natural experiment to assess not only the acceptability of this technology but also the impact that telehealth can have on healthcare costs and outcomes. Due to a substantial transformation in healthcare delivery, payment policies underwent rapid changes in response. In this systematic review, we aimed to evaluate the current evidence of the impact of telehealth use on healthcare costs during the COVID-19 public health emergency across telehealth modalities and health conditions.

The effect of telehealth on cost of healthcare during the COVID-19 pandemic: A systematic review (CINAHL).

Abstract The COVID-19 public health emergency (PHE) necessitated a profound change in the delivery of healthcare services. With a highly infectious virus, telehealth use was expanded to reduce the risk of transmission and improve access to care. The sudden uptake in telehealth provided a natural experiment to assess not only the acceptability of this technology but also the impact that telehealth can have on healthcare costs and outcomes. Due to a substantial transformation in healthcare delivery, payment policies underwent rapid changes in response. In this systematic review, we aimed to evaluate the current evidence of the impact of telehealth use on healthcare costs during the COVID-19 public health emergency across telehealth modalities and health conditions.

Interruptions in bladder cancer care during the COVID-19 public health emergency

BackgroundAcademic and community urology centers participating in a pragmatic clinical trial in non-muscle-invasive bladder cancer completed monthly surveys assessing restrictions in aspects of bladder cancer care due to the COVID-19 Public Health Emergency. Our objective was to describe pandemic-related restrictions on bladder cancer care. MethodsWe invited 32 sites participating in a multicenter pragmatic bladder cancer trial to complete monthly surveys distributed through REDCap beginning in May 2020. These surveys queried sites on whether they were experiencing restrictions in the use of elective surgery, transurethral resection of bladder tumors (TURBT), radical cystectomy, office cystoscopy, and intravesical bacillus Calmette-Guerin (BCG) availability. Responses were collated with descriptive statistics. ResultsOf 32 eligible sites, 21 sites had at least a 50% monthly response rate over the study period and were included in the analysis. Elective surgery was paused at 76% of sites in May 2020, 48% of sites in January 2021, and 52% of sites in January 2022. Over those same periods, coinciding with COVID-19 incidence waves, TURBT was restricted at 10%, 14%, and 14% of sites, respectively, radical cystectomy was restricted at 10%, 14%, and 19% of sites, respectively, and cystoscopy was restricted at 33%, 0%, and 10% of sites, respectively. ConclusionsBladder cancer care was minimally restricted compared with more pronounced restrictions seen in general elective surgeries during the COVID-19 pandemic.

The Long Behavioral Tail of the COVID-19 Pandemic—A Cancer Control Perspective

This Viewpoint discusses the impact of the COVID-19 public health emergency on the trajectory of cancer deaths.

Connecting Coding and Policy: Telemedicine

Telemedicine services are now often subject to payment policies and regulations that were not in effect or not enforced during the COVID-19 public health emergency. This article reviews the general policies that are typically applicable to provision and reporting of telemedicine services based on federal privacy regulations, Current Procedural Terminology (CPT®) guidance, and common payer policies. Topics include the following: Defining telemedicine Planning for telemedicine services Codes and modifiers for telemedicine services Place of service (POS) for telemedicine services Documentation of telemedicine services Payment and payer policies

Federal Telehealth Policy Changes After COVID-19 Public Health Emergency

Federal Telehealth Policy Changes After COVID-19 Public Health Emergency

The impact of Public Health Emergency (PHE) on the news dissemination strength: Evidence from Chinese-Speaking Vloggers on YouTube.

News dissemination plays a vital role in supporting people to incorporate beneficial actions during public health emergencies, thereby significantly reducing the adverse influences of events. Based on big data from YouTube, this research study takes the declaration of COVID-19 National Public Health Emergency (PHE) as the event impact and employs a DiD model to investigate the effect of PHE on the news dissemination strength of relevant videos. The study findings indicate that the views, comments, and likes on relevant videos significantly increased during the COVID-19 public health emergency. Moreover, the public's response to PHE has been rapid, with the highest growth in comments and views on videos observed within the first week of the public health emergency, followed by a gradual decline and returning to normal levels within four weeks. In addition, during the COVID-19 public health emergency, in the context of different types of media, lifestyle bloggers, local media, and institutional media demonstrated higher growth in the news dissemination strength of relevant videos as compared to news & political bloggers, foreign media, and personal media, respectively. Further, the audience attracted by related news tends to display a certain level of stickiness, therefore this audience may subscribe to these channels during public health emergencies, which confirms the incentive mechanisms of social media platforms to foster relevant news dissemination during public health emergencies. The proposed findings provide essential insights into effective news dissemination in potential future public health events.

Advancing shared accountability for meaningful community engagement with socially vulnerable communities: Lessons learned from COVID-19 health education and general outreach in an urban region.

As COVID-19 public health emergency measures come to an end, socially vulnerable communities have reduced access to resources that address social and health disparities created or exacerbated by the pandemic. Social workers must uphold access to healthcare as a human right in the post-pandemic era by reducing social vulnerability and strengthening community resilience to respond to future health emergencies and natural disasters. This paper draws on the experiences of a team of social work researchers, students, and practitioners engaged in efforts to disseminate information on COVID preventive measures and broker access to local health and social resources. This project, based in one of the fastest-growing metropolitan areas in the United States, formed part of the federal research response to promote community engagement in regions most disproportionately impacted by the COVID-19 pandemic. Through participation in health fairs and community events that targeted persons with limited access to healthcare resources, we gathered critical insights on how to build community capacity for meaningful community engagement. Drawing on a conceptual model for evaluating community engagement strategies, we describe three main barriers to collaborative community outreach: weak organizational communication and coordination, inconsistent strategies for requesting on-site health services, and low neighborhood awareness of outreach events. We advance strategies for improvement that engage community-based organizations, health systems, backbone organizations, and community members in targeted activities to build community resilience. This includes inter-organizational communication during outreach event planning, formal processes to promote greater use of mobile health services, centralized event communication, and grassroots outreach event promotion.

Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021

Before and during the COVID-19 public health emergency (PHE), commercially and publicly insured children may have faced different challenges in obtaining consistent and adequate health insurance. To compare overall rates, COVID-19 PHE-related changes, and child and family characteristics associated with inconsistent and inadequate coverage for publicly and commercially insured children. This was a cross-sectional study using nationally representative data from the 2016 to 2021 National Survey of Children's Health of children from age 0 to 17 years living in noninstitutional settings. Parent- or caregiver-reported current child health insurance type defined as public or commercial. Inconsistent insurance, defined as having an insurance gap in the past year; and inadequate insurance, defined by failure to meet 3 criteria: (1) benefits usually/always sufficient to meet child's needs; (2) coverage usually/always allows child to access needed health care practitioners; and (3) no or usually/always reasonable annual out-of-pocket payments for child's health care. Survey-weighted logistic regression was used to compare outcomes by insurance type, by year (2020-2021 vs 2016-2019), and by child characteristics within insurance type. Of this nationally representative sample of 203 691 insured children, 34.5% were publicly insured (mean [SD] age, 8.4 [4.1] years; 47.4% female) and 65.5% were commercially insured (mean [SD] age, 8.7 [5.6]; 49.1% female). Most publicly insured children were either non-Hispanic Black (20.9%) or Hispanic (36.4%); living with 2 married parents (38.4%) or a single parent (33.1%); and had a household income less than 200% of the federal poverty level (79%). Most commercially insured children were non-Hispanic White (62.8%), living with 2 married parents (79.0%); and had a household income of 400% of the federal poverty level or higher (49.1%). Compared with commercially insured children, publicly insured children had higher rates of inconsistent coverage (4.2% vs 1.4%; difference, 2.7 percentage points [pp]; 95% CI, 2.3 to 3.2) and lower rates of inadequate coverage (12.2% vs 33.0%; difference, -20.8 pp; 95% CI, -21.6 to -20.0). Compared with the period from 2016 to 2019, inconsistent insurance decreased by 42% for publicly insured children and inadequate insurance decreased by 6% for commercially insured children during the COVID-19 PHE (2020-2021). The child and family characteristics associated with inadequate and inconsistent insurance varied by insurance type. The findings of this cross-sectional study indicate that insurance gaps are a particular problem for publicly insured children, whereas insurance inadequacy and particularly, out-of-pocket costs are a challenge for commercially insured children. Both challenges improved during the COVID-19 PHE. Improving children's health coverage after the PHE will require policy solutions that target the unique needs of commercially and publicly insured children.

Preferred Class Modality from a Sample of Community College Students during COVID- 19 and after the End of the Declaration of the Federal COVID-19 Public Health Emergency


 
 
 A student survey was conducted in the fall of 2021, during the COVID-19 pandemic, and summer and fall of 2023, after the end of the federal COVID-19 public health emergency (PHE) declaration. The results of this survey aim to increase an understanding of community college students’ preferences of class modality as they relate to the wider context of their lives. A total of 607 responses were collected on student’s preferred class modality. The findings demonstrate a preference for asynchronous courses during the COVID-19 pandemic. In comparison, the survey showed that after the end of the declaration of the federal COVID-19 public health emergency (PHE), there was a preference for synchronous courses instead of asynchronous.
 
 

Abstract 14656: Virtual Cardiac Rehabilitation is Rarely Used but May Augment Overall Attendance

Introduction: The COVID-19 public health emergency temporarily expanded Medicare reimbursement of cardiac rehabilitation (CR) to cover virtual CR. The purpose of this study was to evaluate the frequency of virtual CR use in Medicare and describe this emerging population of virtual CR patients, as there is currently limited data on the rates and patterns of virtual CR utilization. Methods: The study sample included 100% of Medicare beneficiaries undergoing surgical/percutaneous coronary revascularization or aortic valve replacement between July 2019 and December 2021 in the Medicare Virtual Research Data Center. Professional claims were used to identify CR use within one year of discharge using CPT codes (93797, 93798), and the disaster-related modifiers (“CR” or “DR”) were used to categorize CR visits as synchronized virtual sessions. Descriptive analysis compared patient characteristics and number of CR sessions attended between patients using virtual and facility-based CR. Results: Overall CR use was 32.5% in the entire sample (167066/513735). Any CR use was more prevalent among patients who were male, White, or 65-85 years old, and similar between coronary revascularization vs. aortic valve procedures. Only 14 states reported any virtual CR visits (CA, FL, GA, IL, IN, MI, MN, MO, NY, OR, PA, TN, TX, WI). Within these states, only 1% (886) of all CR users had at least one virtual CR session. The characteristics of patients who utilized virtual CR were largely similar to those who attended facility-based only CR. The median number of virtual sessions was 21 (IQR 26). Of patients who utilized virtual CR, 17.7% (157) also attended at least one facility-based CR session. Notably, combined virtual and facility-based CR utilizers attended a median of 33 (IQR 14) total CR sessions, compared to 25 (IQR 23) CR sessions for patients who attended only facility-based CR. Conclusion: Virtual CR was not widely available or used despite expanded Medicare reimbursement, yet our data suggests that the combined use of virtual and facility-based CR may be associated with a greater number of sessions attended (vs. facility-based only CR). Further research is needed to inform long-term policy decisions, particularly as it pertains to continued Medicare coverage of virtual CR.

Ameliorating emergency Web-enabled teaching in higher education institutions and implications for future emergencies

PurposeThis study aims to investigate the contextual challenges of emergency Web-enabled teaching from instructors’ point of view and their future preference for online education.Design/methodology/approachA total of 165 instructors from various public and private universities and university colleges in Malaysia participated in this online survey. Data were analyzed using multiple regression.FindingsThe significant challenges for future preference for online education in terms of their relative importance were supporting learners, effectiveness, disadvantages and advantages of emergency Web-enabled teaching.Originality/valueThis study discusses theoretical, practical and public policy implications for the future of teaching in higher education due to the COVID-19 public health emergency.

Continuous Medicaid coverage during the COVID-19 public health emergency reduced churning, but did not eliminate it.

Preserving insurance coverage in the wake of pandemic-related job loss was a priority in early 2020. To this end, the Families First Coronavirus Response Act implemented a continuous coverage policy in Medicaid to shore up access to health insurance. Prior to the pandemic, Medicaid enrollees experienced frequent coverage disruptions, known as "churning." The effect of the continuous coverage policy on churning during the COVID-19 public health emergency (PHE) is unknown. We performed a difference-in-differences analysis of nonelderly Medicaid enrollees using longitudinal national survey data to compare a 2019-2020 cohort exposed to the policy with a control cohort in 2018-2019. We found that the policy led to reduced transitions to uninsurance among adults, although not among children. The policy prevented over 300 000 transitions to uninsurance each month. However, disenrollment from Medicaid persisted at a low rate, despite the continuous coverage policy. As the PHE unwinds, policymakers should consider long-term continuous coverage policies to minimize churning in Medicaid.

Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019-2022).

Health centers provide primary and behavioral health care to the nation's safety net population. Many health centers served on the frontlines of the COVID-19 pandemic, which brought major changes to health center care delivery. To elucidate primary care and behavioral health service delivery patterns in health centers before and during the COVID-19 public health emergency (PHE). We compared annual and monthly patients from 2019 to 2022 for new and established patients by visit type (primary care, behavioral health) and encounter visits by modality (in-person, telehealth) across 218 health centers in 13 states. There were 1581,744 unique patients in the sample, most from health disparate populations. Review of primary care data over 4 years show that health centers served fewer pediatric patients over time, while retaining the capacity to provide to patients 65+. Monthly data on encounters highlights that the initial shift in March/April 2020 to telehealth was not sustained and that in-person visits rose steadily after November/December 2020 to return as the predominant care delivery mode. With regards to behavioral health, health centers continued to provide care to established patients throughout the PHE, while serving fewer new patients over time. In contrast to primary care, after initial uptake of telehealth in March/April 2020, telehealth encounters remained the predominant care delivery mode through 2022. Four years of data demonstrate how COVID-19 impacted delivery of primary care and behavioral health care for patients, highlighting gaps in pediatric care delivery and trends in telehealth over time.

Patient Engagement in and Adaptations to Delivery of Outpatient Care for Opioid Use Disorder During the COVID-19 Pandemic.

The authors investigated adaptations to outpatient care delivery and changes in treatment demand and engagement among patients receiving medications for opioid use disorder (MOUD) in the months after the declaration of the COVID-19 public health emergency in 2020. Data were collected through an online survey (June-November 2020) of outpatient MOUD prescribers. The survey obtained information on outpatient practices' adaptations to MOUD treatment and urine drug screening (UDS) and elicited provider views on the effects of the COVID-19 pandemic on patient demand for, and engagement in, treatment. Multivariable regression analyses were used to examine associations among practice characteristics, patient engagement, and service adaptations. Of 516 respondents, 74% reported adaptations to MOUD delivery during the pandemic. Most respondents implemented virtual visits for initial (67%) and follow-up (77%) contacts. Prescribers of buprenorphine were more likely than those who did not prescribe the medication to report MOUD adaptations. Among respondents reporting any MOUD adaptation, 77% made adaptations to their UDS practices. Among 513 respondents who answered COVID-19-related questions, 89% reported that the pandemic had affected the treatment and engagement of their patients. Of these respondents, 30% reported increased difficulty with patient engagement, and 45% reported that their patients preferred virtual visits during this period, whereas 18% endorsed patient preference for in-person visits. Telehealth and federal regulatory easements in response to the COVID-19 pandemic enabled providers to continue treating patients for opioid use disorder in 2020. The results suggest that care adaptations and changes in patient demand and engagement were common in the practices surveyed.