(P-243) Healthcare Resource Use in a US Claims Database During the Early Period of the COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic has placed great strain on the US healthcare system. However, no studies have comprehensively examined the impact of the pandemic on healthcare delivery and access to resources in the US.

Objectives: Assess healthcare resource use (HCRU) including inpatient admissions, emergency room (ER) visits, overall outpatient, and telehealth visits during the early period of the COVID-19 pandemic in the US.

Methods: This cross-sectional study used the IBM Marketscan Early View commercial and Medicare supplemental databases to generate four monthly cohorts (February to May 2020) of individuals with continuous medical and prescription enrollment. HCRU was described in various healthcare settings and also characterized by age and sex.

Results: The cohorts included 20.45, 20.35, 20.26, and 20.13 million US individuals in February, March, April, and May 2020, respectively. Overall, we found similar age and sex distributions across the monthly cohorts. Continued reduction in HCRU was observed in almost all healthcare settings and across all demographics from February to April, with greater decline in ER and outpatient visits than in inpatient admissions. Specifically, relative to February (1.68%), the occurrence of ER visits decreased by 11.87% in March (1.48%) and 46.35% in April (0.90%). The occurrence of outpatient (in-person and telehealth) visits declined by 11.01% from February (34.63%) to March (30.81%) and by 35.11% from February to April (22.47%). Relative to February (0.47%), inpatient admissions decreased by 5.61% in March (0.44%) and 23.85% in April (0.36%). In May, the occurrence of inpatient, ER, and outpatient visits slightly rebounded to 0.40%, 1.10%, and 26.34%, respectively. In contrast, relative to February (0.13%), the telehealth use increased by 13.96 times in March (1.82%) and 30.61 times in April (3.98%), with the greatest increase observed in older adults (65+ years) (relative to February [0.02%]: increase by 66.21 times in March [1.63%] and 138.17 times in April [3.39%]).

Conclusions: In this US claims study, more pronounced reduction was found in ER and outpatient visits than in inpatient admissions during the early pandemic period (March and April 2020), though telehealth visits dramatically increased. A rebound in the use of inpatient, ER, and outpatient services emerged in May. Further monitoring of HCRU is warranted as the pandemic continues to evolve. Observational studies spanning the COVID-19 pandemic period should take changes in HCRU into account and address the potential for related confounding and/or biases.