Outpatient care quality not affected by COVID-19 pandemic, study finds

Hospitalization rates for ambulatory care-sensitive conditions fell among study cohorts

The start of the COVID-19 pandemic saw widespread delays in use of non-COVID-related medical services such as elective surgeries and cancer screenings, leading to concerns about reduced care quality and worse patient outcomes. But a new study finds that, measured by one widely accepted metric, these concerns have not been borne out.

The study examines pre- and post-pandemic trends in hospitalizations for ambulatory care-sensitive conditions (ACSCs) among adult enrollees of Blue Cross-Blue Shield of Michigan’s HMO network, including overall rates of ACSC hospitalizations, lengths of stays, and lengths of ICU stays.

The authors define ACSCs as “admissions for medical problems that are potentially avoidable if they are effectively managed in the outpatient setting,” and call it a “common and well-accepted measure of access to and quality of ambulatory care.” In the pre-pandemic period, from March 2019 to February 2020, the study cohort consisted of 1.24 million individuals. For the post-pandemic period—March 2020 to February 2021—the study cohort was 1.2 million.

The results showed a reduction in hospitalization rates for all types of patients, from a range of 3.09-4.5 hospitalizations per 1000 enrollees before the pandemic to 3.07 per 1000 enrollees in April 2020. They later increased to a range of 3.46-4.07 per 1000 enrollees.

ACSC hospitalizations decreased slightly, from a prepandemic range of 0.36-0.47 to 0.25-0.39 per 1000 enrollees. Much of the decrease in ACSC hospitalizations was associated with a 30%-50% reduction in respiratory-related ACSC relative to the prepandemic period.

Given that ACSC hospitalization rates were down only slightly more than non-ACSC rates, the authors say, it is more likely that the former fell because of a combination of factors specific to patients with respiratory diseases, rather than a change in the quality of ambulatory care. For example, patients with asthma or COPD probably went out less and complied with masking and social distancing recommendations, resulting in less overall exposure to viral and allergic triggers.

In addition, the researchers point to preliminary data showing that adherence to asthma medication regimens improved in the pandemic’s early months among patients with chronic respiratory disease, possibly because of worries over contracting COVID-19. A further possibility is that outpatient physicians worked harder to prevent hospital admissions among their patients with asthma and COPD to reduce their risk of exposure to COVID-19.

The study’s results suggest that “some percentage of ACSC hospitalizations are likely discretionary and responsive to patient behavior and local conditions during the COVID-19 pandemic,” the authors say. Consequently, the results “highlight the limitations of using ACSC hospitalization rates as a proxy for the quality of ambulatory care when simultaneous changes are occurring that may affect the demand for and supply of medical care.”

The study, “Trends in Hospitalizations for Ambulatory Care-Sensitive Conditions During the COVID-19 Pandemic” was published March 17 in
JAMA Network Open