Session Type: Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Patients (pts) with autoimmune diseases managed by rheumatologists represent vulnerable population with risk of serious complications if exposed to novel coronavirus SARS-CoV2. The first case of COVID-19, disease caused by SARS-CoV2, was diagnosed in the US on January 20, 2020. By the beginning of April, 42 states implemented stay-at-home advisories limiting non-essential activity including non-emergency healthcare services leading to the majority of routine healthcare visits being conducted via telehealth method using audio and/or video technology. In May states began lifting stay-at-home orders and gradually renewing economic activity. We evaluated impact of these policies on volume and type of care provided by US community rheumatology practices.
Methods: EMR records from the American Rheumatology Network (ARN) – Trio Health Rheumatology registry were used for the study. The ARN is a physician led and owned organization that supports some of the largest independent practices with over 200 practicing rheumatologists across the US. Pts with rheumatic diseases in care in Jan’19-May’20 were selected for analysis. Trends were evaluated for in-office drug administrations, new starts on targeted immune modulating therapy (TIM) both in-office and self-administered, drug administration, new and existing patient visits, telehealth visits, telephonic services, labs, x-rays, minor surgical procedures, and other diagnostic and treatment procedures.
Results: Of 120,780 pts treated in the study period, 19,449 (16%) were treated in central region, 44,055 (36%) in western, and 57,276 (48%) in southern; there were no practices representing northeast hardest hit by COVID-19.
In Mar’20, treated pt number declined 6% vs Feb’20 and 0.4% vs Mar’19; in Apr’20 pt number declined 4% vs Mar’20 and 13% vs Apr’19, while in May’20 pt number was flat vs Apr’20 and down 12% vs May’19. Considering all services delivered by the practices, there was 12% decline in service volume in Mar’20 vs Feb, 28% decline in Apr’20 vs Mar, and 22% increase in May’20 vs Apr; there was 2% decline in Mar, 36% in Apr, and 23% in May’20 vs corresponding months of 2019.
Most affected services in Mar-Apr were procedures, new and established pt visits, x-rays, and labs [Figure 1]. Telehealth was implemented in Mar’20 with 2,449 pts seen via telehealth visits. Telehealth grew 438% in Apr from Mar reaching 13,176 pts and declined 47% in May over Apr. Telephone services were provided to 226 pts in Mar’20 vs 9 pts in Mar’19, telephone services were up 92% in Apr’20 vs Mar and 487% in May vs Apr. Drug administrations were + 3% in Mar’20 vs Feb, -6% in Apr vs Mar, and +7% in May vs Apr.
Growing pre-COVID trend towards home administration of biologics continued during stay-at-home advisory: in May pt starts on home administered biologics overtook starts on practice administered biologics [Figure 2].
Conclusion: During COVID-19 outbreak in the US stay-at-home advisory period significantly influenced care patterns of pts with rheumatic diseases with sharp growth of telehealth and decline in in-person visits, drug administrations, and diagnostic testing. Further research is needed to evaluate these trends as the pandemic continues.
To cite this abstract in AMA style:Huston K, Soloman N, Radtchenko J, Helfgott S, Singh J, Edgerton C. Change in Utilization of Outpatient Services at US Community Rheumatology Practices During COVID-19 Outbreak [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/change-in-utilization-of-outpatient-services-at-us-community-rheumatology-practices-during-covid-19-outbreak/. Accessed October 25, 2020.
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