Changes in Outpatient Health Care Use After COVID-19 Infection Among Veterans
Authors: Paul L. Hebert, Kyle E. Kumbier, Valerie A. Smith, Denise M. Hynes, Diana J. Govier, Edwin Wong, Brystana G. Kaufman, Megan Shepherd-Banigan, Mazhgan Rowneki, Amy S. B. Bohnert, George N. Ioannou, Edward J. Boyko, Theodore J. Iwashyna, Ann M. O’Hare, C. Barrett Bowling, Elizabeth M. Viglianti, Matthew L. Maciejewski, Andrew Admon, Kathleen Akgun, Livia Anderson, Stacy Anderson, Mihaela Aslan, David Au, Lisa Backus, Kristina Bajema, Aaron Baraff, Lisa Batten, Theodore Berkowitz, Taylor Bernstein, Kristin Berry Wyatt, Joseph Bogdan, Joleen Borgerding, Hayden Bosworth, Nathan Boucher, Nicholas Burwick, Kaitland Byrd, Aissa Cabrales, Jennifer Cano, Wen Chai, Jason Chen, Kei-Hoi Cheung, Kristina Crothers, Graham Cummin, Jeffrey Curtis, Marie Davis, Emily Del Monico, Paul Dennis, Aram Dobalian, Jacob Doll, Jason Dominitz, McKenna Eastment, Vincent Fan, Jacqueline Ferguson, Breana Floyd, Alexandra Fox, Matthew Goetz, Pamela Green, Susan Nicole Hastings, Katrina Hauschildt, Eric Hawkins, Mark Helfand, Alex Hickok, Dana Horowitz, Catherine Hough, Elaine Hu, Kevin Ikuta, Barbara Jones, Makoto Jones, Lee Kamphius, Sara Knight, Anna Korpak, Peggy Korpela, Kenneth Langa, Ryan Laundry, Stacy Lavin, Yuli Li, Jennifer Lindquist, Holly McCready, Cassie Meyer, Martha Michel, Amy Miles, Jessie Milne, Max Monahan, Daniel Morelli, Pradeep Mutalik, Jennifer Naylor, Meike Niederhausen, Summer Newell, Shannon Nugent, Michael Ong, Thomas Osborne, Matthew Peterson, Alexander Peterson, Hallie Prescott, John Pura, Nallakkandi Rajeevan, Ashok Reddy, Marylena Rouse, Somnath Saha, Sameer Saini, Sarah Seelye, Javeed Shah, Troy Shahoumian, Aasma Shaukat, Whitney Showalter, Christopher Slatore, Battista Smith, Nicholas Smith, Elani Streja, Pradeep Suri, Jeremy Sussman, Yumie Takata, Alan Teo, Eva Thomas, Laura Thomas, Anais Tuepker, Aaron Turner, Zachary Veigulis, Elizabeth Vig, Kelly Vranas, Xiao Qing Wang, Katrina Wicks, Kara Winchell, James Womer, Chris Woods, Katherine Wysham, Lei Yan, Donna Zulman
Journal: JAMA Network Open (2024)

Importance The association of COVID-19 infection with outpatient care utilization is unclear. Many studies reported population surveillance studies rather than comparing outpatient health care use between COVID-19–infected and uninfected cohorts. Objective To compare outpatient health care use across 6 categories of care (primary care, specialty care, surgery care, mental health, emergency care, and diagnostic and/or other care) between veterans with or without COVID-19 infection. Design, Setting, and Participants In a retrospective cohort study of Veterans Affairs primary care patients, veterans with COVID-19 infection were matched to a cohort of uninfected veterans. Data were obtained from the Veterans Affairs Corporate Data Warehouse and the Centers for Medicare &amp;amp;amp; Medicaid Services Fee-for-Service Carrier/Physician Supplier file from January 2019 through December 2022. Data analysis was performed from September 2022 to April 2023. Exposure COVID-19 infection. Main Outcomes and Measures The primary outcome was the count of outpatient visits after COVID-19 infection. Negative binomial regression models compared outpatient use over a 1-year preinfection period, and peri-infection (0-30 days), intermediate (31-183 days), and long-term (184-365 days) postinfection periods. Results The infected (202 803 veterans; mean [SD] age, 60.5 [16.2] years; 178 624 men [88.1%]) and uninfected (202 803 veterans; mean [SD] age, 60.4 [16.5] years; 178 624 men [88.1%]) cohorts were well matched across all covariates. Outpatient use in all categories (except surgical care) was significantly elevated during the peri-infection period for veterans with COVID-19 infection compared with the uninfected cohort, with an increase in all visits of 5.12 visits per 30 days (95% CI, 5.09-5.16 visits per 30 days), predominantly owing to primary care visits (increase of 1.86 visits per 30 days; 95% CI, 1.85-1.87 visits per 30 days). Differences in outpatient use attenuated over time but remained statistically significantly higher at 184 to 365 days after infection (increase of 0.25 visit per 30 days; 95% CI, 0.23-0.27 visit per 30 days). One-half of the increased outpatient visits were delivered via telehealth. The utilization increase was greatest for veterans aged 85 years and older (6.1 visits, 95% CI, 5.9-6.3 visits) vs those aged 20 to 44 years (4.8 visits, 95% CI, 4.7-4.8 visits) and unvaccinated veterans (4.5 visits, 95% CI, 4.3-4.6 visits) vs vaccinated veterans (3.2 visits; 95% CI, 3.4-4.8 visits). Conclusions and Relevance This study found that outpatient use increased significantly in the month after infection, then attenuated but remained greater than the uninfected cohorts’ use through 12 months, which suggests that there are sustained impacts of COVID-19 infection.