How has the COVID-19 pandemic impacted the delivery of urologic care in the United States?

Urologic outpatient visits and procedures decrease by approximately 50% in the United States during the initial lockdown phase of the COVID-19 pandemic from March to April 2020, according to a real-world data analysis published online in the Journal of Urology.¹

The researchers reported that the significant and swift decline in outpatient visits and overall procedures during this time period occurred across all ages, races, urology practice types, and geographic location, regardless of the specific timing of a state’s stay-at-home orders. However, the researchers also noted that the magnitude of the decrease and the extent of the recovery since this period has varied.

Daniel J. Lee, MD

“We found that the elderly, female, and patients with Medicaid insurance had the highest decreases in outpatient visits, and among the lowest magnitude recovery compared to pre-pandemic levels. There also appears to be an aspect of regional impact as well, as practices in rural areas, in lower income areas, and especially the Northeast and Midwest have not fully recovered and are anywhere from 20% to 45% below pre-pandemic levels,” study author Daniel J. Lee, MD, Division of Urology, Department of Surgery, University of Pennsylvania Health System, and his coauthors wrote.

Regarding specific urologic visit types, as would be expected, the rates of non-urgent procedures and surgeries decreased more than the rates for those considered urgent. There was a 49%-59% decline in non-urgent procedures compared with a 38%-52% decline in procedures for potentially urgent diagnoses. The declines in surgeries for non-urgent versus potentially urgent conditions were 43%-79% versus 43%-53%, respectively.

The decrease in outpatient visits for African-American patients during the initial lockdown was similar to the decrease for Caucasians and Asians; however, the subsequent recovery to the baseline visit rate was slower for African-American patients. Regarding insurance, the most significant decline in outpatient visits came among Medicare patients at 55%. The lowest percentage of recovery back to baseline outpatient visit rates occurred among Medicaid (73%) and government insurance recipients (69%), respectively.

“This study provides real-world evidence on the decline in urologic care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urologic health services by demographics and procedure type,” the authors wrote.

For their study, the investigators evaluated real-world data captured in the American Urological Association Quality Registry, which compiles information from electronic health record systems. Overall, data were assessed for 3,297,721 unique patients; 2,194,456 procedures; and 12,488,831 outpatient visits. Patient data came from 157 outpatient urologic practices and 3165 providers extending across 48 states. The primary outcomes measure for the study was the number of outpatient visits and procedures (outpatient or inpatient) performed weekly per practice.

The timeframe analyzed was January 1, 2019, to February 28, 2021. During this time period, there were 13,108,874 total visits (outpatient + inpatient). About half of patients were aged 18 to 65 and half were aged >65. Seventy-two percent of patients were male and 28% were female. Regarding race, 54% of patients were white, 2% were Asian, 7% were Black or African American, and race was unknown for 37%.

Urology practice characteristics showed that about 30% of practices had 1 to 5 providers, about 29% of practices had 6 to 14 providers, and about 41% of practices had ≥15 providers. About half (45%) of practices were located in the southern United States, 26% were in the West, 13% were in the Northeast, and 16% were in the Midwest. The median income in the practice zip code was <$50,000 for 40% of practices, $50,000 to $100,000 for 52% of practices, >$100,000 for 6% of practices, and unknown for 2% of practices. Eleven percent of practices had more than 25% of the population below the federal poverty level.

“Outpatient visits and surgical procedures declined and recovered, and the magnitude of both varied by many factors, such as race, insurance type, location, urgency of diagnosis and procedure. The impact of delayed treatment and the differences in decline and recovery should inform approaches for the ongoing treatment of patients both during and post pandemic,” the authors wrote in a “plain language summary” of their findings included with their article.

Reference

1. Please cite this article as: Lee DJ, Shelton JB, Brendel P, et al. Impact of the COVID-19 Pandemic on Urologic Care Delivery in the United States, The Journal of Urology® (2021). Authors accepted manuscript. doi: 10.1097/JU.0000000000002145.