Impact of the COVID-19 Pandemic on Urologic Care Delivery in the United States.

Plain language summaryOutpatient 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.
We examined changes in urologic care delivery due to COVID-19 in the US based on patient, practice, and local/regional demographic and pandemic response features.
We analyzed real-world data from the American Urological Association Quality (AQUA) Registry collected from electronic health record systems. Data represented 157 outpatient urologic practices and 3,165 providers across 48 US states and territories, including 3,297,721 unique patients, 12,488,831 total outpatient visits, and 2,194,456 procedures. The primary outcome measure was the number of outpatient visits and procedures performed (inpatient or outpatient) per practice per week, measured from January 2019 to February 2021.
We found large (>50%) declines in outpatient visits from March 2020 to April 2020 across patient demographic groups and states, regardless of timing of state stay-at-home orders. Non-urgent outpatient visits decreased more across various non-urgent procedures (49-59%) than for procedures performed for potentially urgent diagnoses (38-52%); surgical procedures for non-urgent conditions also decreased more (43-79%) than those for potentially urgent conditions (43-53%). African American patients had similar decreases in outpatient visits compared with Asians and Caucasians, but also slower recoveries back to baseline. Medicare-insured patients had the steepest declines (55%) while those on Medicaid and Government insurance had the lowest percentage of recovery to baseline (73, and 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.