Patterns of Care Utilization and Hepatocellular Carcinoma Surveillance: Tracking Care Across the Pandemic

Am J Gastroenterol. 2022 Sep 16. doi: 10.14309/ajg.0000000000002011. Online ahead of print.

ABSTRACT

BACKGROUND AIMS: We studied longitudinal trends in mortality, outpatient, and inpatient care for cirrhosis in a national cohort in the first 2 years of the COVID-19 pandemic. We evaluated trends in hepatocellular carcinoma (HCC) surveillance and factors associated with completion.

METHODS: Within the national cirrhosis cohort in the Veterans Administration from 2020 to 2021, we captured mortality, outpatient primary care (PCP), gastroenterology/hepatology (GI/HEP) visits, and hospitalizations. HCC surveillance was computed as percent of time up to date with surveillance every 6 months (PTUDS). Multivariable models for PTUDS were adjusted for patient demographics, clinical factors, and facility-level variables.

RESULTS: The total cohort was 68,073; 28,678 were eligible for HCC surveillance. Outpatient PCP and GI/HEP appointment rates initially dropped from 30% to 7% with a rebound one year into the pandemic and steady subsequent use. Telemedicine monthly visit rates rose from less than 10% to a peak of 20% with a steady gradual decline. Nearly 70% of Veterans were up to date with HCC surveillance prior to the pandemic with an early pandemic nadir of about 50%, and 60% PTUDS 2 years into the pandemic. In adjusted models, use of a population-based cirrhosis dashboard (β 8.5, 95% CI 6.9 - 10.2), GI/HEP visits both in-person (β 3.2, 95% CI 2.9- 3.6) and telemedicine (β 2.1, 95% CI 1.9-2.4) were associated with higher PTUDS.

CONCLUSIONS: Outpatient utilization and HCC surveillance rates have rebounded but remain below baseline. Population-based approaches and specialty care for cirrhosis were associated with higher completion of HCC surveillance.

PMID:36114778 | DOI:10.14309/ajg.0000000000002011