COVID-19 Impacts on Primary Care Clinic Care Management Processes

Article Figures & Data

Table 1.

Example Care Management Process Questions With Strong Evidence for an Association With Quality Outcomes

Does your clinic:

Have a system for tracking laboratory tests until results are available to the clinician?
Manage patient care using checklists of tests or interventions that are needed for prevention or monitoring of diabetes?
Have a systematic approach to identify and remind patients with chronic illnesses who are due for testing (eg, LDL test or dilated eye exam)?
Routinely provide after-visit follow up as a component of care management to your patients with diabetes by someone other than a physician, PA, or NP?
Have guideline-based reminders for age-appropriate preventive services (eg, influenza immunizations) the patient should receive during patient appointments?
Have a systematic process to screen or assess patients for alcohol/substance abuse?
Provide or refer patients to formal support programs for weight loss management to assist in self-management for conditions or age-specific risk factors?
Routinely provide written materials that explain recommended medical care guidelines for their illness to encourage patient self-management?
Have systems to encourage patient self-management for diabetes?
Have a formal process (ie, a written plan with a set of procedures and defined end points for accountability) for measuring performance for individual physicians or for the clinic site?

LDL = low-density lipoprotein; NP = nurse practitioner; PA = physician assistant.

Table 2.

Clinic Characteristics by Survey Participation Years (2017, 2019, 2021)

Characteristic	1-2 Surveys, Any Years	2 Surveys, 2017 and 2019	All 3 Surveys
Clinics, No.	287	59	269
Current System Size, No. (%)^{^a}
1-11	72 (25.1)	16 (27.1)	59 (21.9)
>12	215 (74.9)	43 (72.9)	210 (78.1)
Clinic Size, No. (%)^{^b}
1-9	…	…	139 (51.7)
>10	…	…	118 (43.9)
Unknown	…	…	12 (4.5)
Clinic Location, No. (%)
Rural	130 (45.3)	21 (35.6)	100 (37.2)
Urban	157 (54.7)	38 (64.4)	169 (62.8)

↵a System size (number of primary care clinic locations) changed over time due to acquisition of small health care systems by larger systems.
↵b Clinic size (number of clinicians) was captured only in 2021. On average, in small clinics 42% of clinicians were advance practice providers (nurse practitioners, physicians assistants), and in large clinics 30% of clinicians are advance practice providers.

Table 3.

PPC-RS Trends in Total Score and the Subgroups, System Size, and Geography (N = 269)

Survey Domains	Survey Items, No.	All Clinics, %	Current System Size^{^a}			Geography
Survey Domains	Survey Items, No.	All Clinics, %	<12 Sites, %	≥12 Sites, %	P Value^{^b}	Rural, %	Urban, %	P Value
Information & Tracking	6				.084			<.001
2017		80.5	77.4	81.3		2.7	79.2
2019		82.7	85.3	82.0		8.8	79.1
2021		83.1	75.7	85.2		6.5	81.2
Chronic Disease Management	65				<.001			<.001
2017		68.5	59.6	71.0		0.5	67.3
2019		69.9	64.9	71.3		4.9	66.9
2021		72.5	61.7	75.6		5.5	70.8
Patient Self-Management	25				<.001			<.001
2017		77.8	70.6	79.9		9.4	76.9
2019		78.6	75.3	79.5		1.8	76.7
2021		80.8	73.5	82.9		4.2	78.9
Care Plans, Shared Decisions	6				<.001			.069
2017		65.6	54.2	68.8		7.8	64.3
2019		70.1	58.8	73.3		1.5	69.3
2021		73.4	62.7	76.4		8.3	70.5
Performance Measurement^{^c}	3				<.001			.023
2017		93.4	88.1	94.9		4.0	93.1
2019		94.4	91.5	95.2		6.0	93.5
2021		89.3	81.4	91.6		3.3	87.0
Managing High Risk Patients	2				<.001			.780
2017		82.2	62.7	87.6		7.0	85.2
2019		86.1	76.3	88.8		8.5	84.6
2021		83.6	77.1	85.5		7.5	81.4
Overall Survey^{^c}	107				<.001			<.001
2017		72.1	63.8	74.5		3.9	71.1
2019		73.7	69.1	74.9		8.0	71.1
2021		75.8	66.1	78.5		9.0	73.9

CMP = care management process; PPC-RS = Physician Practice Connections Readiness Survey.
Note: Data only for clinics completing all 3 surveys in 2017, 2019, and 2021. Results presented as the average percentage of CMPs present at the clinics.
↵a System size (based on number of primary care locations) changed over time due to acquisition of small health care systems by larger systems.
↵b Statistical significance of system size, clinic size, or geography, computed using ANOVA test, controlling for time trend.
↵c Only includes items present in all 3 years of the survey.

Table 4.

COVID-19 Supplement Question Responses Overall and by System Size (N = 269)

Survey Item	Overall	Current System Size^{^a}
Survey Item	Overall	<12 Sites	≥12 Sites	P Value
Visits by telephone/video pre-pandemic, %				.44
None	58.4	86.4	50.5
1-20	36.4	13.6	42.9
≥21	2.9	0.9	6.8
Visits by telephone/video at pandemic peak, %				<.001
None	0.4	0.0	0.5
1-20	18.2	27.1	15.7
21-40	27.5	23.7	28.6
41-60	22.7	20.3	23.3
61-80	19.0	18.6	19.1
81-100	10.4	10.2	10.5
Visits by telephone/video in 2021, %				.31
None	0.4	0.0	0.5
1-20	66.2	76.6	63.3
21-40	27.1	20.3	29.1
≥41	4.4	3.4	4.8
How disruptive has the pandemic been to diabetes care management?, %				.13
Not at all	0.0	0.0	0.0
Slightly	10.4	8.5	11.0
Moderately	32.0	27.1	33.3
Very	32.0	43.4	29.1
Extremely	23.4	22.0	23.8

Note: Data only for clinics completing all 3 surveys in 2017, 2019, and 2021.
↵a System size (number of primary care clinic locations) changed over time due to acquisition of small health care systems by larger systems.