Well Visit Trends by Patient Age Group Before and During the COVID-19 Pandemic

Context: Adult well visits declined at the start of the COVID-19 pandemic. Existing studies have reported conflicting results for well-visit trends among patients under 2 years of age. None have reported trends for infants (0-12 months) nor measured well visit trends for all age groups through the emergence of the Delta variant.

Objective: We determined if well visits for Healthcare Effectiveness Data and Information Set (HEDIS) defined age groups decreased during the COVID-19 pandemic, including through the emergence of the Delta variant, compared to visits prior to the pandemic.

Study Design: Retrospective cohort.

Dataset: A large, multi-state midwestern Virtual Data Warehouse of de-identified electronic health records.

Population studied: Eligible patients (n=798,571) had one or more well visits between 7/1/2018 and 6/30/2021.

Outcome measures: Well visit utilization trends (visits per month) were computed for HEDIS defined age groups: 0 to 12 months of age, 1-4 years, 5-11 years, 12-17 years, 18-39 years, 40-64 years, ≥65 years of age). Joinpoint regression models and monthly percent change (MPC) were computed to measure well visit trends over a 3 year period.

Results: There we no significant changes in well visits for infants (< 1 year of age) (MPC=-0.1; 95% CI=-0.3, 0.1). For children 1-4 years and all adult age groups, visits decreased from 1/2020 to 4/2020 (MPC range -20 to -40), increased from 4/2020-7/2020 (MPC range 30 to 72), and remained stable after 7/2020. Seasonal variation in well visits occurred among children 5-17 with low utilization in January and Feburary 2019 and high utilization prior to the start of the school year in August 2019. However, in 2020, the lowest utilization occurred in April 2020 and the seasonal variation normalized and remained stable through onset of the Delta variant.

Conclusions: Infant well visits did not decline at the onset (3/1/2020) of the COVID-19 pandemic among patients using a large midwestern health care system. The rapid decline in well visits for other age groups in 4/2020 was followed by a quick and long-term return to pre-pandemic utilization rates by 7/2020. Infants did not experience a gap in primary care and the short period of decreased preventive care utilization may not have impacted health.