August 12, 2022

Increased health care use among patients after COVID-19

A Kaiser Permanente study of more than 250,000 people shows that patients with COVID-19 use more health services in the 6 months following their infection.

Contact: Elizabeth Schainbaum

Terry Kanakri

PASADENA, Calif. — A study led by Kaiser Permanente in Southern California of patients from 8 health care organizations across the United States showed that COVID-19 was associated with a 4% increase in use of health care services over the 6 months after initial infection. The study was published August 12, 2022, in JAMA Network Open.

Some people who were infected with the virus that causes COVID-19 continued to experience effects from the infection, known as post-COVID conditions or long COVID, long after symptoms of the acute infection had subsided. This study showed that the greatest increase in encounters for these patients was in virtual visits, followed by emergency department visits.

“This study showed us that, in terms of the number of follow-up visits, a substantial amount of health care utilization occurs in the 6 months following the acute stage of SARS-CoV-2 infection, which highlights the potential for COVID-19 to exert an ongoing demand on health care organizations,” said Sara Y. Tartof, PhD, a lead author who is an epidemiologist with the Kaiser Permanente Southern California Department of Research & Evaluation and a faculty member of the Kaiser Permanente Bernard J. Tyson School of Medicine, both in Pasadena. “A 4% increase in encounters applied across a large population is a large number of visits associated with substantial cost. The absolute number is big. In this case, it was over 27,000 extra encounters among the 8 health care organizations included in this study.”

Tartof added: “On a broader scale, this study will help health care organizations develop their long-term strategic plans to meet patients’ needs following COVID-19 infection.”

This study included patients of all ages from 8 large integrated health care organizations across the United States who completed a COVID-19 diagnostic test between March 1 and November 1, 2020. Patients were matched on age, sex, race, ethnicity, site, and date of COVID-19 test, and were followed for 6 months. The final matched study group consisted of 127,859 patients who tested positive for COVID-19 and 127,859 patients who tested negative.

  • Overall coronavirus infection was associated with a 4% increase in health care use over 6 months, predominantly for virtual encounters, followed by emergency department visits.
  • COVID-19-associated health care encounters for 18 conditions remained elevated 6 months from the acute stage of illness, with the largest increase in COVID-19-related utilization including:
    • lingering COVID-19
    • alopecia, also known as hair loss
    • pulmonary embolism or deep vein thrombosis
      difficulty breathing
  • In total, extra health care use associated with the effects of COVID-19 infection consisted of 212.9 additional encounters per 1,000 patients with COVID-19.
    The study is one of the largest and most comprehensive studies of post-COVID utilization among children under age 17.
  • COVID-19-positive children experienced increased health care use over 6 months for pulmonary embolism or deep vein thrombosis; irregular heartbeat; difficulty breathing; and ear, nose, and throat disorders.

“With complete data from all care settings across large integrated health care organizations, this study represents one of the largest and most comprehensive studies of post-COVID conditions to date,” said Debbie Malden, DPhil, a lead author who is an epidemiologist with the Department of Research & Evaluation and an Epidemic Intelligence Service officer with the Centers for Disease Control and Prevention.

This study was conducted within the Vaccine Safety Datalink, a research collaboration led by the CDC that combines electronic health record databases to conduct large epidemiological studies. The 8 sites that contributed data were Kaiser Permanente Southern California (lead site), Denver Health, HealthPartners Institute, Kaiser Permanente Colorado, Kaiser Permanente Northern California, Kaiser Permanente Northwest, Kaiser Permanente Washington, and Marshfield Clinic Research Institute.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve approximately 12.6 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations clinical research, health education, and the support of community health.