National trends in emergency conditions through the Omicron COVID-19 wave in commercial and Medicare Advantage enrollees

Maria A Stevens; Edward R Melnick; Samuel T Savitz; Molly Moore Jeffery; Bidisha Nath; Alexander T Janke

doi:10.1002/emp2.13023

National trends in emergency conditions through the Omicron COVID-19 wave in commercial and Medicare Advantage enrollees

J Am Coll Emerg Physicians Open. 2023 Aug 12;4(4):e13023. doi: 10.1002/emp2.13023. eCollection 2023 Aug.

Authors

Maria A Stevens^{1

2

3

4}, Edward R Melnick^{5

6}, Samuel T Savitz^{1

2}, Molly Moore Jeffery^{1

2

7}, Bidisha Nath⁵, Alexander T Janke^{5

8}

Affiliations

¹ Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester Minnesota USA.
² Division of Health Care Delivery Research Mayo Clinic Rochester Minnesota USA.
³ Department of Health Policy and Management University of North Carolina at Chapel Hill Chapel Hill North Carolina USA.
⁴ OptumLabs Eden Prairie Minnesota USA.
⁵ Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA.
⁶ Department of Biostatistics (Health Informatics) Yale School of Public Health New Haven USA.
⁷ Department of Emergency Medicine Mayo Clinic Rochester USA.
⁸ Institute for Healthcare Policy and Innovation University of Michigan/VA Ann Arbor Ann Arbor Michigan USA.

Abstract

Objective: To evaluate trends in emergency care sensitive conditions (ECSCs) from pre-COVID (March 2018-February 2020) through Omicron (December 2021-February 2022).

Methods: This cross-sectional analysis evaluated trends in ECSCs using claims (OptumLabs Data Warehouse) from commercial and Medicare Advantage enrollees. Emergency department (ED) visits for ECSCs (acute appendicitis, aortic aneurysm/dissection, cardiac arrest/severe arrhythmia, cerebral infarction, myocardial infarction, pulmonary embolism, opioid overdose, pre-eclampsia) were reported per 100,000 person months from March 2018 to February 2022 by pandemic wave. We calculated the percent change for each pandemic wave compared to the pre-pandemic period.

Results: There were 10,268,554 ED visits (March 2018-February 2022). The greatest increases in ECSCs were seen for pulmonary embolism, cardiac arrest/severe arrhythmia, myocardial infarction, and pre-eclampsia. For commercial enrollees, pulmonary embolism visit rates increased 22.7% (95% confidence interval [CI], 18.6%-26.9%) during Waves 2-3, 37.2% (95% CI, 29.1%-45.8%] during Delta, and 27.9% (95% CI, 20.3%-36.1%) during Omicron, relative to pre-pandemic rates. Cardiac arrest/severe arrhythmia visit rates increased 4.0% (95% CI, 0.2%-8.0%) during Waves 2-3; myocardial infarction rates increased 4.9% (95% CI, 2.1%-7.8%) during Waves 2-3. Similar patterns were seen in Medicare Advantage enrollees. Pre-eclampsia visit rates among reproductive-age female enrollees increased 31.1% (95% CI, 20.9%-42.2%), 23.7% (95% CI, 7.5%,-42.3%), and 34.7% (95% CI, 16.8%-55.2%) during Waves 2-3, Delta, and Omicron, respectively. ED visits for other ECSCs declined or exhibited smaller increases.

Conclusions: ED visit rates for acute cardiovascular conditions, pulmonary embolism and pre-eclampsia increased despite declines or stable rates for all-cause ED visits and ED visits for other conditions. Given the changing landscape of ECSCs, studies should identify drivers for these changes and interventions to mitigate them.

Keywords: COVID‐19; emergency care sensitive conditions; opioid overrdose; opioid use disorder.

Abstract

Grants and funding