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An Accountable Care Organization Maintains Access for Appendicitis During the COVID-19 Pandemic
Alicia D Menchaca1, Candace C Style2, Ling Wang3
1Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio; Department of General Surgery, Indiana University, Indianapolis, Indiana.
Insights
The COVID-19 pandemic did not increase complicated appendicitis in pediatric Medicaid patients. Accountable care organizations (ACOs) may ensure continued healthcare access during crises.
Area of Science:
- Pediatric Healthcare
- Epidemiology
- Public Health
Background:
- Reports indicated delayed pediatric appendicitis treatment during the pandemic, leading to increased complicated cases.
- The COVID-19 pandemic's impact on pediatric acute appendicitis incidence and severity required investigation.
Purpose of the Study:
- To investigate the association between the COVID-19 pandemic and the incidence and severity of acute appendicitis in pediatric Medicaid patients.
- To assess if an accountable care organization (ACO) model impacts healthcare access during a public health crisis.
Main Methods:
- A population-based approach using claims data from a pediatric Medicaid ACO in Ohio (Partners For Kids) from April to August 2017-2020.
- Calculated monthly incidence rates of acute appendicitis per 100,000 covered lives and compared rates of complicated appendicitis over time.
- Performed diagnosis code validation for complicated vs. uncomplicated appendicitis at a specific hospital.
Main Results:
- No significant difference in the overall incidence of acute appendicitis was observed across the four years.
- The proportion of complicated appendicitis cases varied significantly over the study period (P=0.005).
- A higher proportion of complicated appendicitis cases occurred in 2018 compared to 2019 and 2020.
Conclusions:
- The COVID-19 pandemic was not associated with reduced access to acute appendicitis treatment for pediatric Medicaid patients within the studied ACO.
- The findings suggest that ACOs can facilitate sustained healthcare access for their populations during unexpected public health emergencies.
Introduction:
It has been reported that pediatric patients experienced a delay in treatment for acute appendicitis during the pandemic, resulting in increased rates of complicated appendicitis. We investigated the association of the COVID-19 pandemic and the incidence and severity of acute appendicitis among pediatric Medicaid patients using a population-based approach.
Methods:
The claims database of Partners For Kids, a pediatric Medicaid accountable care organization (ACO) in Ohio, was queried for cases of acute appendicitis from April to August 2017-2020. The monthly rate of acute appendicitis/100,000 covered lives was calculated each year and compared over time. Rates of complicated appendicitis were also compared. Diagnosis code validation for classification as complicated or uncomplicated appendicitis was performed for patients treated at our hospital.
Results:
During the study period, 465 unique cases of acute appendicitis were identified. Forty percent (186/465) were coded as complicated. No significant difference in the incidence of acute appendicitis cases was observed across the 4 y, either in an overall comparison or in pairwise comparisons (P > 0.15 for all). The proportion of acute appendicitis cases that were coded as complicated did vary significantly over the 4-year study period (P = 0.005); this was due to this proportion being significantly higher in 2018 than in either 2019 (P = 0.005 versus 2018) or 2020 (P = 0.03 versus 2018).
Conclusions:
The COVID-19 pandemic was not associated with reduced access to treatment for acute appendicitis among patients in a pediatric Medicaid ACO. This suggests that an ACO may promote continued healthcare access for their covered population during an unexpected crisis.
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