Identifying trajectories across care modalities before and after COVID-19 using sequence analysis

The COVID-19 pandemic propelled the growth of virtual care, yet its longitudinal impact on care utilization remains understudied. We used multichannel sequence analysis to classify 10,671 adults with diabetes by outpatient utilization patterns with their primary and diabetes care teams, including remote and in-person visits, at two San Francisco health systems from April 2019 to March 2023. Patients who transitioned to digital care were disproportionately Black or White, Medicare beneficiaries, and had higher comorbidity burdens. Individuals who increased their combined in-person and remote healthcare utilization were disproportionately Hispanic, Spanish-preferring, and had greater disease burden. Those who decreased utilization were predominantly Asian, preferred Chinese, and had low patient portal engagement. While technology-enabled care models have the potential to enhance access, some populations may be at risk of reduced access to care. Health systems should consider targeted interventions to ensure equitable telehealth access for populations at risk of digital exclusion as remote care expands.