The Association of the First Surge of the COVID-19 Pandemic with the High- and Low-Value Outpatient Care Delivered to Adults in the USA

J Gen Intern Med. 2022 Nov;37(15):3979-3988. doi: 10.1007/s11606-022-07757-1. Epub 2022 Aug 24.


Background: The first surge of the COVID-19 pandemic entirely altered healthcare delivery. Whether this also altered the receipt of high- and low-value care is unknown.

Objective: To test the association between the April through June 2020 surge of COVID-19 and various high- and low-value care measures to determine how the delivery of care changed.

Design: Difference in differences analysis, examining the difference in quality measures between the April through June 2020 surge quarter and the January through March 2020 quarter with the same 2 quarters' difference the year prior.

Participants: Adults in the MarketScan® Commercial Database and Medicare Supplemental Database.

Main measures: Fifteen low-value and 16 high-value quality measures aggregated into 8 clinical quality composites (4 of these low-value).

Key results: We analyzed 9,352,569 adults. Mean age was 44 years (SD, 15.03), 52% were female, and 75% were employed. Receipt of nearly every type of low-value care decreased during the surge. For example, low-value cancer screening decreased 0.86% (95% CI, -1.03 to -0.69). Use of opioid medications for back and neck pain (DiD +0.94 [95% CI, +0.82 to +1.07]) and use of opioid medications for headache (DiD +0.38 [95% CI, 0.07 to 0.69]) were the only two measures to increase. Nearly all high-value care measures also decreased. For example, high-value diabetes care decreased 9.75% (95% CI, -10.79 to -8.71).

Conclusions: The first COVID-19 surge was associated with receipt of less low-value care and substantially less high-value care for most measures, with the notable exception of increases in low-value opioid use.

Keywords: COVID-19; high-value care; low-value care; medical overuse; quality of healthcare.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care
  • Analgesics, Opioid / therapeutic use
  • COVID-19* / epidemiology
  • COVID-19* / therapy
  • Female
  • Humans
  • Male
  • Medicare
  • Pandemics
  • United States / epidemiology


  • Analgesics, Opioid