{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:18:48Z","timestamp":1787764728881,"version":"build-2784847793"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J GEN INTERN MED"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>COVID-19 infection may cause long-term changes in healthcare utilization, but heterogeneity in these changes by severity of COVID-19 infection in a national cohort is not well understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Examine a broad set of utilization measures up to 12 months after COVID-19 infection, and assess heterogeneity in utilization by whether individuals were hospitalized for their initial infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Using the Merative Marketscan commercial and Medicare Advantage (MA) databases, we performed an event-study analysis comparing within-person changes in healthcare utilization after COVID-19 infection relative to before COVID-19 infection. Models were stratified by hospitalization status, and controlled for temporal changes in utilization rates, linear pre-infection trends, and observable individual confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>901,458 adults with a diagnosis of COVID-19 infection between March 1, 2020, and December 31, 2021, enrolled continuously for 12\u00a0months before and after their infection, of whom 54,097 were hospitalized and 847,361 were not hospitalized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Measures<\/jats:title>\n                    <jats:p>Rates of admissions, emergency department (ED) visits, outpatient visits, physical therapy visits, home health services visits, and filled prescriptions for any medication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Results<\/jats:title>\n                    <jats:p>Patients hospitalized for their COVID-19 infection experienced five months of elevated re-admission risk, small declines in ED visits during post-infection months 6\u201312, and large relative increases in post-infection utilization of all types of ambulatory care that persisted for 12\u00a0months after infection. Patients not hospitalized for their COVID-19 infection experienced an elevated risk of admission for all post-infection months; no significant change in ED visits; small increases in outpatient visits, home health services use, and use of prescription medications; and small decreases in use of physical therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We found long-lasting changes in healthcare utilization after COVID-19 infection up to a year after infection, particularly among those with more severe illness, highlighting the importance of ongoing interventions to support the needs of COVID-19 survivors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11606-026-10730-x","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:26:44Z","timestamp":1787761604000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Changes in Healthcare Utilization up to 12 Months After COVID-19 Infection"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5232-8663","authenticated-orcid":false,"given":"Nora V.","family":"Becker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Parent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore J.","family":"Iwashyna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Z.","family":"Ayanian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"10730_CR1","doi-asserted-by":"publisher","unstructured":"Carenzo L, Protti A, Dalla Corte F, et al. Short-term health-related quality of life, physical function and psychological consequences of severe COVID-19. Ann Intensive Care. 2021;11(1):91. https:\/\/doi.org\/10.1186\/s13613-021-00881-x.","DOI":"10.1186\/s13613-021-00881-x"},{"key":"10730_CR2","doi-asserted-by":"publisher","unstructured":"Nasserie T, Hittle M, Goodman SN. Assessment of the frequency and variety of persistent symptoms among patients with COVID-19: a systematic review. JAMA Netw Open. 2021;4(5):e2111417. https:\/\/doi.org\/10.1001\/jamanetworkopen.2021.11417.","DOI":"10.1001\/jamanetworkopen.2021.11417"},{"key":"10730_CR3","doi-asserted-by":"publisher","unstructured":"Admon AJ, Iwashyna TJ, Kamphuis LA, et al. Assessment of symptom, disability, and financial trajectories in patients hospitalized for COVID-19 at 6 months. JAMA Netw Open. 2023;6(2):e2255795. https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.55795.","DOI":"10.1001\/jamanetworkopen.2022.55795"},{"key":"10730_CR4","doi-asserted-by":"publisher","unstructured":"Yuan N, Lv ZH, Sun CR, et al. Post-acute COVID-19 symptom risk in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis. Front Public Health. 2023;11. https:\/\/doi.org\/10.3389\/fpubh.2023.1112383.","DOI":"10.3389\/fpubh.2023.1112383"},{"key":"10730_CR5","doi-asserted-by":"publisher","unstructured":"Iwashyna TJ, Smith VA, Seelye S, et al. Self-reported everyday functioning after COVID-19 infection. JAMA Netw Open. 2024;7(3):e240869. https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.0869.","DOI":"10.1001\/jamanetworkopen.2024.0869"},{"key":"10730_CR6","doi-asserted-by":"publisher","unstructured":"Donnelly JP, Wang XQ, Iwashyna TJ, Prescott HC. Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system. JAMA. 2021;325(3):304-306. https:\/\/doi.org\/10.1001\/jama.2020.21465.","DOI":"10.1001\/jama.2020.21465"},{"key":"10730_CR7","doi-asserted-by":"publisher","unstructured":"Tartof SY, Malden DE, Liu ILA, et al. Health care utilization in the 6 months following SARS-CoV-2 infection. JAMA Netw Open. 2022;5(8):e2225657. https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.25657.","DOI":"10.1001\/jamanetworkopen.2022.25657"},{"key":"10730_CR8","doi-asserted-by":"publisher","unstructured":"Hernandez-Romieu AC. Health care utilization and clinical characteristics of nonhospitalized adults in an integrated health care system 28\u2013180 days after COVID-19 diagnosis \u2014 Georgia, May 2020\u2013March 2021. MMWR Morb Mortal Wkly Rep. 2021;70. https:\/\/doi.org\/10.15585\/mmwr.mm7017e3.","DOI":"10.15585\/mmwr.mm7017e3"},{"key":"10730_CR9","unstructured":"Melnick G, O\u2019Leary JF. After Their Initial Diagnosis, Many Adult COVID-19 Patients Continue Seeking Medical Care for up to Six Months or More. Epic Research; 2021. https:\/\/epicresearch.org\/articles\/after-their-initial-diagnosis-many-adult-covid-19-patients-continue-seeking-medical-care-for-up-to-six-months-or-more.\u00a0Accessed Oct 26, 2025."},{"key":"10730_CR10","doi-asserted-by":"publisher","unstructured":"Koumpias AM, Schwartzman D, Fleming O. Long-haul COVID: healthcare utilization and medical expenditures 6\u00a0months post-diagnosis. BMC Health Serv Res. 2022;22(1):1010. https:\/\/doi.org\/10.1186\/s12913-022-08387-3.","DOI":"10.1186\/s12913-022-08387-3"},{"key":"10730_CR11","doi-asserted-by":"publisher","unstructured":"Govier DJ, Niederhausen M, Takata Y, et al. Risk of potentially preventable hospitalizations after SARS-CoV-2 infection. JAMA Netw Open. 2024;7(4):e245786. https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.5786.","DOI":"10.1001\/jamanetworkopen.2024.5786"},{"key":"10730_CR12","doi-asserted-by":"publisher","unstructured":"Hebert PL, Kumbier KE, Smith VA, et al. Changes in outpatient health care use after COVID-19 infection among veterans. JAMA Netw Open. 2024;7(2):e2355387. https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.55387.","DOI":"10.1001\/jamanetworkopen.2023.55387"},{"key":"10730_CR13","doi-asserted-by":"publisher","unstructured":"Banchelli F, Gagliotti C, De Paoli A, et al. The incidence of outpatient care within 24 months from SARS-CoV-2 infection in the general population: a multicenter population-based cohort study. BMC Infect Dis. 2025;25(1):142. https:\/\/doi.org\/10.1186\/s12879-025-10526-0.","DOI":"10.1186\/s12879-025-10526-0"},{"key":"10730_CR14","doi-asserted-by":"publisher","unstructured":"Zaidan M, Neira DP, Polychronopoulou E, Yong-Fang K, Sharma G. Healthcare utilization 9 months pre- and post- COVID-19 hospitalization among patients discharged alive. PLOS ONE. 2024;19(6):e0303509. https:\/\/doi.org\/10.1371\/journal.pone.0303509.","DOI":"10.1371\/journal.pone.0303509"},{"key":"10730_CR15","unstructured":"Boston University COVID-19 Clinical Algorithms for Admission and Discharge. December 20, 2020. https:\/\/www.bumc.bu.edu\/id\/covid-19-response\/clinical-algorithms-for-admission-and-discharge\/.\u00a0Accessed Jul 7, 2026."},{"key":"10730_CR16","doi-asserted-by":"crossref","unstructured":"Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8.","DOI":"10.1097\/00005650-199801000-00004"},{"key":"10730_CR17","doi-asserted-by":"publisher","unstructured":"Chu YT, Ng YY, Wu SC. Comparison of different comorbidity measures for use with administrative data in predicting short- and long-term mortality. BMC Health Serv Res. 2010;10(1):140. https:\/\/doi.org\/10.1186\/1472-6963-10-140.","DOI":"10.1186\/1472-6963-10-140"},{"key":"10730_CR18","doi-asserted-by":"publisher","unstructured":"Mehta HB, Li S, An H, Goodwin JS, Alexander GC, Segal JB. Development and validation of the summary elixhauser comorbidity score for use with ICD-10-CM\u2013coded data among older adults. Ann Intern Med. 2022;175(10):1423-1430. https:\/\/doi.org\/10.7326\/M21-4204.","DOI":"10.7326\/M21-4204"},{"key":"10730_CR19","doi-asserted-by":"publisher","unstructured":"Miller DL. An introductory guide to event study models. J Econ Perspect. 2023;37(2):203-230. https:\/\/doi.org\/10.1257\/jep.37.2.203.","DOI":"10.1257\/jep.37.2.203"},{"key":"10730_CR20","doi-asserted-by":"publisher","unstructured":"Becker NV, Moniz MH, Tipirneni R, Dalton VK, Ayanian JZ. Utilization of women\u2019s preventive health services during the COVID-19 pandemic. JAMA Health Forum. 2021;2(7):e211408. https:\/\/doi.org\/10.1001\/jamahealthforum.2021.1408.","DOI":"10.1001\/jamahealthforum.2021.1408"},{"key":"10730_CR21","doi-asserted-by":"publisher","unstructured":"Becker NV, Karmakar M, Tipirneni R, Ayanian JZ. Trends in hospitalizations for ambulatory care\u2013sensitive conditions during the COVID-19 pandemic. JAMA Netw Open. 2022;5(3):e222933. https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.2933.","DOI":"10.1001\/jamanetworkopen.2022.2933"},{"key":"10730_CR22","doi-asserted-by":"publisher","unstructured":"Neath AA, Cavanaugh JE. The bayesian information criterion: background, derivation, and applications. WIREs Comput Stat. 2012;4(2):199-203. https:\/\/doi.org\/10.1002\/wics.199.","DOI":"10.1002\/wics.199"},{"key":"10730_CR23","unstructured":"Weesie HM. On seemingly unrelated estimation and the cluster-adjusted sandwich estimator. Stata Tech Bull. 1999;52:34-47."},{"key":"10730_CR24","doi-asserted-by":"publisher","unstructured":"Krumholz HM. Post-hospital syndrome--an acquired, transient condition of generalized risk. N Engl J Med. 2013;368(2):100-102. https:\/\/doi.org\/10.1056\/NEJMp1212324.","DOI":"10.1056\/NEJMp1212324"},{"key":"10730_CR25","doi-asserted-by":"publisher","unstructured":"Prescott HC, Langa KM, Liu V, Escobar GJ, Iwashyna TJ. Increased 1-year healthcare use in survivors of severe sepsis. Am J Respir Crit Care Med. 2014;190(1):62-69. https:\/\/doi.org\/10.1164\/rccm.201403-0471OC.","DOI":"10.1164\/rccm.201403-0471OC"},{"key":"10730_CR26","doi-asserted-by":"publisher","unstructured":"Chechulina V, Sheikh F, L\u00f3ser M, Englesakis M, Barrett K, Sepsis Canada. Healthcare costs after sepsis: a systematic review. Crit Care. 2025;29(1):381. https:\/\/doi.org\/10.1186\/s13054-025-05600-7.","DOI":"10.1186\/s13054-025-05600-7"},{"key":"10730_CR27","doi-asserted-by":"publisher","unstructured":"Fang H, Frean M, Sylwestrzak G, Ukert B. Trends in disenrollment and reenrollment within US commercial health insurance plans, 2006-2018. JAMA Netw Open. 2022;5(2):e220320. https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.0320.","DOI":"10.1001\/jamanetworkopen.2022.0320"}],"container-title":["Journal of General Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11606-026-10730-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11606-026-10730-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11606-026-10730-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:26:45Z","timestamp":1787761605000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11606-026-10730-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":27,"alternative-id":["10730"],"URL":"https:\/\/doi.org\/10.1007\/s11606-026-10730-x","relation":{},"ISSN":["0884-8734","1525-1497"],"issn-type":[{"value":"0884-8734","type":"print"},{"value":"1525-1497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"assertion":[{"value":"17 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was exempted from IRB review due to the use of de-identified data.","order":1,"name":"Ethics","label":"Ethics Approval and Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Dr. Becker reports receiving funding from the Michigan Value Collaborative, a Collaborative Quality Initiative under Blue Cross Blue Shield of Michigan\u2019s (BCBSM) Value Partnerships program, outside the submitted work. Dr. Ayanian receives research funding from the National Institute on Aging outside the submitted work.","order":2,"name":"Ethics","label":"Conflict of Interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Clinical Trial Number","group":{"name":"EthicsHeading","label":"Declarations"}}]}}