An Accountable Care Organization Maintains Access for Appendicitis During the COVID-19 Pandemic

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. METHODOLOGY: The claims database of Partners For Kids, a pediatric Medicaid accountable care organization in Ohio, was queried for cases of acute appendicitis from April–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 years, 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 vs. 2018) or 2020 (p=0.03 vs. 2018). CONCLUSIONS: The COVID-19 pandemic was not associated with reduced access to treatment for acute appendicitis among patients in a pediatric Medicaid accountable care organization. This suggests that an accountable care organization may promote continued healthcare access for their covered population during an unexpected crisis.