Background: While most patients are first diagnosed as outpatients, subsequent need and risk factors for COVID-related urgent medical care has not been described.

Objectives: To estimate incidence and identify risk factors for 30-day COVID-related urgent medical visits among patients first presenting with COVID in the outpatient setting.

Methods: We used the Optum® de-identified COVID-19 Electronic Health Record dataset to identify adults’ first COVID diagnosis (dx) or positive (+) SARS-CoV-2 test (first test/diagnosis=index date [ID]) in the outpatient setting (06/01/2020–12/10/2020) among members of an integrated US healthcare delivery network with ≥1 visit <2 years of the ID. Patients with a previous COVID dx or SARS-CoV-2 + test were excluded. Outcome was 30-day COVID-related urgent medical visits defined as urgent care (UC)/emergency room (ER) visits or hospitalizations (H) (COVID dx during encounter), or COVID-related Hs (COVID as primary or admitting dx). Cumulative incidence function was used to estimate 30-day incidence and 95% confidence intervals (CI) of urgent medical visits. Competing risk regression models were used to derive adjusted hazard ratios (aHR) and 95% CIs assessing relationship between demographics, index month, region, comorbidities, pregnancy, first COVID encounter setting (ER/UC vs not), and baseline healthcare resource use (ER/UC, H) with outcomes.

Results: The 30-day incidence of COVID-related ER/UC/H among 206,741 patients (mean age [standard deviation]: 46.7 years [17.8]; 58.8% women; 77.5% White), was 9.4% (95% CI: 9.3%–9.6%) and 3.8% (95% CI: 3.7%–3.9%) for COVID-related H. Incidence of 30-day COVID-related ER/UC/H and H was highest in the oldest patients (≥85 years: 21.9%/13.0%), those with chronic kidney disease (CKD; 22.8%/12.6%), chronic obstructive pulmonary disease (COPD; 21.5%/11.7%), and ER/UC-based diagnosis (20.5%/8.2%). In adjusted models, factors most strongly associated with 30-day UC/ER/H were older age (aHR [95% CI] ≥85 vs 18–34 years: 3.1 [2.9–3.4]), class III obesity (BMI ≥40 vs 18.5–<25 kg/m^2: 1.7 [1.6–1.8]), pregnancy (2.1 [1.9–2.2]), prior H (2.1 [2.1–2.2]), and ER/UC as setting of COVID diagnosis (2.5 [2.4–2.5]). The same risk factors were most strongly associated with COVID-related Hs.

Conclusions: Those at highest risk of an urgent medical visit within 30 days of an outpatient dx or + test were older, had CKD or COPD, and were first diagnosed in the ER/UC. After adjustment, older age, obesity, ER/UC as setting of COVID dx, prior H, and pregnancy remained strongly associated with 30-day urgent medical visits.