PA-20-070: Evaluating home healthcare agency and home healthcare professional responsiveness to safety threats during older adults' care transitions in the era of COVID-19

SHHC机构在COVID-19期间处于识别和解决患者安全风险的独特地位 流行病SHHC提供者是为数不多的亲自进行临床评估和治疗的人员之一 在大流行期间。在家庭环境中提供护理面临着许多挑战， 相关指导侧重于医院或机构环境。SHHC机构需要数据表征 护理过渡模式的变化、最佳做法的数据以及针对家庭健康环境的指导， SHHC组织结构，以及老年人快速识别和解决患者的特定需求 在COVID-19时代的护理过渡期间的安全。 该补充的目标是确定SARS-CoV-2大流行如何影响（1）护理过渡 老年人和家庭健康提供者从医院回家后的经历，以及（2） 两个地理区域的SHHC参与机构的组织结构和流程受到影响 不同的流行病。补充利用赠款人员和研究人员的专业知识， 位于纽约市的美国最大的非营利SHHC机构，以及一家服务于城市的大型SHHC机构 以及位于马里兰州的巴尔的摩的郊区人口。 子目标1d：描述COVID-19大流行对老年人护理过渡模式的影响 在两个受大流行影响不同的地理区域。我们将收集以下措施， 两个大型SHHC机构作为母研究的研究地点（巴尔的摩，马里兰州，和纽约市， 纽约）在大流行开始前后一年的时间内：（1）数量、敏锐度、 特征，以及转诊至SHHC的老年人的30天艾德访视或住院，以及（2）频率 和拒绝SHHC服务的患者的特征。 次级目标1 e：比较和对比SHHC机构和SHHC专业人员的反应中的最佳做法 两个研究中心的患者安全威胁。我们将利用我们的专业知识， 因素的方法进行半结构化的采访与SHHC管理人员，工作人员和一线供应商在 这两个研究中心将（1）确定在大流行期间护理过渡期间对老年人安全的新威胁， 以及（2）确定SHHC机构和供应商如何适应和应对这些威胁的最佳实践。 研究结果将允许在不同地理位置进行比较，快速确定未满足的需求， 制定并向SHHC机构传播最佳实践，以确保患者在 在COVID-19时代，医院到家庭的健康过渡。调查结果还将提供关于以下方面的关键知识： SHHC机构如何调整护理提供，管理，决策和运营以应对 to the pandemic流行.这些知识可以为未来的SHHC操作和护理过渡改进工作提供信息。

SHHC agencies are in a unique position to identify and address patient safety risks during the COVID-19 pandemic. SHHC providers are among the few personnel conducting in-person clinical evaluations and treatment during the pandemic. There are numerous challenges providing care in home environments, and pandemic- related guidance has focused on hospital or institutional settings. SHHC agencies need data characterizing changes to care transitions patterns, data on best practices, and guidance tailored to home health settings, SHHC organizational structures, and the specific needs of older adults to quickly identify and address patient safety during care transitions in the COVID-19 era. The goal of the supplement is to identify how the SARS-CoV-2 pandemic has impacted (1) care transitions experiences of older adults and home health providers' after coming home from the hospital, and (2) organizational structure and processes of participating SHHC agencies in two geographic areas impacted differently by the pandemic. The supplement leverages the expertise of grant personnel and study staff at the largest not-for-profit SHHC agency in the US located in New York City, and a large SHHC agency serving urban and suburban populations located in Baltimore, Maryland. Sub-aim 1d: Characterize the impact of the COVID-19 pandemic on older adults' care transitions patterns in two geographic regions impacted differently by the pandemic. We will collect the following measures at two large SHHC agencies serving as study sites in the parent study (Baltimore, Maryland, and New York City, New York) for a period of one year before and after the beginning of the pandemic: (1) changes in volume, acuity, characteristics, and 30-day ED visit or hospitalization of older adults being referred to SHHC, and (2) frequency and characteristics of patients refusing SHHC services. Sub-aim 1e: Compare and contrast best practices in SHHC agency and SHHC professionals' responses to patient safety threats across the two study sites. We will leverage our expertise with qualitative and human factors methods to conduct semi-structed interviews with SHHC administrators, staff, and front-line providers at the two study sites to (1) identify novel threats to older adults' safety during care transitions during the pandemic, and (2) identify best practices for how SHHC agencies and providers can adapt and respond to these threats. Study findings will allow for comparison across geographic sites, rapid identification of unmet needs and for development and dissemination of best practices to SHHC agencies for ensuring patient safety during the hospital-to-home health transition in the era of COVID-19. Findings will also provide critical knowledge regarding how SHHC agencies have adjusted care delivery, management, decision-making, and operations in response to the pandemic. This knowledge can inform future SHHC operations and care transitions improvement efforts.