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

卫生与公众健康中心机构在识别和解决新冠肺炎期间患者安全风险方面处于独特地位 大流行。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许多挑战，而且大流行- 相关指导侧重于医院或机构设置。SHHC机构需要数据表征 更改护理过渡模式、最佳实践数据和针对家庭健康环境量身定做的指导， SHHC组织结构和老年人的特定需求，以快速识别和解决患者 新冠肺炎时代护理过渡期间的安全。 附录的目的是确定SARS-CoV-2大流行如何影响(1)护理过渡 老年人和家庭保健提供者出院回家后的经历，以及(2) 在受影响的两个地理区域参加卫生和健康中心机构的组织结构和程序 因大流行而有所不同。该补编利用了资助人员和研究人员在 位于纽约市的美国最大的非营利性SHHC机构，以及为城市服务的大型SHHC机构 以及位于马里兰州巴尔的摩的郊区人口。 次级目标1D：描述新冠肺炎大流行对老年人护理过渡模式的影响 在受大流行影响不同的两个地理区域。我们会在下列地点收集下列措施 在母研究中充当研究地点的两个大型SHHC机构(巴尔的摩、马里兰州和纽约市， 纽约)在大流行开始前后的一年期间：(1)音量、敏锐度、 特征，以及转诊至卫生保健中心的老年人30天急诊或住院，以及(2)频率 拒绝SHHC服务的患者的特征。 次级目标1e：比较和对比卫生和卫生局机构和卫生和卫生局专业人员的反应方面的最佳做法 两个研究地点的患者安全威胁。我们将利用我们在质量和人力方面的专业知识 与SHHC管理人员、工作人员和一线提供者进行半结构化访谈的因素方法，请访问 这两个研究地点的目的是(1)确定疫情期间护理过渡期间对老年人安全的新威胁， 以及(2)确定SHHC机构和提供者如何适应和应对这些威胁的最佳实践。 研究结果将允许跨地理地点进行比较，快速确定未满足的需求，并 制定最佳做法并向卫生和健康中心机构传播，以确保患者在 新冠肺炎时代的医院到家庭健康过渡。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 对大流行的影响。这些知识可以为未来的SHHC手术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.