Impact of the COVID-19 pandemic on patient outcomes, telehealth care delivery, and treatment for unhealthy alcohol use in vulnerable patients with advanced liver disease across two healthcare systems

COVID-19 大流行对两个医疗系统中晚期肝病弱势患者的患者治疗结果、远程医疗保健服务以及不健康饮酒治疗的影响

• 批准号: 10412120
• 负责人: Mandana Khalili
• 金额: $ 69.9万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10412120
• 关键词: 2019-nCoV; Address; Adherence; Affect; Alcohol consumption; Alcoholic Liver Diseases; Alcohols; Ascites; Biological Models; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; COVID-19 risk; Cardiovascular Diseases; Caring; Cause of Death; Chronic; Chronic Disease; Chronic Kidney Failure; Cirrhosis; Clinic; Clinical; Communities; Complex; Computerized Medical Record; Counseling; Data; Deterioration; Diabetes Mellitus; Diagnostic Services; Disease; Disease Management; Disease Outcome; Dissemination and Implementation; Encephalopathies; Ensure; Esophageal Varix; Evaluation; Fibrosis; Gastrointestinal Hemorrhage; Goals; Health; Health system; Healthcare Systems; Hepatology; High Prevalence; Individual; Intervention; Laboratories; Life Experience; Liver; Liver Cirrhosis; Liver diseases; Medical; Mental disorders; Modeling; Monitor; Morbidity - disease rate; Natural experiment; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Persons; Physicians; Police; Population; Prevalence; Prevention; Preventive measure; Primary Health Care; Primary carcinoma of the liver cells; Process; Psychological Impact; Quality Indicator; Quality of Care; Quality of life; Randomized Controlled Trials; Recovery; Reporting; Risk; Risk Factors; SARS-CoV-2 infection; Sampling; Service delivery model; Services; Social isolation; Substance Use Disorder; Surveys; System; Telemedicine; Testing; Time; United States; United States Department of Veterans Affairs; Veterans; Vulnerable Populations; acute liver disease; addiction; alcohol abstinence; alcohol abuse therapy; alcohol intervention; alcohol misuse; barrier to care; care delivery; care outcomes; chronic alcohol ingestion; chronic liver disease; comorbidity; coronavirus disease; disorder prevention; drinking; effective intervention; efficacy evaluation; ethnic minority; experience; follow-up; health care availability; health care service; health disparity; health disparity populations; high risk; improved; infection risk; innovation; liver function; liver transplantation; medical specialties; mortality; motivational enhancement therapy; novel; pandemic disease; patient population; prevent; prospective; public health priorities; racial and ethnic; reduced alcohol use; response; safety net; satisfaction; screening; screening services; socioeconomic disadvantage; telehealthcare; treatment as usual

PROJECT SUMMARY The COVID-19 pandemic has had a significant adverse impact on vulnerable populations with serious comorbid medical conditions. Individuals with advanced chronic liver disease (CLD) are among those most strongly affected by disruptions in care and are also highly susceptible to poor outcomes associated with SARS-CoV-2 infection. It is critical to understand how to effectively manage these patients during the course of the pandemic. The rising prevalence of cirrhosis, an end-stage of CLD, is a significant contributor to morbidity and mortality in the United States and alcohol use is a major risk factor. Thus, effective intervention for alcohol cessation is a high-priority need. In addition, high quality advanced CLD with adherence to known quality indicators is associated with positive patient outcomes, critical to enhanced survival, and quality of life. Vulnerable populations including veterans and those receiving care in safety net systems are at significant risk for liver and COVID-19 related health disparities. They also have known barriers to healthcare access and are at high risk for disengagement from care. The COVID-19 pandemic has significantly disrupted the traditional health care delivery models, but the impact on outcomes of vulnerable patients with advanced CLD is currently unknown. Moreover, the widespread use of telemedicine as a mitigation strategy within these health systems due to COVID-19 has provided an unprecedented opportunity for evaluation and innovation of care delivery models. Better understanding of patients' experience with telemedicine and impact on their outcomes is urgently needed to establish processes and polices that ensure equity in access, sustainability, and high-quality care delivery. To address these critical issues, we propose to evaluate the care of patients with advanced CLD during the pandemic within hepatology practices in two generalizable health systems serving vulnerable populations, a public safety net system and Veterans Affairs healthcare systems. Furthermore, we will examine the efficacy of a stepped care intervention (i.e., motivational interviewing and addiction physician management) via telemedicine to treat alcohol use as an adjunct to usual hepatology care. We will also examine COVID-19 outcomes. We propose the following aims: 1) Evaluate the impact of the COVID-19 pandemic on clinical outcomes of vulnerable patients with advanced CLD receiving care in hepatology practices, in a natural experiment; 2) Evaluate patient-reported experiences with use of telemedicine in response to the pandemic to deliver hepatology specialty care in those with advanced CLD; and 3) Conduct a randomized controlled trial evaluating the efficacy and feasibility of a stepped alcohol treatment using telemedicine on unhealthy alcohol use in patients with alcohol-related CLD receiving care in hepatology practices, compared with usual care. We hypothesize that we will observe an increase in adverse patient outcomes in the post-pandemic period, that the patient experience and satisfaction with telemedicine as a mitigation strategy to reduce COVID-19 risk will improve, and that patients receiving stepped care will be more likely to reduce or abstain from alcohol use. 1

项目总结