Long-Term Effects of COVID-19-induced Health Care Delivery Changes on Patient & Workforce Processes & Outcomes in Safety Net Practices Caring for Health Disparity Populations

COVID-19 引起的医疗保健服务变化对患者的长期影响

• 批准号: 10440740
• 负责人: Nicole Jill Cook
• 金额: $ 54.38万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-21 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10440740
• 关键词: Adoption; African American; Back; Budgets; COVID-19; COVID-19 pandemic; COVID-19 pandemic effects; Caring; Case Study; Chronic Care; Chronic Disease; Clinic; Communities; Community Health Networks; Computerized Medical Record; Country; Data; Decision Making; Depression screen; Disadvantaged; Disasters; Evolution; Financial Hardship; Health; Health Expenditures; Healthcare; Healthcare Systems; Home; Hour; Human; Information Technology; Insurance; Intervention; Interview; Knowledge; Laboratories; Language; Latino; Long-Term Effects; Measures; Medicaid; Movement; Natural Disasters; Natural experiment; Neighborhood Health Center; Outcome; Outpatients; Patient Care; Patient-Focused Outcomes; Patients; Persons; Population; Populations at Risk; Prenatal care; Preventive service; Primary Health Care; Process; Provider; Public Health Practice; Quality of Care; Refugees; Reporting; Research; Rural Health Centers; Sampling; Seasonal Variations; Social Change; Social Policies; Subgroup; Surveys; Telephone; Time Series Analysis; United States National Institutes of Health; Visit; Work; acute care; base; birth control; comparative; cost; disparity reduction; experimental study; follow-up; functional status; health care delivery; health care disparity; health disparity; health disparity populations; health equity; health inequalities; improved; innovation; insight; long term consequences of COVID-19; low socioeconomic status; multiple chronic conditions; novel; outreach; pandemic disease; patient registry; personalized care; population health; practice-based research network; remote visit; reproductive; response; safety net; secondary analysis; service delivery; telehealth; tool

Long-Term Effects of COVID-19-induced Health Care Delivery Changes on Patient & Workforce Processes & Outcomes in Safety Net Practices Caring for Health Disparity Populations ABSTRACT / PROJECT SUMMARY Primary care provides more than half of all outpatient visits ― 500 million each year ― with only 30% of the healthcare workforce and <6% of national healthcare expenditure, informed by only 0.2% of the NIH research budget. Healthcare systems based on primary care have healthier populations, greater equity, and lower costs. Our ongoing national practice and patient surveys show that the pandemic and resulting ongoing health care system and social changes are having a devastating effects on the primary care workforce and its ability to integrate and personalize care in a fragmented, impersonal, inequitable healthcare system. Yet, amidst the COVID-19 natural disaster, ongoing primary care innovations provide hope for advancing equity for health disparity populations. We have a unique opportunity to study the effects of the pandemic in a national network of 926 community health centers serving >2.6 million patients from health disparity populations. The proposed study will: 1) Identify changes in health care delivery to health disparity populations in community health centers in response to the continuing practice, social and policy changes launched by the COVID-19 pandemic; 2) Assess the longitudinal impact of these practice changes on care quality in health disparity populations; 3) Examine the ongoing effects of these changes on community health center workforce stability; 4) Identify promising strategies to improve healthcare equity after a natural disaster & varied human response. In response to PA-20-172: Long-Term Effects of Disasters on Health Care Systems Serving Health Disparity Populations, we will conduct a time series analysis of practice changes and associated patient and workforce outcomes initiated by the COVID-19 pandemic and the ongoing changes stimulated by it. Monthly analyses will examine longitudinal changes in practice processes, patient outcomes, and workforce stability for health disparity and other at-risk populations. For a five-year period going back to January 2020 ― the month of the first known COVID-19 case in the US and the start of responding public health and practice changes ― we will analyze and publicly report, on a monthly basis, practice changes and patient outcomes, to rapidly inform decision making about primary care of health disparity populations. Subgroup analyses will examine differences across 26 states that have had different societal responses to the pandemic. The findings from these quantitative analyses of millions of patients being seen in hundreds of community health centers also will be used to identify a purposive sample of exemplars and contrasting practices for in-depth case studies of practice innovations that show promise in reducing healthcare disparities. Findings will generate vital new knowledge on the longitudinal effect of a pandemic on care provided to health disparity populations and on the sustainability of the primary care community health center workforce, and will inform efforts to improve health care equity after a natural disaster and varied human responses.

COVID-19 引起的医疗保健服务变化对患者和劳动力的长期影响 照顾健康差异人群的安全网实践的过程和结果 摘要/项目摘要 初级保健提供了超过一半的门诊就诊量——每年 5 亿人次——但仅占 30% 医疗保健劳动力和不到 6% 的国家医疗保健支出，仅 0.2% 的 NIH 提供信息 研究预算。以初级保健为基础的医疗保健系统拥有更健康的人口、更大的公平性和 降低成本。我们正在进行的国家实践和患者调查表明，这一流行病及其造成的持续 卫生保健系统和社会变革正在对初级保健人员及其队伍产生毁灭性影响。 在分散的、非个性化的、不公平的医疗保健系统中整合和个性化护理的能力。 然而，在 COVID-19 自然灾害中，持续的初级保健创新为人们带来了希望 促进健康不平等人群的公平。我们有一个独特的机会来研究影响 全国 926 个社区卫生中心网络为超过 260 万名健康患者提供服务 人口差距。拟议的研究将： 1) 确定社区卫生中心向健康差异人群提供医疗保健服务的变化 应对 COVID-19 大流行引发的持续实践、社会和政策变化； 2) 评估这些实践变化对健康差异人群护理质量的纵向影响； 3) 检查这些变化对社区卫生中心劳动力稳定性的持续影响； 4) 确定有希望的策略，以在自然灾害和不同的人类反应后改善医疗保健公平性。 回应 PA-20-172：灾害对服务于健康的医疗保健系统的长期影响 差异人群，我们将对实践变化以及相关患者和患者进行时间序列分析 COVID-19 大流行引发的劳动力成果及其引发的持续变化。每月 分析将检查实践过程、患者结果和劳动力稳定性的纵向变化 健康差距和其他高危人群。自 2020 年 1 月起的五年期间——该月 美国首例已知的 COVID-19 病例以及开始应对公共卫生和实践变化 ― 我们将每月分析并公开报告实践变化和患者结果，以快速 为健康差异人群的初级保健决策提供信息。亚组分析将检查 26 个州对这一流行病采取了不同的社会反应，但存在差异。研究结果来自 这些对数百个社区卫生中心就诊的数百万患者的定量分析也将 用于确定有目的的范例样本和对比实践，以进行深入的案例研究 实践有望减少医疗保健差距的创新。 研究结果将产生关于大流行病对提供的护理的纵向影响的重要新知识 人口健康差距以及初级保健社区卫生中心劳动力的可持续性， 并将为自然灾害和各种人类反应后改善医疗保健公平性的努力提供信息。