Long-Term Effects of COVID-19 and Health Care Delivery Changes on Health Disparity Populations Living with Multiple Chronic Conditions

摘要/项目摘要 患有多种慢性病(MCC)的人消费很高比例的医疗保健 资源，但没有得到一次一种疾病的科学证据和医疗保健提供的良好服务 系统。初级保健，在家庭和社区背景下关注整个人，有很好的 将人们的护理与医疗保健中心，特别是社区卫生中心整合起来的潜力不足 (CHCs)，重点关注健康差距人群。新冠肺炎大流行及其引发的社会和健康 医疗系统的反应发现了巨大的医疗差异，同时也刺激了创新 在一个原本支离破碎的、 客观、不公平的医疗保健制度。特别是，在持续的人--的背景下进行远程保健访问- 专注的人际关系、综合的精神健康服务以及接触MCC高危患者可提供 希望提高医疗保健服务的公平性和质量。我们有独一无二的 在由926个社区卫生中心提供服务的全国网络中研究大流行的影响的机会 来自健康差距人群的260万患者。建议的研究将会： 1)确定社区卫生中心向MCC患者提供的医疗保健服务的不断变化 应对持续的新冠肺炎大流行及其后果； 2)评估这些实践改变对MCC患者护理质量的影响； 3)确定有前景的新战略，以改善MCC患者的医疗保健。 我们将对实践变化和相关的患者结果进行时间序列分析 应对新冠肺炎大流行。每月分析将检查实践过程中的变化，患者 对于健康差距人群以及患有和不患有多发性硬化症的人群的结果和劳动力稳定性 慢性疾病。追溯到2020年1月-第一个已知的COVID的月份-的五年期间- 19美国病例和开始应对公共卫生和做法的变化-我们将分析和 每月公开报告实践变化和患者结果，以便为决策提供快速信息 关于患有MCC的健康差距人群的初级保健。子组分析将检查差异 26个州对大流行有不同的社会和政策反应。调查结果来自 这些对数百个社区卫生中心就诊的数百万患者的量化分析将是 用于确定有目的的样本样本，以进行深入的案例研究，使量化 发现并确定和描述在减少医疗保健方面表现出希望的实践创新 差距和改善对MCC患者的护理。 研究结果将在大流行对质量和公平的影响方面产生至关重要的新知识 该组织还将向MCC人民提供医疗服务，并将为自然灾害后改善医疗服务公平性的努力提供信息。

ABSTRACT / PROJECT SUMMARY People living with multiple chronic conditions (MCC) consume a high proportion of health care resources but are not well-served by one-disease-at-a-time scientific evidence and health care delivery systems. Primary care, focused on the whole person in their family and community context, has great but under-informed potential to integrate the care of people with MCC, particularly community health centers (CHCs) that focus on health disparity populations. The COVID-19 pandemic and resulting societal and health care system responses have uncovered tremendous care disparities, while also stimulating innovations with great potential to foster integrated personalized primary care for people with MCC in an otherwise fragmented, impersonal, inequitable health care system. In particular, telehealth visits in the context of ongoing person- focused relationships, integrated mental health services, and outreach to high-risk patients with MCC provide hope for advancing the equity and quality of care 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 evolving changes in health care delivery to people with MCC in community health centers in response to the continuing COVID-19 pandemic and its aftermath; 2) Assess the impact of these practice changes on care quality for people living with MCC; 3) Identify promising emerging strategies to improve health care for people living with MCC. We will conduct a time series analysis of practice changes and associated patient outcomes in response to the COVID-19 pandemic. Monthly analyses will examine changes in practice processes, patient outcomes, and workforce stability for health disparity populations and for people with and without multiple chronic conditions. 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 with MCC. Subgroup analyses will examine differences across 26 states that have had different societal and policy responses to the pandemic. The findings from these quantitative analyses of millions of patients being seen in hundreds of community health centers will be used to identify a purposive sample of exemplars for in-depth case studies that put a face on the quantitative findings and identify and characterize practice innovations that show promise in reducing health care disparities and improving care for people living with MCC. Study findings will generate vital new knowledge on the effect of a pandemic on the quality and equity of care provided to people MCC and will inform efforts to improve health care equity after a natural disaster.