Impact of the COVID-19 Pandemic on Safety Net Performance, Disparities, and Vulnerable Children

COVID-19 大流行对安全网绩效、差异和弱势儿童的影响

• 批准号: 10504574
• 负责人: ALISON Evans Cuellar
• 金额: $ 55.06万
• 依托单位: NATIONAL BUREAU OF ECONOMIC RESEARCH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10504574
• 关键词: Age; Black, Indigenous, People of Color; COVID-19 pandemic; COVID-19 pandemic effects; Caring; Characteristics; Child; Childhood; Clinic; Clinical Data; Communities; Continuity of Patient Care; Data; Disease; Drops; Economics; Electronic Health Record; Emergency department visit; Emotional disorder; Epidemic; Event; Family; Health system; Healthcare Systems; Homeless Youth; Homelessness; Immunization; Information Systems; Lesbian Gay Bisexual Transgender Queer; Measures; Medicaid; Mental Health; Mental Health Services; Modeling; Neighborhood Health Center; Neighborhoods; Outcome; Patient-Centered Care; Patients; Performance; Pharmaceutical Preparations; Policies; Population; Prevalence; Preventive service; Provider; Quality of Care; Recovery; Research; Rewards; Risk; Schools; Shapes; Social isolation; Structure; System; Testing; Time; Uninsured; Vaccines; Visit; Vulnerable Populations; age group; care outcomes; community-level factor; comorbidity; coronavirus disease; design; experience; falls; flexibility; foster care; health care delivery; health care disparity; health equity; health inequalities; medical specialties; novel; pandemic disease; payment; psychologic; racial and ethnic disparities; response; safety net; screening; stressor

Project Summary/Abstract The COVID-19 pandemic has been a major test of the health care delivery system, disrupting primary and mental health care to vulnerable children and threatening the financial stability of providers. In doing so, the pandemic created an opportunity to examine where the delivery system is robust and where improvements and alternative policy approaches should be considered. For children with pre-existing vulnerabilities these disruptions, in the face of increased risks from social isolation and economic stressors, are particularly concerning. How health systems recover and respond to the needs of the most vulnerable speaks to the structure of safety net systems and the policies that support them. The proposed study examines multiple vulnerable and at-risk child populations in safety net systems – children with emotional disorders, children who experienced prior abuse, children in foster care, homeless children, children who identify as LGBTQ+, and those who are make Black, Indigenous and people of color (BIPOC). The proposed study uses electronic health record data from the ADVANCE clinical data research network which represents more than 500,000 children treated annually at safety net, community health centers. This unique clinic network cares for largely uninsured and publicly insured children in 30 states. In addition, the study also uses Medicaid data in 3 of the largest study states to examine additional primary and mental health care outcomes. The aims of the study are to examine changes in primary and mental health care to vulnerable children through the pandemic, transition and recovery periods, to examine health inequities in care over time, and to uncover clinic, community, and payment policy drivers in safety net performance, in order to inform a multi-pronged, corrective policy response to redress gaps.

项目总结/摘要 2019冠状病毒病大流行是对医疗保健提供系统的重大考验，扰乱了初级和初级保健服务， 精神卫生保健的脆弱儿童和威胁到供应商的财政稳定。这样做 大流行病创造了一个机会，可以检查交付系统在哪些方面是健全的，在哪些方面有所改进， 应考虑其他政策办法。对于那些已经存在脆弱性的儿童， 面对社会孤立和经济压力因素带来的风险增加， 关于卫生系统如何恢复和应对最脆弱群体的需求， 安全网系统的结构和支持它们的政策。这项研究将审查多个 安全网系统中的弱势和高危儿童群体-有情绪障碍的儿童、 有过虐待经历的儿童，寄养儿童，无家可归的儿童，认同为LGBTQ+的儿童，以及 黑人、土著和有色人种（BIPOC）。 这项研究使用了来自ADVANCE临床数据研究网络的电子健康记录数据 这代表了每年在安全网社区卫生中心接受治疗的50多万儿童。这 独特的诊所网络照顾30个州基本上没有保险和公共保险的儿童。此外该 研究还使用3个最大研究州的医疗补助数据来检查其他初级健康和心理健康状况 护理结果。这项研究的目的是检查初级和精神卫生保健的变化， 儿童在大流行、过渡和恢复期间的健康状况，审查长期以来保健方面的不公平现象， 并揭示诊所，社区和支付政策在安全网绩效中的驱动因素，以告知 采取多管齐下的纠正性政策应对措施，以弥补差距。