Novel, High-Impact Studies Evaluating Health System and Healthcare Professional Responsiveness to COVID-19

评估卫生系统和医疗保健专业人员对 COVID-19 反应的新颖、高影响力研究

• 批准号: 10193144
• 负责人: Olveen Carrasquillo
• 金额: $ 49.71万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10193144
• 关键词: Novel; Impact; Studies; Evaluating; Health

Project Summary The COVID-19 pandemic necessitated a rapid transition from in-person to telehealth visits to comply with “stay-at-home” and social distancing requirements. No information is currently available about the outcomes associated with the telehealth modalities implemented because of COVID-19. The purpose of the study is to quantify the effects of ceasing in-person outpatient visits, and the resulting increased use of telehealth modalities, among patients with differing social vulnerabilities on the outcomes of: (1) disease control (HbA1c, systolic blood pressure) and (2) health care use (inpatient admissions and emergency department visits). The widespread shift to telehealth visits has created the extraordinary opportunity to understand the differential effects of telehealth visits for those with differing social vulnerabilities using real-world data (linked electronic health record ((EHR) and claims) from over 14M Floridians. The study setting is the OneFlorida Clinical Research Consortium and seven of its health system partners (OneFlorida Partners), who together provide care for over 14M, or 64%, of all Floridians. The patient population and focus of our study are individuals with Type 2 diabetes, hypertension, or both. The OneFlorida Partners serve diverse patient populations in terms of social vulnerability. The study is significant in its quantification of the effects of ceasing all non-emergent in- person visits and transitioning to telehealth modalities on the outcomes of disease control and health care use among those experiencing singular and intersecting social vulnerabilities. The study uses a mixed methods design with interviews and surveys of health system leaders and patients, and leverages the natural experiment that occurred with the rapid transition to telehealth, and for some health systems, the transition back to in-person visits. A novel mathematical generalization of a difference-in-differences (DD) approach will be used to model all post-period measurements simultaneously, while accounting for the covariance of repeated measures, thus increasing power relative to the standard DD approaches. The study aims are to: Aim 1: Quantify the effects of the transition from in-person outpatient visits to the implementation of telehealth and the variations of those effects among those with singular and intersecting social vulnerabilities, on disease control (blood pressure, HbA1c) and health care use (inpatient admissions and emergency department visits). Aim 2. Explore and examine experiences with shared decision-making and care for a subset of patients. Aim 3: Compare the profile of telehealth implementation before and during the COVID-19 pandemic for each OneFlorida clinical partner using in-depth interviews and data reports. Aim 4: Disseminate findings and lessons learned at 6-month intervals throughout the study period using stakeholder engaged, multi-level communication strategies tailored to patients, families, clinicians, health system leaders, third party payers and policymakers.

项目摘要 新冠肺炎大流行要求从面对面就诊快速过渡到远程医疗就诊，以符合 “呆在家里”和社交距离的要求。目前还没有关于结果的信息。 与新冠肺炎实施的远程医疗模式相关联。研究的目的是 量化停止面对面门诊的影响，以及由此增加的远程医疗使用 (1)疾病控制(HbA1c， (2)医疗保健用途(住院和急诊科就诊)。这个 向远程医疗访问的广泛转变为理解这种差异创造了非同寻常的机会 使用真实世界数据对具有不同社会脆弱性的人进行远程保健访问的影响(链接的电子 超过1400万佛罗里达州人的健康记录((EHR)和索赔)。研究的背景是One佛罗里达临床 研究联盟及其七个卫生系统合作伙伴(One佛罗里达合作伙伴)，他们共同提供 照顾1400多万佛罗里达州人，占所有佛罗里达州人的%。我们研究的患者群体和重点是患有 2型糖尿病、高血压或两者兼而有之。One佛罗里达合作伙伴在以下方面为不同的患者群体提供服务 社会脆弱性。这项研究在量化停止所有非紧急情况的影响方面具有重要意义。 关于疾病控制和卫生保健使用结果的人员访问和向远程保健模式的过渡 在那些经历了单一和交叉的社会脆弱性的人中。这项研究采用了混合方法 通过对卫生系统领导人和患者的采访和调查进行设计，并利用自然 随着向远程医疗的快速过渡而发生的实验，对于一些卫生系统来说，过渡 回到面对面的访问。差分(DD)方法的一种新的数学推广将 用于同时对所有后期测量进行建模，同时考虑 重复的措施，从而相对于标准的DD方法增加了功率。研究的目的是： 目标1：量化从面对面门诊到实施远程保健过渡的影响 以及这些影响在具有单一和交叉社会脆弱性的人中对疾病的影响的变化 控制(血压、糖化血红蛋白)和医疗保健使用(住院和急诊科就诊)。 目的2.探索和检验共享决策和护理部分患者的经验。 目标3：比较每个国家在新冠肺炎大流行之前和期间的远程保健实施情况 使用深入访谈和数据报告的One佛罗里达临床合作伙伴。 目标4：在整个研究期间每隔6个月传播研究结果和经验教训 利益相关者参与的多层次沟通策略，专为患者、家庭、临床医生、健康人员量身定做 系统领导者、第三方付款人和政策制定者。