COVID-19 Healthcare Access and Sequelae Evaluation

COVID-19 医疗保健获取和后遗症评估

• 批准号: 10320654
• 负责人: Marc Kowalkowski
• 金额: $ 14.66万
• 依托单位: CAROLINAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-23 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10320654
• 关键词: Acute; Address; Affect; Anxiety; Award; COVID-19; COVID-19 patient; Caring; Clinical; Clinical Trials; Cognitive; Complex; Data; Data Collection; Data Reporting; Discrimination; Electronic Health Record; Evaluation; Evaluation Studies; Family; Goals; Health; Health system; Healthcare; Heterogeneity; Home Care Services; Hospitals; Hypotension; Hypoxia; Impaired cognition; Impairment; Infection; Infrastructure; Inpatients; Knowledge; Learning; Mechanical ventilation; Mental Depression; Mental Health; Mental disorders; Methods; Morbidity - disease rate; Nurses; Organ failure; Outcome; Outcome Measure; Outpatients; Parents; Patient Outcomes Assessments; Patient Recruitments; Patient-Focused Outcomes; Patients; Population; Quality of life; Recovery; Rehabilitation therapy; Research Personnel; Resources; SARS-CoV-2 infection; Sedation procedure; Sepsis; Skilled Nursing Facilities; Sleep; Surveys; Survivors; Telephone; Testing; Time; Work; care systems; clinically significant; cohort; comorbidity; comparison group; cost; effectiveness evaluation; effectiveness outcome; experience; follow-up; functional status; health care availability; hospital readmission; implementation outcomes; improved; improved outcome; mortality; novel; pragmatic trial; programs; randomized trial; satisfaction; severe COVID-19; social stigma; survivorship; treatment as usual; treatment effect; virtual; virtual delivery

PROJECT SUMMARY Emerging data suggest that COVID-19 survivors will experience long-lasting physical, cognitive, and mental health sequelae, similar to non-COVID-19 sepsis survivors. However, COVID-19 may also cause specific sequelae that result from unique aspects of the SARS-CoV-2 infection. Currently, data comparing long-term outcomes for COVID-19 vs non-COVID-19 sepsis survivors are lacking. Our prior work has shown that a multicomponent transitional care strategy after sepsis discharge improves health outcomes for sepsis survivors. However, several factors, including distancing requirements and healthcare-related stigma, discrimination, or refusal of care challenge the delivery of optimal transitional support for survivors of COVID-19. The extent to which COVID-19 sepsis survivors have restricted access to transitional support after discharge and the long-term functional, cognitive, and mental health sequelae of COVID- 19-related sepsis are unknown. The central goal of the COVID-19 Healthcare Access and Sequelae Evaluation (CHASE) study is to advance knowledge of post-illness deficits and challenges experienced by survivors of COVID-19-related sepsis and inform delivery of post- sepsis transitional care to improve outcomes for both COVID-19 and non-COVID-19 sepsis survivors. To achieve this goal, we will leverage the strengths of our ongoing pragmatic trial of sepsis survivors (R01NR018434) to enable efficient and representative recruitment of patients for focused data collection and longitudinal assessment of patients with COVID-19 sepsis and a comparison group of patients with non-COVID-19 sepsis. We will evaluate a core outcomes measure set of long-term outcomes at 90- and 180-days (AIM 1), assess COVID-19-related limitations to accessing pivotal post-discharge healthcare support (AIM 2), and explore if the effects of our novel sepsis transition and recovery (STAR) program, delivered virtually through a nurse navigator, are generalizable to COVID-19 survivors (AIM 3). We hypothesize that COVID- 19 sepsis survivors will experience poorer long-term outcomes and more restricted access to post-discharge care compared to non-COVID-19 sepsis survivors. Our proposal capitalizes on the existing infrastructure, trial cohort, and data collection of the parent award as an efficient approach to achieving our aims with limited additional time and cost. Findings from the CHASE study will provide key information to health systems on specific challenges experienced by COVID-19 sepsis survivors and the utility of STAR, a scalable, virtually integrated transition program, to improve outcomes for sepsis survivors with and without COVID-19.

项目总结 新兴数据表明，新冠肺炎幸存者将经历长期的身体，认知， 和精神健康后遗症，类似于非新冠肺炎败血症幸存者。然而，新冠肺炎 也可能导致SARS-CoV-2感染的独特方面造成的特定后遗症。 目前，比较新冠肺炎和非新冠肺炎败血症幸存者的长期结果的数据 都是缺乏的。我们先前的工作表明，多成分过渡期护理策略在 脓毒症排泄物可改善败血症幸存者的健康结局。然而，有几个因素， 包括距离要求和与医疗保健相关的污名、歧视或拒绝 CARE对为新冠肺炎幸存者提供最佳过渡支持提出了挑战。广度 新冠肺炎败血症幸存者在接受治疗后获得过渡性支持的机会受到限制 出院和COVID的长期功能、认知和精神健康后遗症- 与脓毒症相关的19例尚不清楚。新冠肺炎的核心目标是医疗卫生和 后遗症评估(CHASE)研究是为了促进对疾病后缺陷和 新冠肺炎相关脓毒症幸存者经历的挑战并告知分娩后 脓毒症过渡期护理可改善新冠肺炎和非新冠肺炎脓毒症的预后 幸存者。为了实现这一目标，我们将利用我们正在进行的务实试验的优势 败血症幸存者(R01NR018434)，以实现高效和有代表性的患者招募 用于新冠肺炎脓毒症患者的重点数据收集和纵向评估 对照组为非新冠肺炎脓毒症患者。我们将评估一项核心成果 评估90天和180天的长期结果集(AIM 1)，评估与新冠肺炎相关的 获取关键的出院后医疗支持(AIM 2)的限制，并了解 我们新的脓毒症转移和恢复(STAR)计划的效果，实际上是通过 护士导航员，适用于新冠肺炎幸存者(目标3)。我们假设COVID- 19名脓毒症幸存者将经历更差的长期结果和更多的限制获得 出院后护理与非新冠肺炎败血症幸存者的比较。我们的建议充分利用了 现有的基础设施、试验队列和父级裁决的数据收集作为一种高效 以有限的额外时间和成本实现我们的目标的方法。追逐中的发现 研究将向卫生系统提供关于以下方面面临的具体挑战的关键信息 新冠肺炎败血症幸存者和STAR的效用，这是一种可扩展、几乎集成的过渡 该计划旨在改善接受和不接受新冠肺炎治疗的脓毒症幸存者的预后。