ImpAct of COVID-19 on CaRe TransitOns and Health OutcomeS for Vulnerable PopulationS in Nursing Homes and Home HealthCARE Agencies (ACROSS-CARE)

新冠肺炎大流行对老年弱势群体(即种族/民族)的影响不成比例 少数民族和农村居民)。收购新冠肺炎的高风险以及这些脆弱群体的可怕后果 人口的高患病率和其他社会决定因素在一定程度上解释了 健康。家庭医疗机构(HHA)和疗养院(NHS)为以下疾病提供基本的急性后服务 老年患者数量众多。大流行扰乱了从医院到HHA的护理过渡 NHS，这可能导致重要的健康后果，包括扩大现有健康 差距。在我们之前的，即新冠肺炎之前的研究中，我们发现，当HHS和NHS提供最好的 减少了感染预防和控制(IPC)医院感染的做法。以这部小说为基础 以前的工作，并由国家少数民族健康和健康差距研究所(NIMHD)指导 框架，本研究的目的是：1)描述HHA和NH IPC计划在 应对全国范围内的新冠肺炎大流行，并检查服务设施的这些变化是否有所不同 弱势群体中占很大比例；2)新冠肺炎如何扰乱医院入院和 随后向HHAS和NHS的排放，并确定中断是否会对 3)量化新冠肺炎对住院患者、HHA和NH健康结局的影响 以及HHS和NHS的IPC方案在减少疫情对脆弱地区的影响方面的有效性 和非弱势老年人口。在目标1中，我们将进行定性访谈和全国调查 哈斯和英国国民健康保险制度。我们将从核心的HHA和NHS中抽取样本，这些样本来自我们在新冠肺炎之前的调查和扩充 根据需要配备新的设施。我们将把以前的调查和新的2022年调查联系起来，以检查 IPC计划，并确定这些变化在主要服务于弱势群体的设施方面是否有所不同 人口。在目标2中，我们将使用纵向(2013至2022)医疗保险和医疗补助中心(CMS)数据 描述如何选择紧急和选择性入院和出院处置给HHA和HHA 国民健康保险制度随着新冠肺炎的变化而改变；以及这些变化是否对脆弱人群有所不同。在目标3中，我们 将我们的COVID前调查和2022年调查与CMS纵向数据联系起来，以对健康结果进行建模 老年医疗保险受益者(即新冠肺炎病例、感染、再住院和死亡)，控制 对于当地的新冠肺炎环境。我们之前对NHS和HHAS的IPC进行的全国调查都是理想的 新颖的基线数据。利用我们之前的工作，这项创新的研究将解决新冠肺炎对 老年易受伤害患者的过渡和健康结果(即，种族和少数民族与非 拉丁裔白人和城市与农村)，确定健康差距和有效做法，以减轻健康 差距。这项研究结果还将为NHS、HHA和政策制定者在未来规划传染病方面提供信息 减少疾病紧急情况和缩小健康差距。

The COVID-19 pandemic has disproportionately impacted elderly vulnerable populations (i.e., racial/ethnic minorities and rural residents). The high risk for acquiring COVID-19 and the dire outcomes in these vulnerable populations is partially explained by the high prevalence of comorbidities and other social determinants of health. Home healthcare agencies (HHAs) and nursing homes (NHs), provide essential post-acute services for a large number of elderly patients. The pandemic has disrupted care transitions from hospitals to HHAs and NHs, which may lead to important health outcomes consequences, including the widening of existing health disparities. In our previous, pre-COVID-19 studies, we have found that when HHAs and NHs provide best practices in infection prevention and control (IPC) nosocomial infections are reduced. Building upon this novel previous work and guided by the National Institute on Minority Health and Health Disparities (NIMHD) framework, the aims of this study are to: 1) Describe how HHA and NH IPC programs have changed in response to the COVID-19 pandemic across the nation, and examine if these changes vary for facilities serving a large proportion of vulnerable populations; 2) Characterize how COVID-19 disrupted hospital admissions and subsequent discharges to HHAs and NHs, and determine if the disruptions disproportionately affected vulnerable populations; and, 3) Quantify the impact of COVID-19 on inpatient, HHA and NH health outcomes and the effectiveness of IPC programs in HHAs and NHs in reducing the impact of the pandemic in vulnerable and non-vulnerable elderly populations. In Aim 1, we will conduct qualitative interviews of and a national survey of HHAs and NHs. We will sample from the core HHAs and NHs from our pre-COVID-19 surveys and augment with new facilities as needed. We will link our prior surveys and the new 2022 survey to examine changes in IPC programs and determine if these changes differed in facilities predominately serving vulnerable populations. In Aim 2, we will use longitudinal (2013 to 2022) Centers for Medicare and Medicaid (CMS) data to characterize how select urgent and elective hospital admissions and discharge dispositions to HHAs and NHs changed with COVID-19; and, whether these changes differed for vulnerable populations. In Aim 3, we will link our pre-COVID surveys and the 2022 survey with longitudinal CMS data to model the health outcomes (i.e., COVID-19 cases, infections, rehospitalizations and mortality) of elderly Medicare beneficiaries, controlling for the local COVID-19 environment. Our prior national surveys of IPC in both NHs and HHAs are ideal and novel baseline data. Leveraging our prior work, this innovative study will address the impact of COVID-19 on transitions and health outcomes of elderly, vulnerable patients (i.e., racial and ethnic minorities versus non- Latinx whites and urban versus rural), identify health disparities and effective practices to mitigate health disparities. The study findings will also inform NHs, HHAs and policymakers in future planning for infectious disease emergencies and decrease health disparities.