Long-Term Effects of COVID-19-induced Health Care Delivery Changes on Patient & Workforce Processes & Outcomes in Safety Net Practices Caring for Health Disparity Populations

新冠肺炎引发的医疗服务提供方式变化对患者和劳动力的长期影响 关注健康差距人群的安全网实践的过程和结果 摘要/项目摘要 初级保健提供了一半以上的门诊就诊--每年5亿人次--而只有30% 医疗保健劳动力和占全国医疗保健支出的6%，只有0.2%的国家卫生研究院提供了信息 研究预算。以初级保健为基础的医疗体系拥有更健康的人群，更公平，以及 更低的成本。我们正在进行的全国实践和患者调查表明，大流行和由此产生的 卫生保健系统和社会变化正在对初级保健工作人员及其 能够在支离破碎、客观、不公平的医疗保健系统中整合和个性化护理。 然而，在新冠肺炎自然灾害中，正在进行的初级保健创新提供了希望 推进健康差距人群的公平性。我们有一个独特的机会来研究 由926个社区卫生中心组成的全国网络大流行，为260万健康患者提供服务 不平等的人口。建议的研究将会： 1)确定向社区卫生中心健康差距人群提供的卫生保健服务的变化 应对新冠肺炎疫情引发的持续做法、社会和政策变化； 2)评估这些实践改变对健康差距人群护理质量的纵向影响； 3)检查这些变化对社区卫生中心工作人员稳定性的持续影响； 4)确定在自然灾害后改善医疗公平的有希望的战略&不同的人类反应。 响应PA-20-172：灾害对服务于健康的医疗保健系统的长期影响 ，我们将对实践变化和相关的患者和 新冠肺炎大流行引发的劳动力成果以及由其刺激的持续变化。每月 分析将检查实践过程、患者结果和员工稳定性的纵向变化 健康差距和其他高危人群。追溯到2020年1月的五年期间-该月 美国已知的第一例新冠肺炎病例以及应对公共卫生和做法变化的开始- 我们将每月分析和公开报告实践变化和患者结果，以迅速 向决策提供有关健康差距人群初级保健的信息。子组分析将检查 26个州的差异，这些州对大流行有不同的社会反应。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也将 用于确定有目的的样本样本和对比实践，以进行深入的案例研究 实践在缩小医疗保健差距方面表现出希望的创新。 这些发现将产生至关重要的新知识，即大流行对提供给 健康差距人口和初级保健社区卫生中心工作人员的可持续性， 并将为在自然灾害和各种人类应对措施后改善医疗保健公平的努力提供信息。

Long-Term Effects of COVID-19-induced Health Care Delivery Changes on Patient & Workforce Processes & Outcomes in Safety Net Practices Caring for Health Disparity Populations ABSTRACT / PROJECT SUMMARY Primary care provides more than half of all outpatient visits ― 500 million each year ― with only 30% of the healthcare workforce and <6% of national healthcare expenditure, informed by only 0.2% of the NIH research budget. Healthcare systems based on primary care have healthier populations, greater equity, and lower costs. Our ongoing national practice and patient surveys show that the pandemic and resulting ongoing health care system and social changes are having a devastating effects on the primary care workforce and its ability to integrate and personalize care in a fragmented, impersonal, inequitable healthcare system. Yet, amidst the COVID-19 natural disaster, ongoing primary care innovations provide hope for advancing equity 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 changes in health care delivery to health disparity populations in community health centers in response to the continuing practice, social and policy changes launched by the COVID-19 pandemic; 2) Assess the longitudinal impact of these practice changes on care quality in health disparity populations; 3) Examine the ongoing effects of these changes on community health center workforce stability; 4) Identify promising strategies to improve healthcare equity after a natural disaster & varied human response. In response to PA-20-172: Long-Term Effects of Disasters on Health Care Systems Serving Health Disparity Populations, we will conduct a time series analysis of practice changes and associated patient and workforce outcomes initiated by the COVID-19 pandemic and the ongoing changes stimulated by it. Monthly analyses will examine longitudinal changes in practice processes, patient outcomes, and workforce stability for health disparity and other at-risk populations. 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. Subgroup analyses will examine differences across 26 states that have had different societal responses to the pandemic. The findings from these quantitative analyses of millions of patients being seen in hundreds of community health centers also will be used to identify a purposive sample of exemplars and contrasting practices for in-depth case studies of practice innovations that show promise in reducing healthcare disparities. Findings will generate vital new knowledge on the longitudinal effect of a pandemic on care provided to health disparity populations and on the sustainability of the primary care community health center workforce, and will inform efforts to improve health care equity after a natural disaster and varied human responses.