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

COVID-19引发的医疗服务变化对患者和劳动力的长期影响 照顾健康差异人群的安全网做法的过程和结果 摘要/项目总结 初级保健提供了所有门诊的一半以上-每年5亿次-只有30%的 卫生保健劳动力和<6%的国家卫生保健支出，只有0.2%的国家卫生研究院告知 研究预算。以初级保健为基础的医疗保健系统使人口更健康，更公平， 降低成本。我们正在进行的国家实践和患者调查显示，大流行及其造成的持续 卫生保健系统和社会变革正在对初级保健工作人员及其 在一个支离破碎、缺乏人情味、不公平的医疗保健系统中整合和个性化护理的能力。 然而，在COVID-19自然灾害中，持续的初级保健创新为以下方面带来了希望： 促进健康差距人口的公平。我们有一个独特的机会来研究 在926个社区卫生中心的全国网络中发生了一场大流行病，为260多万名患者提供卫生服务。 人口差距。拟议的研究将： 1)确定社区卫生中心向健康差异人群提供卫生保健的变化， 应对COVID-19大流行引发的持续实践、社会和政策变化; 2)评估这些实践变化对健康差异人群的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)确定有前途的战略，以改善医疗保健公平后，自然灾害和各种人类的反应。 PA-20-172：灾害对卫生保健系统的长期影响 差异人群，我们将对实践变化和相关患者进行时间序列分析， COVID-19疫情引发的劳动力成果及其引发的持续变化。每月 分析将检查实践过程中的纵向变化，病人的结果和劳动力的稳定性， 健康差距和其他高危人群。五年的时间可以追溯到2020年1月-这个月 美国首例已知的COVID-19病例以及应对公共卫生和实践变化的开始- 我们将每月分析并公开报告实践变化和患者结果， 为健康差距人群的初级保健决策提供信息。亚组分析将检查 26个州对这一流行病的社会反应不同，存在差异。的结果 这些对数百个社区卫生中心的数百万患者进行的定量分析也将 用于确定有目的的范例样本和对比实践，以进行深入的案例研究， 实践创新，显示出减少医疗差距的希望。 研究结果将产生重要的新知识，了解大流行对向以下人群提供的护理的纵向影响： 健康差距人口和初级保健社区卫生中心劳动力的可持续性， 并将为在自然灾害和各种人类反应之后改善卫生保健公平性的努力提供信息。

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.