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

项目摘要 2019冠状病毒病大流行需要从面对面访问快速过渡到远程医疗访问，以遵守 “呆在家里”和社交距离要求。目前没有关于结果的信息 与因COVID-19而实施的远程医疗模式相关。研究的目的是 量化停止面对面门诊的影响，以及由此导致的远程医疗使用的增加 模式，在具有不同社会脆弱性的患者中，对以下结果的影响：（1）疾病控制（HbA 1c， 收缩压）和（2）卫生保健使用（住院和急诊）。的 远程医疗访问的广泛转变为了解差异创造了非凡的机会， 使用真实世界数据（链接的电子 超过1400万佛罗里达人的健康记录（EHR）和索赔。研究环境为OneFlorida Clinical 研究联盟及其七个卫生系统合作伙伴（OneFlorida Partners），他们共同提供 照顾超过14 M，或64%的佛罗里达人。我们研究的患者人群和重点是 2型糖尿病、高血压或两者兼而有之。OneFlorida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， 个人访问和向远程保健模式过渡，以了解疾病控制和保健使用的结果 在那些经历单一和交叉的社会脆弱性。该研究采用了混合方法 通过对卫生系统领导人和患者的访谈和调查进行设计，并利用自然资源， 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， 回到个人访问。一种新的差分中差分（DD）方法的数学推广将 用于同时对所有后期测量进行建模，同时考虑以下因素的协方差 重复测量，从而相对于标准DD方法增加功率。研究的目的是： 目标1：量化从门诊就诊到实施远程保健的过渡的影响 以及这些影响在那些具有单一和交叉社会脆弱性的人群中的变化， 控制（血压，HbA 1c）和医疗保健使用（住院和急诊）。 目标2.探索和检查经验与共享决策和护理的一个子集的病人。 目标3：比较2019冠状病毒病大流行之前和期间远程医疗实施的概况， OneFlorida临床合作伙伴使用深入访谈和数据报告。 目标4：在整个研究期间每隔6个月传播一次研究结果和经验教训， 利益相关者参与，针对患者、家庭、临床医生、健康 系统领导者、第三方支付者和政策制定者。

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.