Long-Term Effects of COVID-19 and Health Care Delivery Changes on Health Disparity Populations Living with Multiple Chronic Conditions

摘要/项目摘要 患有多种慢性病 (MCC) 的人消费医疗保健的比例很高 资源，但一次只针对一种疾病的科学证据和医疗保健服务无法提供良好服务 系统。初级保健侧重于家庭和社区背景下的整个人，具有很大的作用，但 将人员护理与 MCC（特别是社区卫生中心）整合起来的信息不足的潜力 （CHC）关注健康差异人群。 COVID-19 大流行及其造成的社会和健康问题 护理系统的反应揭示了巨大的护理差异，同时也刺激了创新 在分散的、分散的、 不人性化、不公平的医疗保健系统。特别是，在持续的个人护理背景下进行远程医疗访问 重点关系、综合心理健康服务以及对 MCC 高危患者的外展活动可提供 希望提高健康差异人群的护理公平性和质量。我们有独特的 有机会在由 926 个社区卫生中心组成的全国网络中研究这一流行病的影响 >260 万患者来自健康差异人群。拟议的研究将： 1) 确定社区卫生中心向 MCC 患者提供的医疗保健服务不断变化的情况 应对持续的 COVID-19 大流行及其后果； 2) 评估这些实践变化对 MCC 患者护理质量的影响； 3) 确定有前景的新兴战略，以改善 MCC 患者的医疗保健。 我们将对实践变化和相关患者结果进行时间序列分析 应对 COVID-19 大流行。每月分析将检查实践过程、患者的变化 健康差异人群以及患有和不患有多种疾病的人的结果和劳动力稳定性 慢性病。从 2020 年 1 月（第一个已知的新冠病毒爆发月份）起的五年内， 美国的 19 例病例以及应对公共卫生和实践变化的开始——我们将分析和 每月公开报告实践变化和患者结果，以快速为决策提供信息 关于与 MCC 的健康差异人群的初级保健。亚组分析将检查差异 26 个州对这一流行病采取了不同的社会和政策应对措施。研究结果来自 这些对数百个社区卫生中心就诊的数百万患者的定量分析将 用于识别有目的的范例样本，以进行深入的案例研究，以定量的方式进行研究 发现并确定和描述在减少医疗保健方面显示出希望的实践创新 差异并改善对 MCC 患者的护理。 研究结果将产生关于大流行对质量和公平性影响的重要新知识 向 MCC 人民提供的护理，并将为自然灾害后改善医疗保健公平性的努力提供信息。

ABSTRACT / PROJECT SUMMARY People living with multiple chronic conditions (MCC) consume a high proportion of health care resources but are not well-served by one-disease-at-a-time scientific evidence and health care delivery systems. Primary care, focused on the whole person in their family and community context, has great but under-informed potential to integrate the care of people with MCC, particularly community health centers (CHCs) that focus on health disparity populations. The COVID-19 pandemic and resulting societal and health care system responses have uncovered tremendous care disparities, while also stimulating innovations with great potential to foster integrated personalized primary care for people with MCC in an otherwise fragmented, impersonal, inequitable health care system. In particular, telehealth visits in the context of ongoing person- focused relationships, integrated mental health services, and outreach to high-risk patients with MCC provide hope for advancing the equity and quality of care 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 evolving changes in health care delivery to people with MCC in community health centers in response to the continuing COVID-19 pandemic and its aftermath; 2) Assess the impact of these practice changes on care quality for people living with MCC; 3) Identify promising emerging strategies to improve health care for people living with MCC. We will conduct a time series analysis of practice changes and associated patient outcomes in response to the COVID-19 pandemic. Monthly analyses will examine changes in practice processes, patient outcomes, and workforce stability for health disparity populations and for people with and without multiple chronic conditions. 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 with MCC. Subgroup analyses will examine differences across 26 states that have had different societal and policy responses to the pandemic. The findings from these quantitative analyses of millions of patients being seen in hundreds of community health centers will be used to identify a purposive sample of exemplars for in-depth case studies that put a face on the quantitative findings and identify and characterize practice innovations that show promise in reducing health care disparities and improving care for people living with MCC. Study findings will generate vital new knowledge on the effect of a pandemic on the quality and equity of care provided to people MCC and will inform efforts to improve health care equity after a natural disaster.