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

摘要/项目总结 患有多种慢性病（MCC）的人消耗很高比例的医疗保健 资源，但没有得到一次一种疾病的科学证据和卫生保健服务 系统.初级保健，侧重于整个人在他们的家庭和社区的背景下，有很大的，但 信息不足的潜力，以整合与MCC的人，特别是社区卫生中心的护理 （CHC），重点关注健康差距人群。2019冠状病毒病疫情及其对社会和健康的影响 护理系统的反应揭示了巨大的护理差距，同时也刺激了创新， 巨大的潜力，以促进综合个性化的初级保健的人与MCC在一个否则分散， 不人性化不公平的医疗体系特别是，在持续的个人- 集中的关系，综合的心理健康服务，以及对MCC高危患者的外展， 希望促进健康差距人口的公平和护理质量。我们有一个独特 有机会在全国926个社区卫生中心网络中研究大流行的影响， > 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患者提供医疗保健服务的不断变化 应对持续的COVID-19疫情及其后果; 2)评估这些实践变化对MCC患者护理质量的影响; 3)确定有希望的新兴战略，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局进行时间序列分析， 应对COVID-19疫情。每月分析将检查实践过程中的变化，患者 结果，以及健康差异人群以及有和没有多重疾病的人群的劳动力稳定性 慢性病从2020年1月开始的五年时间里，也就是第一次已知的COVID爆发的月份， 美国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，以快速告知决策 关于MCC人群健康差异的初级保健。亚组分析将检查差异 在26个国家，对这一流行病采取了不同的社会和政策对策。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， 用于识别有目的的样本，用于深入的案例研究， 发现并确定和描述实践创新，这些创新在减少医疗保健方面显示出希望 差异和改善对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， 这将为自然灾害后改善卫生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.