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

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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.