COVID-19 shutdown: impact of healthcare disruptions on cardiovascular health disparities among people with multiple chronic conditions in New York City.

COVID-19 关闭：医疗保健中断对纽约市多种慢性病患者心血管健康差异的影响。

• 批准号: 10707047
• 负责人: John A Dodson
• 金额: $ 67.79万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10707047
• 关键词: Academic Medical Centers; Acute; Acute myocardial infarction; Adopted; Adoption; Adult; Age; Ambulatory Care; Area; Biometry; Blood Pressure; COVID-19; COVID-19 impact; COVID-19 outbreak; COVID-19 pandemic; Cardiovascular Diseases; Cardiovascular system; Caring; Categories; Cessation of life; Chronic; Chronic Disease; Clinical; Clinical Research; Data; Data Science; Diabetes Mellitus; Disasters; Disease Outcome; Disparity; Dyslipidemias; Economically Deprived Population; Economics; Elderly; Electronic Health Record; Epidemiology; Ethnic Origin; Event; Female; Future; Gerontology; Glycosylated hemoglobin A; Health; Health Disparities Research; Health system; Healthcare; Healthcare Systems; Heart Arrest; Heart failure; Hospitals; Hypertension; Institution; Ischemic Stroke; Joints; Left; Long-Term Effects; Longitudinal Studies; Measures; Mediation; Medical; Medicine; Methods; Minority Groups; Modeling; New York City; Obesity; Outcome; Patients; Pattern; Persons; Phase; Policies; Population; Positioning Attribute; Private Hospitals; Public Hospitals; Race; Readiness; Research; Resources; Risk; SARS-CoV-2 infection; Source; Standardization; Subgroup; System; Telemedicine; Translations; Unstable angina; Visit; Vulnerable Populations; aged; cardiovascular disorder epidemiology; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; care delivery; data modeling; disparity reduction; economic disparity; ethnic minority; experience; health care delivery; health care service; health care service utilization; health disparity; health disparity populations; health inequalities; high risk; implementation science; improved; medical schools; minority patient; multidisciplinary; multilevel analysis; multiple chronic conditions; pandemic disease; patient population; poor health outcome; racial minority; sex; social vulnerability; socioeconomic disadvantage; uptake

PROJECT SUMMARY In the first half of 2020, the SARS-CoV-2 (COVID-19) pandemic infected nearly 4 million persons in the U.S. and caused over 150,000 deaths. In the midst of the early phase of this pandemic, people with multiple chronic conditions (MCC) including diabetes, hypertension, obesity, and dyslipidemia, which are increasingly common with age, were left extremely vulnerable to disruptions in healthcare delivery; in New York City (NYC), the first U.S. epicenter of the COVID-19 outbreak, traditional ambulatory care ceased entirely for several months and then reopened at only limited capacity. Implementation of telemedicine and modified in-person visits to bridge this gap was attempted but adopted unevenly, and differential uptake may have worsened existing health disparities. In this context, the unprecedented pandemic-disruption in ambulatory care in NYC provides a singular opportunity to study the long-term effects of disasters on health care systems serving health disparity populations. Our institution, NYU Grossman School of Medicine (NYUGSOM), is uniquely positioned to answer these questions, having been at the center of the COVID-19 pandemic in NYC. We have robust existing data partnerships with the INSIGHT Clinical Research Network, which includes a standardized electronic health record (EHR) network of 5 NYC academic medical centers, and with the NYC Health and Hospitals Corporation (NYC-H+H), the largest public hospital system in the U.S. We will leverage these 2 sources to determine, among people age ≥50 with MCCs (≥2 chronic medical conditions), whether patterns of health system engagement during the acute pandemic disruption phase (3/7/20-7/9/2020) influenced trajectories of 2 chronic diseases (hypertension and diabetes) at 2 years, risk of cardiovascular events at 4 years, and whether disparities in engagement exacerbated health inequities. In Aim 1 we will characterize ambulatory healthcare utilization and quantify disruptions in healthcare services (total disruption vs. delayed care vs. sufficient care) during the acute pandemic phase, overall and by subgroup (e.g. racial/ethnic minority, economically disadvantaged). In Aim 2 we will then assess the impact of total disruption and delayed care in healthcare on 2-year trajectories of chronic disease measures (mean systolic blood pressure, hemoglobin A1c), and in Aim 3 we will measure the impact of healthcare disruptions on major adverse cardiovascular outcomes in the 4 years after the acute pandemic period, and identify their impacts on disparities in CVD outcomes using causal mediation analysis methods. Our findings will guide future disaster preparedness planning and allow health care systems to develop optimal care models to mitigate CVD risk and avoid worsening disparities among socioeconomically disadvantaged and/or minority populations. The MPIs for this project (Dr. Dodson and Dr. Thorpe) combine research experience in cardiovascular medicine, gerontology, epidemiology, and data science, and are joined by Co-I’s (Dr. Divers, Dr. Adhikari, Dr. Vedanthan, Dr. Blecker, Dr. Weiner) who bring expertise in health disparities research, implementation science, biostatistics, and use of EHRs.

项目总结 2020年上半年，新冠肺炎(SARS-CoV-2)大流行在美国感染了近400万人， 造成超过15万人死亡。在这场大流行的早期阶段，患有多发性慢性疾病的人 疾病(MCC)，包括糖尿病、高血压、肥胖症和血脂异常，这些情况越来越常见 随着年龄的增长，我们非常容易受到医疗保健提供中断的影响；在纽约市，第一个 美国新冠肺炎疫情的中心，传统的门诊护理完全停止了几个月， 然后，仅以有限的运力重新开放。实施远程医疗和改良的亲临桥梁 这一差距曾被尝试过，但被采用得不均衡，差异摄取可能恶化了现有的健康状况 差距。在这种背景下，史无前例的大流行扰乱了纽约市的门诊护理，提供了一个独特的 研究灾害对服务于健康差距的卫生保健系统的长期影响的机会 人口。我们的机构，纽约大学格罗斯曼医学院(NYUGSOM)，处于独特的位置来回答 这些问题一直是纽约新冠肺炎大流行的中心。我们有稳健的现有数据 与Insight临床研究网络的伙伴关系，其中包括标准化的电子健康 由纽约市5个学术医疗中心组成的记录(EHR)网络，并与纽约市健康和医院公司合作 (NYC-H+H)，美国最大的公立医院系统。我们将利用这两个来源来确定，在 年龄在≥50岁并患有MCC(≥2慢性疾病)的人，无论卫生系统的参与模式 在急性大流行中断阶段(2020年3月7日至2020年7月9日)影响了两种慢性病的发展轨迹 (高血压和糖尿病)2年后发生心血管事件的风险，以及 参与加剧了健康方面的不平等。在目标1中，我们将描述门诊医疗服务的使用情况和 量化急诊期间的医疗服务中断(完全中断、延迟护理和充分护理) 大流行阶段，总体和分群体(例如，种族/少数民族、经济上处于不利地位的人)。在《目标2》中，我们 然后将评估医疗保健领域的全面中断和延迟护理对慢性疾病的两年轨迹的影响 疾病测量(平均收缩压，血红蛋白A1c)，在目标3中，我们将测量 在急性大流行后的4年内，医疗保健中断对主要心血管不良后果的影响， 并使用因果中介分析方法确定它们对心血管疾病结局差异的影响。我们的发现 将指导未来的备灾规划，并允许医疗保健系统开发最佳护理模式 降低心血管疾病风险，避免社会经济弱势群体和/或少数群体之间的差距进一步扩大 人口。这个项目的MPI(Dodson博士和Thorpe博士)结合了 心血管医学、老年学、流行病学和数据科学，并加入了Co-I的(Divers博士、Dr.Divers、Dr. Adhikari、Vedanthan博士、Blecker博士、Weiner博士)带来了健康差距研究方面的专业知识， 实施科学、生物统计学和电子健康记录的使用。