Long COVID Care Resources and Education to Advance Community Health (REACH)

新冠肺炎影响了美国数百万人，并对弱势群体造成了不成比例的影响，包括低收入人群和有色人种社区，他们经常面临获得医疗保健的障碍。作为可信赖的、可访问的提供者，联邦合格的医疗保健中心（fqhc）有能力通过在医疗服务不足的社区提供长期COVID护理来帮助减轻不平等现象。我们建议建立一种护理模式，即长期COVID护理资源和教育促进社区卫生（REACH），其中一个集中协调的多学科长期COVID中心计划，支持社区中的安全网fqhc网络并与之合作，将有助于扩大和改善对长期COVID的弱势患者群体的护理。斯坦福长期COVID中心项目是一个基于团队的多学科临床和研究项目，植根于初级保健和专业护理合作伙伴关系，并与社区卫生中心网络和圣马特奥医疗中心等主要社区合作伙伴一起，我们的目标是扩大该项目的覆盖范围，并通过以下具体目标扩大长期COVID弱势患者的可及性：提高社区对患者和临床医生Long - COVID的认识和教育。目标2：通过创建具有点对点异步和实时咨询的协作学习社区，支持合作伙伴安全网fqhc中的初级保健提供者。目标3：改善斯坦福中心诊所的长期COVID护理转诊协调和访问。我们的方法是在基于证据和完善的慢性护理模式（CCM）的基础上，采用创新的组成部分，以适应和响应快速变化的长期COVID护理格局。我们将利用评估科学部门、社区参与办公室和继续医学教育中心的同事的协同专业知识，在合作的fqhc中实施分层教育推广和点对点初级保健支持战略。我们将采用阶梯式楔形设计，并在Reach、有效性、采用、实施和维护（RE-AIM）框架的指导下，采用形成性和总括性混合方法对模型进行评估，以评估整个项目的覆盖范围和影响，并在整个Reach项目期间调整策略。作为合作的一部分，我们将与AHRQ和学习社区的其他接受者合作，分享、整合和传播学习成果，共同努力，支持初级保健社区开展长期COVID教育和管理。总体目标是扩大对长冠状病毒感染的弱势患者获得全面、协调和以人为本的护理的机会。

Long COVID affects millions of people in the U.S. and has disproportionately impacted vulnerable populations including low-income persons and communities of color who often face barriers to healthcare access. As trusted, accessible providers, federally-qualified healthcare centers (FQHCs) are well-positioned to help mitigate inequities by providing access to Long COVID care in their medically underserved communities. We propose that a care model, Long COVID Care Resources and Education to Advance Community Health (REACH) where a centrally-coordinated, multidisciplinary Long COVID hub program that supports and partners with networks of safety-net FQHCs in the community will help expand and improve the care of vulnerable patient populations suffering from Long COVID. The Stanford Long COVID hub program is a team-based multidisciplinary clinical and research program rooted in a primary care-specialty care partnership and, together with key community partners including Community Health Center Network and San Mateo Medical Center and others, our goal is to extend the reach of this program and expand access for vulnerable patients with Long COVID through the following specific aims: AIM 1: Improve community awareness and education on Long COVID for patients and clinicians. AIM 2: Support primary care providers in partner safety-net FQHCs by creating a collaborative learning community with peer-to-peer asynchronous and real-time consultation. AIM 3: Improve Long COVID care referral coordination and access at the Stanford hub clinic. Our approach is to build upon the evidence-based and well-established Chronic Care Model (CCM) with innovative components that are adaptive and responsive to the rapidly changing landscape of Long COVID care. We will implement the tiered educational outreach and peer-to-peer primary care support strategies across partnering FQHCs with synergistic expertise from our colleagues at the Evaluation Sciences Unit, Office of Community Engagement, and Center for Continuing Medical Education. We will utilize a stepped wedge design and evaluate the model with a formative and summative mixed-methods approach guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to assess overall project reach and impact and adapt strategies throughout the REACH project duration. As part of the cooperative, we will collaborate with AHRQ and other recipients in the Learning Community to share, incorporate, and disseminate learnings in a collective effort to support the primary care community in Long COVID education and management. Overall the goals are to expand access to comprehensive, coordinated, and person-centered care for vulnerable patients with Long COVID.