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

长期COVID影响着美国数百万人，并对包括低收入者和经常面临医疗保健障碍的有色人种在内的弱势群体产生了不成比例的影响。作为值得信赖的、可访问的提供者，联邦合格的医疗保健中心(FQHC)处于有利地位，通过在其医疗服务不足的社区提供长期COVID护理来帮助缓解不平等。我们建议一种护理模式，长期COVID护理资源和教育，以促进社区健康(REACH)，其中一个中央协调的、多学科的长期COVID中心计划，支持并与社区中的安全网FQHC网络合作，将有助于扩大和改善对患有长期COVID的弱势患者群体的护理。斯坦福Long COVID HUB计划是一个以团队为基础的多学科临床和研究计划，植根于初级保健-专科护理合作伙伴关系，并与包括社区卫生中心网络和圣马特奥医疗中心在内的主要社区合作伙伴一起，通过以下具体目标扩大该计划的覆盖范围，并扩大长期COVID弱势患者的机会：目标1：提高患者和临床医生对Long COVID的社区意识和教育。目标2：通过创建一个具有点对点、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护理转诊协调和准入。我们的方法是建立在基于证据和成熟的慢性护理模式(CCM)的基础上，该模式具有创新的组成部分，能够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股、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实施分级教育外展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、Efficiency、Adption、Implementation和Maintenance(RE-AIM)框架的指导下，使用形成性和总结性混合方法对模型进行评估，以评估总体项目覆盖范围和影响，并在整个REACH项目持续时间内调整策略。作为合作的一部分，我们将与AHRQ和学习社区的其他受助者合作，分享、整合和传播学习成果，共同努力支持初级保健社区的长期COVID教育和管理。总体而言，目标是扩大对患有长期冠状病毒感染的弱势患者的全面、协调和以人为中心的护理。

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.