Advancing Long COVID Care in our Community through Access, Equity, and Collaboration

项目摘要/摘要 慢性COVID对每个人的表现都不同，可能会导致致残、改变生活的症状 如极度疲劳、认知功能障碍、呼吸困难和自主神经功能障碍 年龄谱，包括以前健康的人和患有极少疾病或没有疾病的人 与急性新冠肺炎感染相关的症状。多学科的长期COVID诊所是 在新冠肺炎大流行的初始阶段提供耐心支持，但随着大流行正在转向新的 在这一阶段，护理模式也必须演变，以满足老年人复杂的医疗、康复和社会需求 感染长冠状病毒的人数不断增加。这个项目的目的是 将现有的基于大学的Long CoVID诊所转变为更广泛的Long CoVID社区网络 以扩大公平获得护理的机会，改善患者护理体验，并支持初级保健 从业者。该项目将投资于两个特别缺乏服务的人群：1)圣彼得堡的黑人社区。 密苏里州路易斯市，这是一个历史上受到虐待的人口，他们继续被以前的 批准的种族隔离做法；以及2)密苏里州的农村社区。目标1是扩大公平 通过以下方式获得长期COVID护理：1)建设临床能力，2)消除护理的结构性障碍。这 将通过以下方式实现：1)为长期COVID诊所聘请更多的临床医生，以减少等待时间； 以及2)取消对不成比例地影响服务不足的临床评估的患者要求 人口。目标2是通过以下方式改善长期COVID护理体验：1)简化交叉护理 多学科和物理护理场所，以及2)支持患者的社会需求。这将会实现的 通过：1)支持临床病例经理直接协助患者协调医疗和 与社区资源联系，以及2)反复评估和解决以下转介挑战 诊所。目标3是支持初级保健团队，因为他们通过共同创建：1)护理长期COVID患者 为初级保健医生提供教育资源，以及2)简化初级保健医师和初级保健医师之间的沟通和转介途径 专业临床医生。这将通过让多个关键利益攸关方参与来实现：1)开发多个 与长期COVID患者评估和管理有关的医疗教育材料；2)传播 通过文化和后勤首选的方法(包括通过建立的、值得信赖的社区)提供材料 并通过已建立的ECHO(增强社区医疗保健成果)虚拟 教育基础设施)；以及3)改进现有的移交流程，以最大限度地减少 PCP团队和促进他们的能力，以满足患者的需求。持续的利益相关者投入，全面 使用混合方法方法的数据跟踪和迭代需求评估将促进进行中的项目 评估和适应，以回应社区不断变化的需求。

PROJECT SUMMARY/ABSTRACT Long COVID manifests differently for each person and can contribute to disabling, life-changing symptoms such as extreme fatigue, cognitive dysfunction, breathing difficulty, and autonomic dysfunction in people across the age spectrum, including in people who were previously healthy and in people who had minimal or no symptoms associated with acute COVID-19 infection. Multidisciplinary Long COVID clinics were a mainstay of patient support during the initial phases of the COVID-19 pandemic, but as the pandemic is shifting to a new phase, care models must also evolve in order to meet the complex medical, rehabilitative, and social needs of the continually growing number of people who are affected by Long COVID. The purpose of this project is to transform an existing, university-based Long COVID clinic into a broader Long COVID community network in order to expand equitable access to care, improve the patient care experience, and support primary care practitioners. This project will invest in two particularly underserved populations: 1) the Black community in St. Louis, Missouri, which is a historically mistreated population who continues to be marginalized by previously sanctioned segregation practices; and 2) rural communities across Missouri. Aim 1 is to expand equitable access to Long COVID care by: 1) building clinical capacity, and 2) removing structural barriers to care. This will be accomplished by: 1) hiring additional clinicians for the Long COVID Clinic in order to reduce wait times; and 2) removing patient requirements for clinic evaluation that disproportionately affect underserved populations. Aim 2 is to improve the Long COVID care experience by: 1) streamlining care that crosses multiple disciplines and physical care sites, and 2) supporting patients’ social needs. This will be accomplished by: 1) supporting a clinical case manager to directly assist patients with coordinating medical care and connecting with community resources, and 2) iteratively assessing and addressing referral challenges between clinics. Aim 3 is to support primary care teams as they care for patients with Long COVID by co-creating: 1) educational resources for PCPs, and 2) streamlined communication and referral pathways between PCPs and specialty clinicians. This will be accomplished by engaging multiple key stakeholders to: 1) develop multi- modality educational materials related to Long COVID patient assessment and management; 2) disseminate materials via culturally and logistically preferred approaches (including via established, trusted community intermediaries and via an established ECHO (Enhanced for Community Healthcare Outcomes) virtual educational infrastructure); and 3) refine existing handoff processes to minimize the administrative workload on PCP teams and facilitate their ability to meet patients’ needs. Continuous stakeholder input, comprehensive data tracking, and iterative needs assessments using mixed methods approaches will facilitate ongoing project evaluation and adaptation in order to respond to the community’s evolving needs.