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

项目总结/摘要 长期COVID对每个人的表现不同，可能导致致残，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那些有最少或没有 急性COVID-19感染相关症状。多学科的长期COVID诊所是 在COVID-19大流行的最初阶段，患者支持，但随着大流行转向新的 在这一阶段，护理模式也必须发展，以满足复杂的医疗，康复和社会需求， 受新冠肺炎影响的人数不断增加。该项目的目的是 将现有的大学Long COVID诊所转变为更广泛的Long COVID社区网络， 扩大公平获得医疗服务的机会，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）圣路易斯的黑人社区。 路易斯，密苏里州，这是一个历史上被虐待的人口谁继续被边缘化，以前 认可的隔离做法; 2）整个密苏里州的农村社区。目标1：扩大公平 通过以下方式获得长期COVID护理：1）建立临床能力，2）消除护理的结构性障碍。这 将通过以下方式实现：1）为Long COVID诊所雇用更多的临床医生，以减少等待时间; 以及2）取消患者对诊所评估的要求，这些要求不成比例地影响服务不足 人口数量。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 多学科和物理护理站点，以及2）支持患者的社会需求。这将是完成 通过：1）支持临床病例经理直接协助患者协调医疗护理， 与社区资源连接，以及2）迭代评估和解决 诊所。目标3是通过共同创建以下内容，支持初级保健团队护理长期COVID患者： 为PCP提供教育资源，以及2）简化PCP与 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Long COVID患者评估和管理相关的模态教育材料; 2）传播 材料通过文化和后勤首选的方法（包括通过建立，值得信赖的社区 中介机构和通过已建立的ECHO（增强社区医疗保健成果）虚拟 教育基础设施）;以及3）改进现有的移交过程，以尽量减少 PCP团队和促进他们的能力，以满足病人的需求。持续的利益攸关方投入，全面 数据跟踪和使用混合方法的迭代需求评估将促进正在进行的项目 评估和调整，以应对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.