Novel Statewide Response to Post-COVID Care Delivery

项目总结 慢性冠状病毒病是一个重要的公共卫生威胁，影响着数百万人，其中包括60万人 科罗拉多州。目前的长期COVID护理是高度分散的，本质上是可变的，并且在不断演变。 创造一种新的方法，通过继续教育和精简护理来实践支持高龄患者 COVID将改善护理集成和患者体验。我们将实施科罗拉多州多学科 翻译网络(CO-MTN)由综合、多学科的长期COVID护理诊所和初级护理机构组成 护理诊所在分级护理提供途径中协同工作。Co-MTN创建了双向翻译 护理网络，用于整合MDC、PCP和团队之间的专业知识、教育、转诊和护理，以及 他们的病人。共同MTN包括1)科罗拉多州支持的长期COVID实践社区 由三个地理上分布的疾病控制和预防中心组成，2)全州范围的实践研究网络 代表280家初级保健机构，称为科罗拉多州流动机构和国家网络 3)经过验证的远程教育系统，用于为卫生保健从业者提供专业培训， 社区卫生保健成果的推广。共同MTN包括执行战略，以支持 分级护理途径，包括培训和学习社区，以支持具有更好知识的PCP 和能力，并为科罗拉多州的长期COVID患者提供特殊护理，并实践促进 有效地将PCP关怀落实到他们的实践中，并与MDC进行协调。联合MTN将帮助Long 科罗拉多州的COVID患者，并有可能扩展到其他州。指导实施和 评估，我们将利用探索、准备、实施和可持续传播 实施框架。我们将衡量维持情况，将其视为在 项目期的最后六个月。使用定性、定量和混合的方法，我们将评估 对患者的覆盖范围和有效性，以及采用、实施和维护 使用基于以下目标的RE-AIM框架的实施战略：目标1：实施 通过CO-MTN提供简化实施支持的集成、分级护理交付途径，并衡量ITS 对科罗拉多州患者长期COVID护理的影响，特别是那些被描述为服务不足的患者，以及 2)减轻患者长期COVID症状负担和严重程度的有效性。目标2： 确定CO-MTN对1)通过初级保健采用CO-MTN分级护理提供模式的影响 这些诊所内的诊所和初级保健医生；2)实施分级护理路径；3)维持 经过活动项目期的分级护理路径关键组件。我们的团队由国家专家组成 在长期COIVD护理、以实践为基础的研究和实施科学方面。共同努力，我们的多学科 团队将通过CO-MTN结构和支持进行合作，提供高质量的长期COVID护理。

PROJECT SUMMARY Long COVID is an important public health threat impacting millions of individuals including 600,000 Coloradans. Current Long COVID care is highly fragmented, variable in nature, and in constant evolution. Creating a novel approach to practice support with continued education and streamlining care for high Long COVID will improve care integration and patient experience. We will implement the Colorado Multidisciplinary Translation Network (CO-MTN) comprised of integrated, multidisciplinary Long COVID care clinics and primary care clinics working together in a tiered care delivery pathway. CO-MTN creates a bidirectional translational care network for integrating expertise, education, referrals, and care between MDCs, PCPs and teams, and their patients. CO-MTN includes 1) the State of Colorado-supported Long COVID Community of Practice comprised of three geographically distributed MDCs, 2) a state-wide practice-based research network representing 280 primary care practices, known as the State Networks of Colorado Ambulatory Practices & Partners, and 3) a proven tele-education system used to provide health care practitioners specialty training, Extension for Community Healthcare Outcomes. CO-MTN includes implementation strategies to support the tiered care pathway including training and learning communities to support PCPs with improved knowledge and capacity and provide exceptional care for Colorado Long COVID patients, and practice facilitation to effectively implement the PCP care in their practice and coordinate with the MDCs. CO-MTN will help Long COVID patients in Colorado and have the potential for scaling to other states. To guide implementation and evaluation, we will utilize the Exploration, Preparation, Implementation and Sustainment dissemination and implementation framework. We will measure sustainment as continued involvement in the network during the final six months of the project period. Using qualitative, quantitative, and mixed methods, we will evaluate the Reach and Effectiveness for patients, and the Adoption, Implementation and Maintenance of the implementation strategies using the RE-AIM framework based on the following aims: Aim 1: Implement an integrated, tiered care delivery pathway with facilitated implementation support via CO-MTN and measure its effect on 1) Reach of Long COVID care to Colorado patients, specifically those described as underserved, and 2) Effectiveness on reducing Long COVID symptom burden and severity for patients engaged. Aim 2: Determine the effect of CO-MTN on 1) Adoption of the CO-MTN tiered care delivery model by primary care clinics and PCPs within these clinics, 2) Implementation of the tiered care pathway, and 3) Maintenance of the tiered care pathway key components past the active project period. Our team is comprised of national experts in Long COIVD care, practice-based research, and implementation science. Together, our multidisciplinary team will partner through CO-MTN structures and support to deliver high quality Long COVID care.