Collaborative Research: Disruption and Resilience in Healthcare Routines Following Adverse Events

当例行公事被打乱时，人们希望恢复正常。如果中断很小，比如爆胎，恢复起来就很容易。如果中断是严重的，复苏可能会更加困难。例如，COVID大流行造成的停工迫使医生、护士和其他临床工作人员寻找新的方法来照顾他们的病人。这项研究将使用这个例子来研究中断对医疗保健程序的影响。人们的预期是，例行公事会从小干扰中恢复过来，但大干扰的影响更难预测。在重大中断后，一些例行公事可能会恢复正常，而另一些则可能不会。这个项目的目标是发现影响日常生活中稳定性和变化的基本机制。为了了解是什么让一些例行公事比其他例行公事更强大，罗切斯特大学医学中心将在四个医学领域研究COVID大流行的影响：皮肤科、骨科、肿瘤科和心脏病学。来自电子健康记录的数据将被用来研究关闭和其他类型的中断的影响，如软件和计费代码的变化。来自网络科学的工具将被用来将例行公事建模为行动模式。这些方法将使人们能够非常精确地对破坏前后的行动模式进行比较。一个动作的强度在多大程度上取决于动作模式本身的结构将被考察。将编制新冠肺炎大流行期间门诊临床常规的数据以及各种材料，以便与更广泛的受众交流研究结果。最终，这项研究将导致更好地理解如何使机构惯例在大大小小的灾难面前变得更加可靠和有效。这一奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

When routines are disrupted, people want to get back to normal. If the disruption is minor, like a flat tire, recovery is easy. If the disruption is major, recovery may be more difficult. For example, the shutdowns caused by the COVID pandemic forced doctors, nurses, and other clinical staff to find new ways to care for their patients. This research will use this example to study the effects of disruptions on healthcare routines. The expectation is that routines will “bounce back” from minor disruptions, but the effects of major disruptions are more difficult to predict. After major disruptions, some routines may return to normal, while others may not. The goal of this project is to discover basic mechanisms that influence stability and change in routines. To understand what makes some routines stronger than others, the effects of the COVID pandemic will be studied in four medical fields at the University of Rochester Medical Center: dermatology, orthopedics, oncology, and cardiology. Data from electronic health records will be used to study the effects of shutdowns and other kinds of disruptions, such as changes in software and billing codes. Tools from network science will be used to model routines as patterns of action. These methods will allow comparisons to be made between patterns of action before and after a disruption with great precision. The extent to which the strength of a routine depends on the structure of the action pattern itself will be examined. Data will be produced on outpatient clinical routines during the COVID-19 pandemic along with a variety of materials to communicate the findings with a broader audience. Ultimately, this research will lead to a better understanding of how institutional routines can be made more reliable and effective in the face of disasters large and small.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.