A Multi-Site Evaluation of Primary Care Accessibility and Utilization during COVID-19

摘要 拟议研究的目标是评估患者获得和利用初级保健的情况 新冠肺炎扰乱了三个医疗系统，重点是慢性病患者。我们的 严格的评估有三个目标。目标1是确定患者是否能够获得初级保健 对于那些确实获得医疗服务的人，确定获得医疗服务的方式(面对面、远程医疗(视频 或电话)、异步通信或多个模式)。此外，我们将确定哪些亚群 不成比例地受到影响，包括并且可能根本无法获得护理。目标2是确定 跨三个站点的数字健康访问的障碍和促进者。目标3是评估通道是如何使用的 在新冠肺炎期间获得初级保健，或无法获得初级保健，影响未来的医疗保健 慢性病患者和其他高危人群的获取和利用。 这项研究是MedStar Health、Stanford Health Care和 山间医疗保健公司。该项目利用了不同研究团队的广泛专业知识， 包括数据科学家、人为因素专家、信息学家、健康差距研究人员和临床 数字健康方面的专家。该提案直接与AHRQ的优先医疗保健领域保持一致 更方便、更安全。为了实现目标一和目标三，我们将使用严格的数据科学和信息学 方法：研究方法。为了实现目标2，我们将采用混合方法，其中包括对主题的采访 来自三个地点的专家和患者，以社会技术系统模型作为基础 我们的采访。 这项研究的贡献将包括对访问模式的详细了解，其中 经常使用的、可能受新冠肺炎影响不成比例的患者群体，以及识别 数字医疗保健模式的障碍和促进者。我们严谨的传播计划包括 将结果传达给政策制定者和倡导团体、临床领导人和其他组织 服务于改善临床实践，以及学术受众。AIM 1的结果将在4- 项目开工6个月，整个项目将在两年内完成。

ABSTRACT The objective of the proposed research is to evaluate how patient access and utilization of primary care was disrupted by COVID-19 across three healthcare systems, with a focus on patients with chronic conditions. Our rigorous evaluation has three aims. Aim 1 is to determine whether patients were able to access primary care and, for those who did access care, identification of the modalities to access care (in-person, telehealth (video or phone), asynchronous communication, or multiple modalities). Further, we will identify subpopulations that were disproportionately affected including and may not have been able to access care at all. Aim 2 is to identify barriers and facilitators to digital health access across three sites. Aim 3 is to evaluate how the modality used to access primary care, or the lack of access to primary care, during COVID-19 impacts future healthcare access and utilization for patients with chronic conditions, and other at-risk populations. The research effort is a unique collaborative between MedStar Health, Stanford Health Care, and Intermountain Healthcare. This project utilizes the extensive expertise of the diverse research team which includes data scientists, human factors experts, informaticists, health disparities researchers and clinical experts in digital health. The proposal is directly aligned with AHRQ’s priority area of making health care accessible and safer. To achieve aims one and three we will use rigorous data science and informatics methods. To achieve aim 2, we will use a mixed methods approach that includes interviews of subject matter experts and patients from each of the three sites with a socio-technical systems model as the foundation for our interviews. Contributions from this research will include a detailed understanding of access modalities that are most frequently used, patient populations that may be disproportionately impacted by COVID-19, and identification of barriers and facilitators to digital health models of care. Our rigorous dissemination plan includes communication of results to policymakers and advocacy groups, clinical leaders and other organizations that serve to improve clinical practice, as well as academic audiences. Results from aim 1 will be available within 4- 6 months of project start and the entire project will be completed in two years.