Novel, High-Impact Studies Evaluating Health System and Healthcare Professional Responsiveness to COVID-19

人是主要的项目摘要 背景：我们正在经历一个与历史上任何事件都不同的事件。全球大流行病，被称为 “COVID-19”，已成为世界各地医疗保健系统独一无二的压力测试。尺寸、 由于这一流行病的规模和速度，必须迅速传播数据和调查结果。的 美国初级保健实践对COVID-19的反应是一个大规模的自然实验， 初级保健，以满足大多数人的需要。然而，在美国大流行开始的时候， 一个组织、联邦机构或国家数据集，能够提供有关 初级保健实践或他们的病人的经验。目的：2020年3月13日，美国宣布 COVID-19全国紧急状态，我们的团队创建了一个国家研究合作实验室，并推出了“快速 COVID-19初级保健调查”（C19调查），以填补这一空白。C19试点调查始于一项基于临床医生的调查， 每周一次的全国调查，以监测美国初级保健实践的反应，挑战和能力， COVID-19大流行。4周后，我们启动了一项补充性的基于患者的C19调查。人 初步将允许C19调查在试点阶段之后继续进行。我们将研究这些反应， 挑战和初级保健实践的能力，以评估复原力和适应性决定- 疫情期间所需。借鉴患者和临床医生，我们将研究快速 初级保健采用数字健康以及数字健康的积极和消极后果 1）在不同环境中获得护理，2）患者和临床医生的护理提供经验，以及3） 数字健康与初级保健患者和初级保健团队之间的关系的互动。研究方法： 这是一个探索性序贯设计的混合方法学习评价。定期调查将 在整个2年研究期间分发给确定的临床医生和患者组。这些将开始每周 并将演变为每两周一次，然后每月一次的调查，以应对自然演变的变化， 大流行和随后的初级保健实践反应。研究小组将每周进行一次快速 完成数据收集、分析、传播和调整调查工具的学习周期 在7天内。该团队还将使用双月深度学习周期来开发时间序列和趋势- 基于分析，提供了这些研究结果及其长期影响的更广泛的对话 稳定和加强美国初级保健平台。受益：COVID-19疫情暴露了 初级保健长期和零散投资不足的代价。审查迅速通过 数字健康及其对患者和临床医生在大流行期间的护理体验的影响可以为 急需的战略，1）阻止初级保健崩溃的直接威胁，2）确定实践和资金 这些战略能够稳定初级保健做法，3）能够长期加强初级保健。

PROJECT SUMMARY FOR PEOPLE ARE PRIMARY Background: We are experiencing an event unlike any in living history. The global pandemic, referred to as “COVID-19”, has become a one-of-a-kind stress test on health care systems around the world. The size, scope, and speed of this pandemic has created an imperative for rapid dissemination of data and findings. The response of US primary care practices to COVID-19 is a large-scale natural experiment of the capacity of primary care to meet the majority of people's needs. And yet, at the start the pandemic in the US, there was no one organization, federal agency, or national dataset able to provide real-time on-the-ground data regarding the experiences of primary care practices or their patients. Purpose: On March 13, 2020, as the US declared COVID-19 a national emergency, our team created a national research Collaboratory and launched the “Quick COVID-19 Primary Care Survey” (C19 Survey) to fill that gap. The Pilot C19 Survey began as a clinician-based weekly national survey to monitor the response, challenges, and capacity of US primary care practices during the COVID-19 pandemic. After 4 weeks, we launched a complementary patient-based C19 Survey. People Are Primary would allow the C19 Surveys to continue beyond the Pilot stage. We will examine the responses, challenges, and capacity of primary care practices in order to evaluate the resilience and adaptive decision- making required during the pandemic. Drawing on both patients and clinicians, we will examine the rapid adoption of digital health by primary care as well as the positive and negative consequences of digital health on 1) access to care across varied settings, 2) patient and clinician care delivery experiences, and 3) the interaction of digital health with relationships between primary care patients and primary care teams. Methods: This is a mixed-methods learning evaluation with an exploratory sequential design. Regular surveys will be distributed to identified clinician and patient groups throughout the 2-year study period. These will begin weekly and will evolve into biweekly and then monthly surveys in response to changes in the natural evolution of the pandemic and subsequent primary care practice response. The research team will engage in weekly rapid learning cycles that complete data collection, analysis, dissemination, and adjustment to survey instrument within a 7-day period. The team will also use bimonthly deep learning cycles to develop time series and trend- based analysis, offering a more extended conversation of these findings and their implications for the long-term stability and strengthening of the US primary care platform. Benefit: The COVID-19 pandemic has exposed the costs of chronic and fragmented under-investment in primary care. Examination of the rapid adoption of digital health and its impact on patient and clinician experiences of care during the pandemic can inform a much needed strategy to 1) stop the immediate threat of primary care collapse, 2) identify practice and funding strategies able to stabilize primary care practices, and 3) enable the long term strengthening of primary care.