Quality, Safety, Value: Impact of sudden shift to telehealth due to COVID-19 within Nurse-led care models located in Colorado rural and urban communities

质量、安全、价值：在护士主导的护理模式中，由于COVID-19而突然转向远程医疗的影响 位于科罗拉多农村和城市社区 项目摘要 COVID-19危及本已岌岌可危的美国医疗体系，促使其突然转变 在提供初级和产前护理，行为健康和公共卫生服务的远程保健， 为城市和农村社区的数百万弱势美国人提供最佳的护理环境。 在科罗拉多，创新的护士主导的护理模式是医疗保健服务的重要组成部分， 在种族、地理和经济上处于弱势的人口。这是通过公认的 联邦合格的健康中心，认证护士助产实践和护士家庭的结构 伙伴关系（NFP）家访计划。远程保健的广泛实施是一种变化， 需要系统研究以支持系统内学习的医疗保健服务，快速适应以改善 获取和健康成果，以及知情的增强措施，以确保未来系统的可持续性 挑战虽然证据支持护士主导的电话和远程医疗的积极患者结果 针对特定人群的干预措施，我们的综合和高技能的护理科学家团队旨在评估， 这是第一次，这种从面对面到虚拟护理的紧急和直接转变的影响扩大了 一系列医疗保健服务。利用这一自然实验的长期目标是评估远程医疗 支持弱势患者在行为健康、初级和产前护理方面寻求护士主导的护理， 家庭探访模式在整个科罗拉多的城市和农村社区。通过全州网络 合作，我们的中心假设是，护士领导的护理的好处将承受快速远程医疗 在科罗拉多实施，以应对COVID-19。使用观察性时间序列设计， COVID-19评估和快速传播组内和组间远程医疗创新和挑战， 我们将告知这种新兴护理模式的演变，以支持那些患有多种慢性疾病的人， 通过交叉性的透镜减少护理方面的差距。通过目标1，我们 将评估突然实施远程医疗对护士主导的全州医疗保健利用率的影响， 行为健康、初级/产前护理和家访的模式在科罗拉多的种族中， 地理和经济上的弱势群体。在目标2中，我们将进一步评估结果 （预期/非预期）在COVID-19之后突然实施远程医疗对患者结果的影响。通过 目标3，我们将描述病人和供应商的经验，突然远程医疗实施在科罗拉多 采用包括访谈和调查的混合方法。本研究将利用RE-AIM模型 通过季度分析评估远程保健的覆盖范围、采用、实施和维护情况， 向参与机构传播，以便适应不利趋势。分析了均匀和 患者层面的索赔数据、调查和访谈将提供证据，为高质量、安全 可访问的，公平的和负担得起的护士主导的远程医疗，可扩展到美国其他地区采用。

Quality, Safety, Value: Impact of Sudden shift to Telehealth due to COVID-19 within Nurse-led care Models located in Colorado Rural and Urban Communities Project Summary COVID-19 has jeopardized the already precariously positioned US healthcare system, prompting a sudden shift in the delivery of primary and prenatal care, behavioral health, and public health services to the telehealth environment for optimized access to care for millions of vulnerable Americans in urban and rural communities. In Colorado, innovative nurse-led models of care are a vital component of healthcare delivery for the most ethnically, geographically, and economically vulnerable populations. This is possible through recognized structures of federally qualified health centers, certified nurse midwifery practices, and the Nurse-Family Partnership (NFP) home visitation program. The widespread implementation of telehealth is a change in healthcare delivery that requires systematic study to support within-system learning, rapid adaptation to improve access and health outcomes, and informed enhancements to ensure sustainability to endure future system challenges. While evidence supports positive patient outcomes for nurse-led telephonic and telehealth interventions for specific populations, our integrated and highly skilled team of nurse scientists aims to evaluate, for the first time, the impact of this urgent and immediate shift from in-person to virtual care for an expanded array of healthcare services. The long-term goal of leveraging this natural experiment is to evaluate telehealth to support vulnerable patients seeking nurse-led care within behavioral health, primary and prenatal care, and home visitation models in urban and rural communities across Colorado. Through statewide network collaboration, our central hypothesis is that the benefits of nurse-led care will withstand rapid telehealth implementation in Colorado in response to COVID-19. Using an observational, time series design shaped by COVID-19 to evaluate and rapidly disseminate within- and between-group telehealth innovations and challenges, we will inform the evolution of this emerging care model to support those with multiple chronic conditions, vulnerable populations, and to reduce disparities in care through a lens of intersectionality. Through Aim 1, we will evaluate the impact of sudden telehealth implementation on statewide healthcare utilization in nurse-led models of behavioral health, primary/prenatal care, and home visitation in Colorado among ethnically, geographically, and economically vulnerable populations. In Aim 2, we will further evaluate the consequences (intended/unintended) of sudden telehealth implementation on patient outcomes following COVID-19. Through Aim 3, we will characterize the patient and provider experience of sudden telehealth implementation in Colorado using a mixed method approach involving interviews and surveys. This study will leverage the RE-AIM model to assess reach, adoption, implementation and maintenance of telehealth with quarterly analysis and dissemination to participating institutions, allowing for adaptation to negative trends. Analysis of uniform and patient-level claims data, surveys and interviews will provide evidence to inform delivery of high quality, safe, accessible, equitable and affordable nurse-led telehealth, scalable for adoption in other regions of the US.