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

摘要 这项研究的目的是评估患者对初级保健的获取和利用情况， 受COVID-19影响，三个医疗保健系统受到影响，重点关注慢性病患者。我们 严格的评估有三个目标。目的1是确定患者是否能够获得初级保健 对于那些确实获得护理的人，确定获得护理的方式（面对面，远程保健（视频 或电话）、异步通信或多模态）。此外，我们将确定亚群， 受到不成比例的影响，包括可能根本无法获得护理。目标2：识别 障碍和促进者的数字健康访问三个网站。目的3是评估如何使用模态 在COVID-19期间获得初级保健或缺乏初级保健会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。 这项研究工作是MedStar Health、斯坦福大学医疗保健和 山间医疗该项目利用了多样化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，健康差异研究人员和临床 数字健康专家该提案直接与AHRQ的优先领域相一致， 更方便更安全为了实现目标一和三，我们将使用严格的数据科学和信息学 方法.为了实现目标2，我们将使用混合方法，包括主题访谈 专家和病人从每个三个网站与社会技术系统模型的基础， 我们的采访。 这项研究的贡献将包括对最常见的访问方式的详细了解。 经常使用，可能受到COVID-19不成比例影响的患者人群，以及识别 数字医疗模式的障碍和促进因素。我们严格的传播计划包括 将结果传达给决策者和倡导团体、临床领导者和其他组织， 有助于改善临床实践，以及学术受众。目标1的结果将在4- 6个月的项目启动，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.