Leveraging Health System Telehealth and Informatics Infrastructure to Create a Continuum of Services for COVID-19 Screening, Testing, and Treatment: A Learning Health System Approach

项目摘要/摘要 新冠肺炎大流行在几乎没有警告的情况下到达美国，因此感染了公共卫生和医疗 提供护理的系统没有为应对大流行做好充分准备。有效筛选、测试和 治疗这种危险的病毒对医疗系统来说是一个前所未有的挑战 同时，他们在维持正常的病人护理方面也面临着巨大的经济挑战。最健康 系统有灾难计划，但计划侧重于短期事件，如大规模伤亡或 飓风。南卡罗来纳医科大学(MUSC)制定了一项完善的、经过测试的灾难计划 通常为应对飓风造成的干扰而实施。该计划的一个重要方面是免费虚拟 由MUSC远程健康中心主办的紧急护理(VUC)访问。通过跨区域的协作 多学科团队和战略规划，四个远程保健方案和相应的信息学系统 在疫情爆发的最初几周部署了：VUC筛查、新冠肺炎远程患者监测 积极的患者，持续的虚拟监测，以降低劳动力风险和个人保护的利用 设备，以及门诊护理向远程保健的过渡。但是，速度快，需求多样，而且高 服务量是史无前例的，因此这些变化需要广泛的评估以更好地做好准备 以应对未来的挑战。这项建议旨在通过检查这四个因素的影响来告知这些选择 远程医疗方案和相应的信息学创新，作为对新冠肺炎大流行的初步反应。 将特别关注这些创新解决患者和医护人员安全问题的能力 以及提供高质量的护理。此外，继续监测这些事件的后果 方案，包括任何无意加剧的医疗差距，将与 为减轻这些影响和缩小照顾社会弱势群体的差距而采取的步骤。我们的特定 目的是：目标1：描述筛查、检测和治疗中程序性干预的特点 以及新冠肺炎的紧急要求如何修改了标准的远程医疗或医疗系统流程；目标 2：衡量和比较卫生系统新冠肺炎在以下方面的调整：总病人量， 服务接收、交付学习曲线和安全/质量指标随时间的变化，重点 关于观察到的服务不足和高危人群的差异；目标3：评估人群健康 从患者和提供者的角度出发的结果、价值和成本，并特别关注 获得急性护理的机会、预防性护理方面新出现的缺口、新冠肺炎应对措施的意外后果， 对服务不足和高危人群的不同影响，以及农村地区和 在宽带“数字沙漠”中。研究结果将提供必要的证据，将COVID后的护理转变为： 提高医疗质量，优化价值，支持支付规则的变化，并减轻种族影响， 地理、数字接入和经济差距存在于我们当前的医疗保健提供系统中。

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic reached the US with little warning, and thus caught both public health and medical care delivery systems inadequately prepared to cope with the pandemic. Effectively screening, testing and treating the population for this dangerous virus became an unprecedented challenge for healthcare systems which were in parallel suffering enormous economic challenges in maintaining normal patient care. Most health systems have disaster plans, but the plans are focused on short-term events, such as mass casualties or hurricanes. The Medical University of South Carolina (MUSC) had a well-developed and tested disaster plan normally implemented to respond to disruptions due to hurricanes. An important facet of the plan is free Virtual Urgent Care (VUC) visits hosted by the MUSC Center for Telehealth. Through collaboration across multidisciplinary teams and strategic planning, four telehealth programs with corresponding informatics systems were deployed in the initial weeks of the pandemic: VUC screening, remote patient monitoring for COVID-19 positive patients, continuous virtual monitoring to reduce workforce risk and utilization of personal protective equipment, and the transition of outpatient care to telehealth. However, the speed, diverse needs, and high volume of services were unprecedented and thus these changes require extensive evaluation to better prepare for future challenges. This proposal aims to inform these choices through examining the effects of these four telehealth programs and corresponding informatics innovations as initial responses to the COVID-19 pandemic. Special attention will be paid to the ability of these innovations to address patient and healthcare worker safety and the provision of high-quality care. Additionally, continued surveillance of the consequences of these programs, including any unintentional exacerbation of healthcare disparities, will be examined along with the steps taken to mitigate these effects and close gaps in care for socially vulnerable populations. Our Specific Aims are to: AIM 1: Describe characteristics of programmatic interventions in screening, testing, and treatment and how the urgent COVID-19 requirements modified the standard telehealth or health systems processes; AIM 2: Measure and compare the health systems COVID-19 adjustments with regards to: overall patient volume, service uptake, delivery learning curves, and safety/quality indicators as they changed over time, with emphasis on differences observed for underserved and high-risk populations; and AIM 3: Assess population health outcomes, value, and cost from the perspectives of patients and providers with special attention to changes in access to acute care, emerging gaps in preventive care, unintended consequences of COVID-19 responses, differential effect on underserved and high-risk populations, and specific issues emerging in rural locations and in broadband “digital deserts”. Study findings will provide evidence needed to transform care post-COVID to: improve quality of care, optimize value, support changes in payment regulations, and mitigate effects of racial, geographic, digital access, and economic disparities present in our current healthcare delivery systems.