COVID-19 Mitigation Efforts and Disparities in Access to Routine Preventive Care and Chronic Disease Management

项目摘要 由于缓解政策和行为变化，COVID-19大流行显著减少了获得 初级保健，这可能对慢性病管理和健康结果产生持久影响， 特别是对患有慢性病的医疗和社会弱势群体。新近可用 纵向个人水平的数据使我们能够第一次严格检查这些影响。 尽管有大量且不断增长的文献量化了与COVID-19相关的结果差异， 关于这一流行病如何影响获得初级和预防保健以及 医疗和社会弱势群体的相关健康结果。了解如何 大流行影响了预防保健的利用和慢性病的管理，如 糖尿病（DM）和高血压（HTN），以及下游的结果，是至关重要的解决 由此产生的健康差距，并减轻未来对医疗保健系统的破坏的影响， 推进减少健康差距的干预措施和政策 我们将利用这一新的可用和及时的数据，以检查在医疗保健接收的变化， 流行病我们的数据将包括商业健康保险索赔，以及一个独特的数据集， 为低收入、主要是少数民族患者服务的大型城市安全网县卫生系统的计费数据 人口在这些人群中，我们将包括一个特殊的重点检查个人与DM或HTN。 使用混合方法设计，我们将研究医疗保健利用的变化和 随着时间的推移而中断。为了更全面地了解与中断相关的上下文影响， 护理，我们将通过与患者，提供者和诊所工作人员的访谈获得补充定性数据， 以及来自美国第二大城市卫生系统的卫生系统领导人， 探讨大流行期间和之后初级和预防保健利用不足的原因。我们 具体目标是：（1）量化这一流行病对接受适当教育的种族/族裔差异的影响， 初级保健、慢性病管理和下游健康结果;（2）比较 商业保险人群和安全网人群之间的大流行病缓解努力的效果; 和（3）使用与健康相关的定性访谈， 系统利益相关者。 使用现有的和新的数据集，辅以定性访谈，我们将能够阐明 大流行期间和之后医疗和社会保健管理模式的变化 脆弱的病人。这些信息对于我们决定如何分配医疗资源至关重要 在国家危机中。然而，这些结果在大流行后的环境中同样重要， 病人寻求护理和卫生系统提供护理的方式发生了永久性的改变。

PROJECT SUMMARY As a result of mitigation policy and behavioral changes, the COVID-19 pandemic significantly reduced access to primary care, which is likely to have lasting effects on chronic disease management and health outcomes, particularly for medically and socially vulnerable populations with existing chronic conditions. Newly available longitudinal individual-level data allows us to rigorously examine these effects for the first time. Although there is a large and growing literature quantifying disparities in outcomes related to COVID-19, relatively less is known about how the pandemic has affected access to primary and preventive care as well as associated health outcomes among medically and socially vulnerable populations. Understanding how the pandemic affected the utilization of preventive health care and management of chronic conditions, such as diabetes mellitus (DM) and hypertension (HTN), as well as the downstream outcomes, is critical to addressing resultant health disparities and mitigating the impact of future disruptions to the healthcare system and advancing interventions and policies to reduce health disparities We will leverage this newly available and timely data to examine changes in receipt of healthcare during the pandemic. Our data will include commercial health insurance claims in addition to a unique dataset containing billing data for a large, urban safety-net county health system serving a low-income, largely minority patient population. Within those populations, we will include a special focus examining individuals with DM or HTN. Using a mixed-methods design, we will examine changes in health care utilization and the predictors of disruptions over time. To more comprehensively understand contextual influences related to disruptions in care, we will obtain complementary qualitative data through interviews with patients, providers and clinic staff, and health systems leaders from the second largest municipal health system in the United States that will explore the drivers of underutilization of primary and preventive care during and after the pandemic. Our specific aims are to: (1) quantify the impact of the pandemic on racial/ethnic disparities in receipt of appropriate primary care, chronic disease management, and downstream health outcomes; (2) compare the differential effect of pandemic mitigation efforts between a commercially insured population and a safety net population; and (3) contextualize the secondary health effects of the pandemic using qualitative interviews with health systems stakeholders. Using established and novel data sets, supplemented by qualitative interviews we will be able to shed light on the changes in patterns of care management both during and after the pandemic for medically and socially vulnerable patients. Such information is crucial to determining how we should direct health care resources during national crises. However, these results are equally important in a post-pandemic landscape, in which the way patients seek care and health systems offer care is permanently altered.