ImpAct of COVID-19 on CaRe TransitOns and Health OutcomeS for Vulnerable PopulationS in Nursing Homes and Home HealthCARE Agencies (ACROSS-CARE)

COVID-19大流行对老年弱势群体（即，种族/族裔 少数民族和农村居民）。感染COVID-19的高风险以及这些脆弱群体的可怕后果 部分原因是合并症和其他社会决定因素的高患病率 健康家庭保健机构（HHA）和疗养院（NH）为以下患者提供必要的急性后服务： 大量老年患者。大流行扰乱了从医院到HHA的护理过渡， NHS，这可能导致重要的健康结果后果，包括扩大现有的健康 差距。在我们之前的COVID-19研究中，我们发现，当HHA和NH提供最佳 减少了感染预防和控制（IPC）中的医院感染。基于这部小说 国家少数民族健康和健康差异研究所（NIMHD） 框架，本研究的目的是：1）描述如何HHA和NH IPC程序已经改变， 全国各地对COVID-19大流行的反应，并检查这些变化是否因服务设施而异 很大一部分脆弱人群; 2）描述COVID-19如何扰乱入院， 随后排放到HHAs和NH，并确定中断是否不成比例地影响 弱势群体;以及，3）量化COVID-19对住院患者、HHA和NH健康结果的影响 以及卫生保健机构和国家卫生机构的IPC计划在减少易受感染人群中流行病影响方面的有效性 非弱势老年人。在目标1中，我们将进行定性访谈和全国调查 的HHA和NH。我们将从COVID-19前调查的核心HHA和NH中进行抽样， 根据需要提供新的设施。我们将把先前的调查和2022年的新调查联系起来，以研究 IPC计划，并确定这些变化是否与主要服务于弱势群体的设施不同 人口。在目标2中，我们将使用纵向（2013年至2022年）医疗保险和医疗补助中心（CMS）数据 描述如何选择紧急和择期入院和出院处置到HHA， NHS随COVID-19而变化;以及这些变化是否与弱势人群不同。在目标3中， 将我们的新冠肺炎前调查和2022年调查与纵向CMS数据联系起来，以模拟健康结果 (i.e., COVID-19病例、感染、再住院和死亡率），控制 为当地的COVID-19环境。我们之前在NH和HHA中进行的IPC全国调查是理想的， 新基线数据。利用我们先前的工作，这项创新研究将解决COVID-19对 老年、脆弱患者的过渡和健康结果（即，种族和族裔少数群体与非 拉丁裔白人和城市与农村），确定健康差距和有效的做法，以减轻健康 差距。研究结果还将为NHS，HHA和政策制定者提供未来规划传染病的信息。 疾病紧急情况和减少健康差距。

The COVID-19 pandemic has disproportionately impacted elderly vulnerable populations (i.e., racial/ethnic minorities and rural residents). The high risk for acquiring COVID-19 and the dire outcomes in these vulnerable populations is partially explained by the high prevalence of comorbidities and other social determinants of health. Home healthcare agencies (HHAs) and nursing homes (NHs), provide essential post-acute services for a large number of elderly patients. The pandemic has disrupted care transitions from hospitals to HHAs and NHs, which may lead to important health outcomes consequences, including the widening of existing health disparities. In our previous, pre-COVID-19 studies, we have found that when HHAs and NHs provide best practices in infection prevention and control (IPC) nosocomial infections are reduced. Building upon this novel previous work and guided by the National Institute on Minority Health and Health Disparities (NIMHD) framework, the aims of this study are to: 1) Describe how HHA and NH IPC programs have changed in response to the COVID-19 pandemic across the nation, and examine if these changes vary for facilities serving a large proportion of vulnerable populations; 2) Characterize how COVID-19 disrupted hospital admissions and subsequent discharges to HHAs and NHs, and determine if the disruptions disproportionately affected vulnerable populations; and, 3) Quantify the impact of COVID-19 on inpatient, HHA and NH health outcomes and the effectiveness of IPC programs in HHAs and NHs in reducing the impact of the pandemic in vulnerable and non-vulnerable elderly populations. In Aim 1, we will conduct qualitative interviews of and a national survey of HHAs and NHs. We will sample from the core HHAs and NHs from our pre-COVID-19 surveys and augment with new facilities as needed. We will link our prior surveys and the new 2022 survey to examine changes in IPC programs and determine if these changes differed in facilities predominately serving vulnerable populations. In Aim 2, we will use longitudinal (2013 to 2022) Centers for Medicare and Medicaid (CMS) data to characterize how select urgent and elective hospital admissions and discharge dispositions to HHAs and NHs changed with COVID-19; and, whether these changes differed for vulnerable populations. In Aim 3, we will link our pre-COVID surveys and the 2022 survey with longitudinal CMS data to model the health outcomes (i.e., COVID-19 cases, infections, rehospitalizations and mortality) of elderly Medicare beneficiaries, controlling for the local COVID-19 environment. Our prior national surveys of IPC in both NHs and HHAs are ideal and novel baseline data. Leveraging our prior work, this innovative study will address the impact of COVID-19 on transitions and health outcomes of elderly, vulnerable patients (i.e., racial and ethnic minorities versus non- Latinx whites and urban versus rural), identify health disparities and effective practices to mitigate health disparities. The study findings will also inform NHs, HHAs and policymakers in future planning for infectious disease emergencies and decrease health disparities.