Disasters and Hospital Systems Serving Health Disparity Populations: Identifying the Long Term effects of the COVID-19 Pandemic to Mitigate Future Challenges

为健康差异人群服务的医院系统（HSSHDP）为种族和 少数民族和其他服务不足的社区。HSSHDPs可能会经历自然的长期影响， 以及人为灾害，而这些灾害反过来又会影响它们所服务的人口的健康结果。COVID- 19大流行几乎影响了美国的每一个医疗保健系统，因此提供了一个独特的机会， 研究大规模和长期的压力源对服务于弱势群体的资源不足系统的影响 患者人群。利用灾害管理周期（减灾、备灾、 响应和恢复），该项目建议对以下长期影响进行混合方法研究： COVID-19对美国医院四个关键领域（质量、劳动力、财务和创新）的影响， 特别关注HSSHDPs和他们所服务的人群的健康差异。 该项目将是第一次对国家灾害对HSSHDPs的影响进行重大的国家调查。 这种严格的混合方法研究将是重要的，在确定HSSDHPS的最大和最小的影响， COVID-19大流行，并将加深对导致成功的促成因素的理解， 挑战这项研究将确定可采取行动的最佳做法和挑战， 于2019冠状病毒病大流行期间及之后。这项研究的具体目标是： 目标1.描述COVID-19对医院的长期影响，以及 灾害管理规划活动（包括与联盟的互动）。伙伴合作下 美国医院协会和美国基本医院2000年全国代表性调查 医院将进行检查HSSHDP状态和其他特征的变化。 目标2.分析医院的变化（2018-2023年COVID-19大流行之前、期间和之后）- 水平质量、服务水平和财务，以及患者水平的结果。使用二级数据源， 本研究将集中于HSSHDPs之间的差异，并在上下文中比较HSSHDPs与非HSSHDPs。 目标3。探讨HSSHDP在大流行期间面临的挑战和采取的策略 来克服它们。该研究将包括12个深入的案例研究，使用目的抽样， HSSHDP和非HSSHDP，有或没有COVID-19造成的重大影响。半结构式访谈 与利益攸关方的互动将用于更充分地了解现有结构、挑战、与 联盟和其他灾害管理战略。 目标4。制定优先的政策建议，以提高我们最关键的公众的复原力 卫生系统，以保护我们最脆弱人群的健康， 为他们服务的设施。一个全国性的德尔菲共识小组与国家科学院联合， 科学工程和医学将进行。

Hospital Systems Serving Health Disparity Populations (HSSHDPs) deliver needed services to racial and ethnic minorities and other underserved communities. HSSHDPs may experience long-term effects of natural and man-made disasters that in turn could affect health outcomes for the populations they serve. The COVID- 19 pandemic has affected virtually every US healthcare system and, therefore, provides a unique opportunity to study the effects of large-scale and long-term stressors on under-resourced systems serving vulnerable patient populations. Using the framework of the disaster management cycle (mitigation, preparedness, response, and recovery), this project proposes to conduct a mixed methods study of the long-term effects of COVID-19 on US hospitals across four critical domains (quality, workforce, finances, and innovation), with a special focus on HSSHDPs and on the health disparity populations they serve. This project will be the first major national investigation of the effects of a national disaster on HSSHDPs. This rigorous mixed methods study will be significant in identifying HSSDHPS most and least affected by the COVID-19 pandemic and will deepen the understanding of the contributing factors that led to successes and challenges. The study will identify actionable best practices and challenges to HSSHDPs' operations before, during and after the COVID-19 pandemic. The specific aims of this study are: Aim 1. Describe the long-term effects of COVID-19 on hospitals and the perceived usefulness of disaster management planning activities (including interactions with Coalitions). In partnership with the American Hospital Association and America's Essential Hospitals a nationally representative survey of 2000 hospitals will be conducted to examine variation by HSSHDP status and other characteristics. Aim 2. Analyze changes (before, during, and after the COVID-19 pandemic, 2018-2023) in hospital- level quality, service levels, and finances, and in patient-level outcomes. Using secondary data sources, the study will focus on differences among HSSHDPs, and for context, compare HSSHDPs with non-HSSHDPs. Aim 3. Explore the challenges faced by HSSHDPs during the pandemic and the strategies pursued to overcome them. The study will include 12 in-depth case studies, using purposive sampling to select HSSHDPs and non-HSSHDPs with and without major effects due to COVID-19. Semi-structured interviews with stakeholders will be used to more fully understand existing structures, challenges, interactions with Coalitions, and other disaster management strategies. Aim 4. Develop prioritized policy recommendations to enhance resilience of our most critical public health systems for future disasters to protect the health of our most vulnerable populations and the facilities that serve them. A national Delphi consensus panel in conjunction with the National Academy of Science Engineering and Medicine will be conducted.