Comprehensive Long COVID Care for Underserved Communities: Innovative Delivery and Dissemination Models (Comunidad)

摘要 长期的COVID专科诊所，其中一些有多学科的工作人员，在不同的地点出现，但 许多患有长期COVID的人不容易获得全面、协调的护理。《后新冠肺炎》 德克萨斯大学圣安东尼奥分校的康复诊所不仅为美国第七大城市圣安东尼奥提供服务，而且 还有德克萨斯州南部以农村和西班牙裔/拉丁裔为主的人口，他们受到健康差距的困扰。 然而，我们当前模式的一个主要挑战是等待5个月的新患者预约和 去看医学专家和精神卫生服务提供者的额外延误。此外，考虑到我们的患者群体 许多不利的健康社会决定因素和有限的获得护理的机会，现成的社会工作者是 情况危急，但目前有限。在我们病人的当地社区内，也缺乏初级保健。 在诊断、评估和管理长期冠状病毒感染者方面，有可用的和有知识的提供者。 此外，对长期的COVID和普遍存在的错误信息和虚假信息缺乏认识 我们广阔的南得克萨斯州集水区的社区成员。 改善和扩大圣安东尼奥和南得克萨斯州的长期COVID护理，并测试新的、可持续的 护理模式，我们建议为服务不足的社区进行全面的长期COVID护理： 创新交付和传播模式(COUNIDA)项目，这是一项为期5年的计划，目标有3个： 目标1：在德克萨斯大学圣安东尼奥分校健康中心扩大全方位、多学科的护理。与Patient和 社区代表，我们将制定以证据为基础、针对具体症状的最佳做法进行评估， 治疗和自我护理。临床服务和适当的研究研究转介将由 全职护士、临床协调员和护理将由一个多学科团队提供。为了扩大劳动力， 我们将为卫生专业实习生提供临床轮换。 目标2：与社区提供者合作，为基本的长期COVID评估和 管理层。利用Project ECHO和其他远程监测模式，我们将在 南得克萨斯州乡村诊所的临床医生对患者进行了15分钟的低技术评估 长时间的冠状病毒症状。然后可以在当地管理护理或转介到UT Health Long COVID诊所。 目标3：与社区合作，在社区中传播有关长冠状病毒的最新信息 主要是西班牙裔/拉丁裔，德克萨斯州南部农村社区。基于社区偏好，我们将利用 社区卫生工作者、移动应用程序、社交媒体平台和其他英语交流渠道 和西班牙语，以提高健康素养，并向社区传授长期COVID和获得护理的知识。 我们预计将积极参与AHRQ学习社区，以纳入最新证据- 并与其他长期COVID中心分享有关护理模式的信息。如果在全国范围内采用， 像comunida这样的模式将极大地改善对长期COVID患者的护理。

ABSTRACT Long COVID specialty clinics, some with a multidisciplinary staff, have emerged in various locations, but comprehensive, coordinated care is not readily accessible to many with Long COVID. The Post-COVID-19 Recovery Clinic at UT Health San Antonio serves not only San Antonio, the seventh largest city in the US, but also the largely rural and Hispanic/Latino population of South Texas, a population beset by health disparities. And yet, a major challenge in our current model is the 5-month wait for a new patient appointment and the additional delay to see medical specialists and mental health providers. Further, given our patient population’s many adverse social determinants of health and limited access to care, ready availability of social workers is critical but currently limited. Within our patients’ local communities, there is also a shortage of primary care providers available and knowledgeable about diagnosing, evaluating, and managing people with Long COVID. Moreover, there is a lack of awareness about Long COVID and rife misinformation and disinformation among community members in our vast South Texas catchment area. To improve and expand Long COVID care in San Antonio and South Texas, and to test new, sustainable models of care, we propose to conduct the Comprehensive Long COVID Care for Underserved Communities: Innovative Delivery and Dissemination Models (COMUNIDAD) project, a 5-year program with 3 aims: Aim 1: To expand holistic, multidisciplinary care at UT Health San Antonio. Together with patient and community representatives, we will develop evidence-based, symptom-specific best practices for evaluation, treatment, and self-care. Clinical services and, as appropriate, research study referrals, will be coordinated by a full-time nurse clinical coordinator and care will be provided by a multidisciplinary team. To expand the workforce, we will offer clinical rotations for health professional trainees. Aim 2: To collaborate with community providers on best practices for basic Long COVID evaluation and management. Utilizing Project ECHO and other telementoring modalities, we will disseminate information among clinicians in South Texas rural clinics on conducting a 15-minute, low-tech evaluation of patients presenting with Long COVID symptoms. Care can then be managed locally or referred to the UT Health Long COVID clinic. Aim 3: To partner with the community to disseminate up-to-date information about Long COVID among the largely Hispanic/Latino, rural South Texas communities. Based on community preferences, we will utilize community health workers, mobile apps, social media platforms, and other communication avenues in English and Spanish to increase health literacy and teach the community about Long COVID and accessing care. We anticipate participating actively in the AHRQ learning community to incorporate up-to-date evidence- based care and share information on models of care with other Long COVID centers. If adopted nationally, models such as COMUNIDAD will greatly improve care for persons with Long COVID.