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

COVID-19 对疗养院和家庭医疗保健机构中弱势群体的护理过渡和健康结果的影响 (ACROSS-CARE)

• 批准号: 10472744
• 负责人: Jingjing Shang
• 金额: $ 75.96万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10472744
• 关键词: Acute; Acute myocardial infarction; Address; Administrator; Admission activity; Affect; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; COVID-19 risk; Caring; Cessation of life; Communicable Diseases; Core Facility; Data; Data Sources; Diagnosis; Effectiveness; Elderly; Emergency Situation; Environment; Future; Health; Health Services Accessibility; Healthcare; Healthcare Systems; High Prevalence; Home Care Services; Home Health Care Agencies; Hospitalization; Hospitals; Individual; Infection; Infection Control; Infection prevention; Infrastructure; Inpatients; Interview; Knowledge; Lead; Link; Medicare; Medicare/Medicaid; Methods; Mission; Modeling; National Institute on Minority Health and Health Disparities; Nosocomial Infections; Nursing Homes; Outcome; Patient-Focused Outcomes; Patients; Policies; Population; Public Health; Quality of Care; Reduce health disparities; Replacement Arthroplasty; Research; Risk; Rural; Rural Community; Sampling; Sepsis; Services; Stroke; Surveys; Time; United States; United States Centers for Medicare and Medicaid Services; Visiting Nurse; Vulnerable Populations; Work; acute care; beneficiary; burden of illness; care outcomes; comorbidity; coronavirus disease; design; effectiveness evaluation; ethnic minority; experience; health disparity; high risk; high risk population; hospital readmission; improve minority health; improved; innovation; mortality; nosocomial infection control; novel; older patient; pandemic disease; people of color; post-COVID-19; programs; racial and ethnic; racial minority; response; rural dwellers; rural setting; social health determinants

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.

COVID-19大流行对老年脆弱人群的影响不成比例（即种族/族裔 少数民族和农村居民）。收购Covid-19和这些脆弱的可怕成果的高风险 人口的一部分是由合并症的高流行和其他社会决定因素的高度解释 健康。家庭医疗机构（HHA）和疗养院（NHS）为急性后的服务提供 大量老年患者。大流行已破坏了从医院到HHA的护理过渡和 NHS，可能导致重要的健康结果，包括扩大现有健康状况 差异。在我们以前的前研究前研究中，我们发现，当HHA和NHS提供最佳 预防感染和控制（IPC）的医学院感染的实践降低了。基于这本小说 先前的工作，并由美国国家少数民族健康与健康差异研究所（NIMHD）指导 框架，这项研究的目的是：1）描述HHA和NH IPC计划的变化 对全国共同19-19的大流行的反应，检查这些变化是否因服务的设施而有所不同 大部分脆弱人群； 2）表征COVID-19如何破坏医院入院和 随后释放到HHA和NHS，并确定破坏是否受到不成比例的影响 弱势群体； 3）量化Covid-19对住院，HHA和NH健康结果的影响 IPC计划在HHA和NHS中的有效性减少了大流行对脆弱的影响 和不可能的老年人。在AIM 1中，我们将进行定性访谈和全国调查 HHA和NHS。我们将从核心HHA和NHS中进行采样，并从我们的前期调查中进行调查和增强 根据需要提供新的设施。我们将链接以前的调查和新的2022年调查，以检查 IPC程序并确定这些更改的设施是否有所不同 人群。在AIM 2中，我们将使用Medicare和Medicaid（CMS）数据的纵向（2013年至2022年） 为了表征如何选择紧急和选择性医院入院以及对HHA的出院 NHS随着Covid-19的变化而改变；而且，这些变化是否有所不同。在AIM 3中，我们 将把我们的前循环调查和2022年的调查与纵向CMS数据联系起来，以模拟健康结果 （即，Covid-19案件，感染，复兴和死亡率）的老年医疗保险受益人 适用于当地的Covid-19环境。我们以前对NHS和HHA中IPC的全国性调查都是理想的 新颖的基线数据。利用我们先前的工作，这项创新的研究将解决Covid-19的影响 老年人，脆弱患者的过渡和健康结果（即种族和少数民族与非族裔 拉丁文白人和城市与农村），确定健康差异和有效的做法以减轻健康 差异。研究结果还将在未来的计划中为NHS，HHA和政策制定者提供信息 疾病紧急情况并减少健康差异。