COVID-19 shutdown: impact of healthcare disruptions on cardiovascular health disparities among people with multiple chronic conditions in New York City.

COVID-19 关闭：医疗保健中断对纽约市多种慢性病患者心血管健康差异的影响。

• 批准号: 10707047
• 负责人: John A Dodson
• 金额: $ 67.79万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10707047
• 关键词: Academic Medical Centers; Acute; Acute myocardial infarction; Adopted; Adoption; Adult; Age; Ambulatory Care; Area; Biometry; Blood Pressure; COVID-19; COVID-19 impact; COVID-19 outbreak; COVID-19 pandemic; Cardiovascular Diseases; Cardiovascular system; Caring; Categories; Cessation of life; Chronic; Chronic Disease; Clinical; Clinical Research; Data; Data Science; Diabetes Mellitus; Disasters; Disease Outcome; Disparity; Dyslipidemias; Economically Deprived Population; Economics; Elderly; Electronic Health Record; Epidemiology; Ethnic Origin; Event; Female; Future; Gerontology; Glycosylated hemoglobin A; Health; Health Disparities Research; Health system; Healthcare; Healthcare Systems; Heart Arrest; Heart failure; Hospitals; Hypertension; Institution; Ischemic Stroke; Joints; Left; Long-Term Effects; Longitudinal Studies; Measures; Mediation; Medical; Medicine; Methods; Minority Groups; Modeling; New York City; Obesity; Outcome; Patients; Pattern; Persons; Phase; Policies; Population; Positioning Attribute; Private Hospitals; Public Hospitals; Race; Readiness; Research; Resources; Risk; SARS-CoV-2 infection; Source; Standardization; Subgroup; System; Telemedicine; Translations; Unstable angina; Visit; Vulnerable Populations; aged; cardiovascular disorder epidemiology; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; care delivery; data modeling; disparity reduction; economic disparity; ethnic minority; experience; health care delivery; health care service; health care service utilization; health disparity; health disparity populations; health inequalities; high risk; implementation science; improved; medical schools; minority patient; multidisciplinary; multilevel analysis; multiple chronic conditions; pandemic disease; patient population; poor health outcome; racial minority; sex; social vulnerability; socioeconomic disadvantage; uptake

PROJECT SUMMARY In the first half of 2020, the SARS-CoV-2 (COVID-19) pandemic infected nearly 4 million persons in the U.S. and caused over 150,000 deaths. In the midst of the early phase of this pandemic, people with multiple chronic conditions (MCC) including diabetes, hypertension, obesity, and dyslipidemia, which are increasingly common with age, were left extremely vulnerable to disruptions in healthcare delivery; in New York City (NYC), the first U.S. epicenter of the COVID-19 outbreak, traditional ambulatory care ceased entirely for several months and then reopened at only limited capacity. Implementation of telemedicine and modified in-person visits to bridge this gap was attempted but adopted unevenly, and differential uptake may have worsened existing health disparities. In this context, the unprecedented pandemic-disruption in ambulatory care in NYC provides a singular opportunity to study the long-term effects of disasters on health care systems serving health disparity populations. Our institution, NYU Grossman School of Medicine (NYUGSOM), is uniquely positioned to answer these questions, having been at the center of the COVID-19 pandemic in NYC. We have robust existing data partnerships with the INSIGHT Clinical Research Network, which includes a standardized electronic health record (EHR) network of 5 NYC academic medical centers, and with the NYC Health and Hospitals Corporation (NYC-H+H), the largest public hospital system in the U.S. We will leverage these 2 sources to determine, among people age ≥50 with MCCs (≥2 chronic medical conditions), whether patterns of health system engagement during the acute pandemic disruption phase (3/7/20-7/9/2020) influenced trajectories of 2 chronic diseases (hypertension and diabetes) at 2 years, risk of cardiovascular events at 4 years, and whether disparities in engagement exacerbated health inequities. In Aim 1 we will characterize ambulatory healthcare utilization and quantify disruptions in healthcare services (total disruption vs. delayed care vs. sufficient care) during the acute pandemic phase, overall and by subgroup (e.g. racial/ethnic minority, economically disadvantaged). In Aim 2 we will then assess the impact of total disruption and delayed care in healthcare on 2-year trajectories of chronic disease measures (mean systolic blood pressure, hemoglobin A1c), and in Aim 3 we will measure the impact of healthcare disruptions on major adverse cardiovascular outcomes in the 4 years after the acute pandemic period, and identify their impacts on disparities in CVD outcomes using causal mediation analysis methods. Our findings will guide future disaster preparedness planning and allow health care systems to develop optimal care models to mitigate CVD risk and avoid worsening disparities among socioeconomically disadvantaged and/or minority populations. The MPIs for this project (Dr. Dodson and Dr. Thorpe) combine research experience in cardiovascular medicine, gerontology, epidemiology, and data science, and are joined by Co-I’s (Dr. Divers, Dr. Adhikari, Dr. Vedanthan, Dr. Blecker, Dr. Weiner) who bring expertise in health disparities research, implementation science, biostatistics, and use of EHRs.

项目摘要 在2020年上半年，SARS-COV-2（COVID-19）大流行感染了美国近400万人， 造成超过15万人死亡。在这个大流行的早期阶段，有多个慢性的人 疾病（MCC），包括糖尿病，高血压，肥胖和血脂异常，这些血症越来越普遍 随着年龄的增长，非常容易受到医疗保健服务中断的影响；在纽约市（纽约），第一个 美国联盟19日爆发的美国震中，传统的门诊护理完全停止了几个月， 然后仅以有限的容量重新开放。远程医疗的实施和对桥梁的亲自访问 尝试了这个差距，但被不均匀地采用，差异的吸收可能已经忘记了现有的健康 差异。在这种情况下，纽约市门诊护理中空前的大流行破坏提供了一个单数 研究灾难对卫生差异的医疗保健系统的长期影响的机会 人群。我们的机构NYU Grossman医学院（NYUGSOM），是唯一的回答 这些问题是纽约市COVID-19大流行的中心。我们有强大的现有数据 与Insight临床研究网络的合作伙伴关系，其中包括标准化电子健康 纽约市5个学术医疗中心的记录（EHR）网络以及纽约市健康与医院公司 （NYC-H+H），美国最大的公立医院系统，我们将利用这2个来源来确定 MCC≥50岁的人（≥2个慢​​性病状况），卫生系统参与模式是否存在 在急性大流行阶段（3/7/20-7/9/2020）影响2种慢性疾病的轨迹 （高血压和糖尿病）2年，在4年时发生心血管事件的风险，以及分布是否在 参与加剧了健康不平等。在AIM 1中，我们将表征门诊医疗保健利用和 在急性期间，量化医疗服务中断（全部干扰与延迟护理与足够的护理） 大流行阶段，整体和亚组（例如种族/少数民族，经济上处于不利地位）。在目标2中我们 然后，将评估医疗保健中总干扰和延迟护理对慢性2年轨迹的影响 疾病措施（平均收缩压，血红蛋白A1C），在AIM 3中，我们将衡量 在急性大流行时期的四年中，主要不良心血管结局的医疗保健干扰， 并使用因果中介分析方法确定它们对CVD结果差异的影响。我们的发现 将指导未来的灾难准备计划，并允许医疗保健系统开发最佳护理模型 减轻CVD的风险并避免担心社会经济上的处境不利和/或少数民族的差异 人群。该项目的MPI（Dodson博士和Thorpe博士）结合了研究经验 心血管医学，老年医学，流行病学和数据科学，并由Co-I（潜水员博士，博士）加入 Adhikari，Vedanthan博士，Blecker博士，Weiner博士），他在健康分配研究方面具有专业知识， EHR的实施科学，生物统计学和使用。