COVID-19 Mitigation Efforts and Disparities in Access to Routine Preventive Care and Chronic Disease Management

COVID-19 缓解措施以及获得常规预防性护理和慢性病管理方面的差异

基本信息

批准号：
10626950
负责人：
Cameron Maxwell Kaplan
金额：
$ 47.82万
依托单位：
UNIVERSITY OF SOUTHERN CALIFORNIA
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-20 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10626950
关键词：
Address Adherence Affect Age Ambulatory Care Behavioral COVID-19 COVID-19 mortality COVID-19 pandemic COVID-19 pandemic effects Caring Chronic Chronic Disease Clinic Contracts County Data Data Analyses Data Set Diabetes Mellitus Disease Management Disparity Disparity population Equity Ethnic Origin Future Guidelines Health Health Insurance Health Resources Health system Healthcare Healthcare Systems Hospitalization Hypertension Income Individual Intervention Interview Literature Low Income Population Low income Managed Care Measures Methods Morbidity - disease rate Municipalities Outcome Patients Patterns of Care Persons Pharmacologic Substance Policies Policy Maker Population Preventive care Preventive healthcare Primary Care Primary Health Care Provider Race Recommendation Reduce health disparities Renal function Resources Risk Screening for cancer Social Distance Social Work Time United States Vulnerable Populations access disparities billing data care seeking care systems clinical encounter design ethnic disparity ethnic minority health care service utilization health disparity health equity health management high risk improved insurance claims medical vulnerability minority patient novel pandemic disease pandemic impact pandemic response patient population post-pandemic primary care services racial disparity racial minority safety net severe COVID-19 social vulnerability socioeconomic disadvantage structural determinants

项目摘要

PROJECT SUMMARY As a result of mitigation policy and behavioral changes, the COVID-19 pandemic significantly reduced access to primary care, which is likely to have lasting effects on chronic disease management and health outcomes, particularly for medically and socially vulnerable populations with existing chronic conditions. Newly available longitudinal individual-level data allows us to rigorously examine these effects for the first time. Although there is a large and growing literature quantifying disparities in outcomes related to COVID-19, relatively less is known about how the pandemic has affected access to primary and preventive care as well as associated health outcomes among medically and socially vulnerable populations. Understanding how the pandemic affected the utilization of preventive health care and management of chronic conditions, such as diabetes mellitus (DM) and hypertension (HTN), as well as the downstream outcomes, is critical to addressing resultant health disparities and mitigating the impact of future disruptions to the healthcare system and advancing interventions and policies to reduce health disparities We will leverage this newly available and timely data to examine changes in receipt of healthcare during the pandemic. Our data will include commercial health insurance claims in addition to a unique dataset containing billing data for a large, urban safety-net county health system serving a low-income, largely minority patient population. Within those populations, we will include a special focus examining individuals with DM or HTN. Using a mixed-methods design, we will examine changes in health care utilization and the predictors of disruptions over time. To more comprehensively understand contextual influences related to disruptions in care, we will obtain complementary qualitative data through interviews with patients, providers and clinic staff, and health systems leaders from the second largest municipal health system in the United States that will explore the drivers of underutilization of primary and preventive care during and after the pandemic. Our specific aims are to: (1) quantify the impact of the pandemic on racial/ethnic disparities in receipt of appropriate primary care, chronic disease management, and downstream health outcomes; (2) compare the differential effect of pandemic mitigation efforts between a commercially insured population and a safety net population; and (3) contextualize the secondary health effects of the pandemic using qualitative interviews with health systems stakeholders. Using established and novel data sets, supplemented by qualitative interviews we will be able to shed light on the changes in patterns of care management both during and after the pandemic for medically and socially vulnerable patients. Such information is crucial to determining how we should direct health care resources during national crises. However, these results are equally important in a post-pandemic landscape, in which the way patients seek care and health systems offer care is permanently altered.

项目摘要由于缓解政策和行为的改变，Covid-19大流行大大降低了访问致初级保健，这可能会对慢性疾病管理和健康结果产生持久影响，特别是对于患有现有慢性病的医学和社会脆弱人群。新可用纵向个体级别的数据使我们能够首次严格检查这些效果。尽管有大量的文献量化了与Covid-19的结果中的差异，但关于大流行如何影响获得初级和预防性护理以及医学和社会脆弱人群之间的相关健康结果。了解如何大流行影响了对预防性医疗保健和慢性病的管理的利用，例如糖尿病（DM）和高血压（HTN）以及下游结果，对于解决问题至关重要由此导致的健康差异，并减轻未来中断对医疗保健系统的影响推进干预措施和政策以减少健康差异我们将利用此新的和及时的数据来检查在接收医疗保健期间的变化大流行。我们的数据还将包括商业健康保险索赔，除了包含的独特数据集用于为低收入，大部分少数患者提供的大型城市安全网县卫生系统的计费数据人口。在这些人群中，我们将包括一个特殊的重点，以检查DM或HTN的个人。使用混合方法设计，我们将检查医疗保健利用的变化和预测因素随着时间的流逝而破坏。更全面地了解与中断有关的上下文影响护理，我们将通过与患者，提供者和诊所员工的访谈获得互补的定性数据，以及美国第二大市政卫生系统的卫生系统领导者探索大流行期间和之后的原发性和预防保健的驱动因素不足的驱动因素。我们的具体目的是：（1）量化大流行对种族/种族差异的影响初级保健，慢性疾病管理和下游健康结果；（2）比较差异商业保险人口与安全网人口之间的大流行缓解工作的影响；（3）通过与健康的定性访谈，将大流行的二级健康效应背景系统利益相关者。使用已建立的新型数据集，并补充了定性访谈，我们将能够阐明医疗和社会上大流行期间和之后的护理管理模式的变化脆弱的患者。此类信息对于确定我们应该如何指导医疗保健资源至关重要在国家危机期间。但是，这些结果在大流行景观中同样重要，其中患者寻求护理和卫生系统提供护理的方式将永久改变。