Novel, High-Impact Studies Evaluating Health System and Healthcare Professional Responsiveness to COVID-19

评估卫生系统和医疗保健专业人员对 COVID-19 反应的新颖、高影响力研究

• 批准号: 10310504
• 负责人: Olveen Carrasquillo
• 金额: $ 48.61万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10310504
• 关键词: Novel; Impact; Studies; Evaluating; Health

Project Summary The COVID-19 pandemic necessitated a rapid transition from in-person to telehealth visits to comply with “stay-at-home” and social distancing requirements. No information is currently available about the outcomes associated with the telehealth modalities implemented because of COVID-19. The purpose of the study is to quantify the effects of ceasing in-person outpatient visits, and the resulting increased use of telehealth modalities, among patients with differing social vulnerabilities on the outcomes of: (1) disease control (HbA1c, systolic blood pressure) and (2) health care use (inpatient admissions and emergency department visits). The widespread shift to telehealth visits has created the extraordinary opportunity to understand the differential effects of telehealth visits for those with differing social vulnerabilities using real-world data (linked electronic health record ((EHR) and claims) from over 14M Floridians. The study setting is the OneFlorida Clinical Research Consortium and seven of its health system partners (OneFlorida Partners), who together provide care for over 14M, or 64%, of all Floridians. The patient population and focus of our study are individuals with Type 2 diabetes, hypertension, or both. The OneFlorida Partners serve diverse patient populations in terms of social vulnerability. The study is significant in its quantification of the effects of ceasing all non-emergent in- person visits and transitioning to telehealth modalities on the outcomes of disease control and health care use among those experiencing singular and intersecting social vulnerabilities. The study uses a mixed methods design with interviews and surveys of health system leaders and patients, and leverages the natural experiment that occurred with the rapid transition to telehealth, and for some health systems, the transition back to in-person visits. A novel mathematical generalization of a difference-in-differences (DD) approach will be used to model all post-period measurements simultaneously, while accounting for the covariance of repeated measures, thus increasing power relative to the standard DD approaches. The study aims are to: Aim 1: Quantify the effects of the transition from in-person outpatient visits to the implementation of telehealth and the variations of those effects among those with singular and intersecting social vulnerabilities, on disease control (blood pressure, HbA1c) and health care use (inpatient admissions and emergency department visits). Aim 2. Explore and examine experiences with shared decision-making and care for a subset of patients. Aim 3: Compare the profile of telehealth implementation before and during the COVID-19 pandemic for each OneFlorida clinical partner using in-depth interviews and data reports. Aim 4: Disseminate findings and lessons learned at 6-month intervals throughout the study period using stakeholder engaged, multi-level communication strategies tailored to patients, families, clinicians, health system leaders, third party payers and policymakers.

项目概要 COVID-19 大流行需要从亲自就诊快速过渡到远程医疗就诊，以遵守 目前尚无有关结果的信息。 与因 COVID-19 而实施的远程医疗模式相关。 量化停止亲自门诊的影响以及由此导致的远程医疗使用的增加 在具有不同社会脆弱性的患者中，对以下结果进行不同的治疗方式：(1) 疾病控制（HbA1c、 收缩压）和（2）医疗保健用途（住院和急诊科就诊）。 远程医疗就诊的广泛转变创造了了解差异的绝佳机会 使用真实世界数据（链接电子 来自超过 1400 万佛罗里达人的健康记录（（EHR）和索赔） 研究地点是 OneFlorida Clinical。 研究联盟及其七个卫生系统合作伙伴（OneFlorida Partners）共同提供 为超过 1400 万（即 64%）的佛罗里达人提供护理 我们研究的患者群体和重点是患有以下疾病的个体。 OneFlorida 合作伙伴为 2 型糖尿病、高血压或两者兼而有之的患者群体提供服务。 这项研究的重要意义在于量化了停止所有非紧急干预措施的影响。 人员就诊和过渡到远程医疗模式对疾病控制和医疗保健使用结果的影响 这项研究使用了混合方法。 通过对卫生系统领导者和患者的访谈和调查进行设计，并利用自然 随着向远程医疗的快速过渡而发生的实验，对于某些卫生系统来说，这种过渡 回到面对面的访问。 用于同时对所有后期测量进行建模，同时考虑协方差 重复测量，从而提高相对于标准 DD 方法的功效 该研究的目的是： 目标 1：量化从面对面门诊到实施远程医疗的转变的影响 以及那些具有单一和交叉社会脆弱性的人对疾病的影响的差异 控制（血压、HbA1c）和医疗保健使用（住院和急诊科就诊）。 目标 2. 探索和检查对部分患者进行共同决策和护理的经验。 目标 3：比较每个国家在 COVID-19 大流行之前和期间的远程医疗实施情况 OneFlorida 临床合作伙伴使用深度访谈和数据报告。 目标 4：在整个研究期间，每隔 6 个月传播一次调查结果和经验教训，使用 利益相关者参与，针对患者、家庭、忠诚者、健康状况量身定制的多层次沟通策略 系统领导者、第三方支付者和政策制定者。