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 大流行对老年弱势群体（即种族/族裔）的影响尤为严重 少数民族和农村居民）。感染 COVID-19 的高风险以及这些弱势群体的可怕后果 部分原因是合并症和其他社会决定因素的高患病率 健康。家庭医疗保健机构 (HHA) 和疗养院 (NH) 为以下人群提供必要的急性后服务： 大量老年患者。大流行扰乱了从医院到 HHA 的护理过渡， NHs，这可能会导致重要的健康结果后果，包括扩大现有的健康范围 差异。在我们之前的 COVID-19 之前的研究中，我们发现，当 HHA 和 NH 提供最佳 感染预防和控制（IPC）医院感染的做法减少。以这部小说为基础 先前的工作并由国家少数民族健康和健康差异研究所 (NIMHD) 指导 框架，本研究的目的是： 1) 描述 HHA 和 NH IPC 计划在 应对全国范围内的 COVID-19 大流行，并检查这些变化是否因服务设施而异 很大一部分弱势群体； 2) 描述 COVID-19 如何扰乱住院治疗和 随后向 HHA 和 NH 排放，并确定中断是否受到不成比例的影响 弱势群体； 3) 量化 COVID-19 对住院患者、HHA 和 NH 健康结果的影响 以及 HHA 和 NH 中的 IPC 计划在减少大流行对弱势群体的影响方面的有效性 和非弱势老年人口。在目标 1 中，我们将进行定性访谈和全国调查 HHA 和 NH。我们将从 COVID-19 之前的调查中抽取核心 HHA 和 NH 进行抽样，并增强 根据需要配备新设施。我们将把之前的调查和新的 2022 年调查联系起来，以检查以下方面的变化： IPC 计划并确定这些变化在主要服务于弱势群体的设施中是否有所不同 人口。在目标 2 中，我们将使用纵向（2013 年至 2022 年）医疗保险和医疗补助中心 (CMS) 数据 描述 HHA 如何选择紧急和选择性入院和出院处置 NH 因 COVID-19 发生变化；以及这些变化对于弱势群体是否有所不同。在目标 3 中，我们 将把我们的新冠疫情前调查和 2022 年调查与纵向 CMS 数据联系起来，以对健康结果进行建模 老年医疗保险受益人的（即 COVID-19 病例、感染、再住院和死亡率），控制 适用于当地的 COVID-19 环境。我们之前在 NH 和 HHA 中进行的 IPC 全国调查是理想且可行的。 新颖的基线数据。利用我们之前的工作，这项创新研究将解决 COVID-19 对 老年、弱势患者（即种族和族裔少数群体与非少数群体）的转变和健康结果 拉丁裔白人以及城市与农村），确定健康差异和缓解健康问题的有效做法 差异。研究结果还将为 NH、HHA 和政策制定者提供未来传染病规划的信息 疾病紧急情况并减少健康差距。