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Principal Investigator: Nicole Jill Cook
Organization: CASE WESTERN RESERVE UNIVERSITY
Fiscal Year: 2024
Award: $489,904
Funding agency: National Institute on Minority Health and Health Disparities
Long-Term Effects of COVID-19-induced Health Care Delivery Changes on Patient & Workforce
Processes & Outcomes in Safety Net Practices Caring for Health Disparity Populations
ABSTRACT / PROJECT SUMMARY
Primary care provides more than half of all outpatient visits ― 500 million each year ― with only 30% of
the healthcare workforce and <6% of national healthcare expenditure, informed by only 0.2% of the NIH
research budget. Healthcare systems based on primary care have healthier populations, greater equity, and
lower costs. Our ongoing national practice and patient surveys show that the pandemic and resulting ongoing
health care system and social changes are having a devastating effects on the primary care workforce and its
ability to integrate and personalize care in a fragmented, impersonal, inequitable healthcare system.
Yet, amidst the COVID-19 natural disaster, ongoing primary care innovations provide hope for
advancing equity for health disparity populations. We have a unique opportunity to study the effects of the
pandemic in a national network of 926 community health centers serving >2.6 million patients from health
disparity populations. The proposed study will:
1) Identify changes in health care delivery to health disparity populations in community health centers in
response to the continuing practice, social and policy changes launched by the COVID-19 pandemic;
2) Assess the longitudinal impact of these practice changes on care quality in health disparity populations;
3) Examine the ongoing effects of these changes on community health center workforce stability;
4) Identify promising strategies to improve healthcare equity after a natural disaster & varied human response.
In response to PA-20-172: Long-Term Effects of Disasters on Health Care Systems Serving Health
Disparity Populations, we will conduct a time series analysis of practice changes and associated patient and
workforce outcomes initiated by the COVID-19 pandemic and the ongoing changes stimulated by it. Monthly
analyses will examine longitudinal changes in practice processes, patient outcomes, and workforce stability for
health disparity and other at-risk populations. For a five-year period going back to January 2020 ― the month
of the first known COVID-19 case in the US and the start of responding public health and practice changes ―
we will analyze and publicly report, on a monthly basis, practice changes and patient outcomes, to rapidly
inform decision making about primary care of health disparity populations. Subgroup analyses will examine
differences across 26 states that have had different societal responses to the pandemic. The findings from
these quantitative analyses of millions of patients being seen in hundreds of community health centers also will
be used to identify a purposive sample of exemplars and contrasting practices for in-depth case studies of
practice innovations that show promise in reducing healthcare disparities.
Findings will generate vital new knowledge on the longitudinal effect of a pandemic on care provided to
health disparity populations and on the sustainability of the primary care community health center workforce,
and will inform efforts to improve health care equity after a natural disaster and varied human responses.
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