Session
Shifts in Clinical Care in Response to the COVID-19 Pandemic
APHA 2022 Annual Meeting and Expo
Abstract
Boston Children’s Hospital Community Asthma Initiative during COVID-19
APHA 2022 Annual Meeting and Expo
Background: While many asthma home visit (HV) programs ceased all visits in response to the COVID-19 pandemic, the Community Asthma Initiative (CAI) rapidly modified the model to incorporate virtual visits and supply drop-offs.
Objectives: Restructure an asthma HV model in response to the COVID-19 pandemic to promote health equity.
Methods: On March 13, 2020 Boston Children’s Hospital discontinued HVs. CAI shifted to a new three-part remote model: 1) initial intake and asthma education by the Nurse Case Manager via telephone, 2) Community Health Workers (CHWs) conduct virtual HVs, providing asthma education and home environmental assessments, 3) CHWs drop materials off outside homes. Zip code comparison was performed for where families lived and state COVID-19 numbers. Parental reports at baseline and 12 months were used to assess cumulative reductions in hospitalizations, ED (Emergency Department) visits, missed school days and missed work days from October 1, 2005 to March 31, 2020 (prior CAI model, N=2302) and compared to cumulative outcomes as of March 31, 2022, two years after the implementation of the COVID model. McNemar’s test was used for dichotomous variables and repeated measures analyses for continuous variables.
Results: Since implementing the COVID model CAI has completed 186 intakes and 226 virtual visits. Zip codes of CAI residences overlapped with the highest rates of COVID-19 in primarily low-income, and Black and Hispanic communities, and created a greater demand among families for case management addressing social determinants of health (housing, rent relief, food insecurity, mental health needs, etc.). Cumulatively, as of March 31, 2020, there were significant reductions from intake in the percent of children with any (≥1) hospitalizations (82% reduction), ED visits (55% reduction), missed school days (44% reduction) and missed work days (54% reduction) (all p<0.001). Compared to the COVID model, cumulatively as of March 31, 2022, reductions in the percent of children with any (≥1) hospitalizations, ED visits, missed school days and missed work days were not significantly different. Improvements in continuous outcomes were also highly significant for both groups (all p<0.001).
Conclusions: CAI has successfully shifted the model from in-person HVs to a primarily remote model using virtual visits supplemented with supply drop-offs. Despite this shift, reductions in hospitalizations, ED visits, missed school days and missed work days have remained consistent.
Public Health Implications: The overlap of CAI patients’ homes with communities of high rates of COVID-19 requires addressing health disparities and greater assistance with social determinants of health.
Abstract
Impact of the COVID-19 Pandemic on Federally Qualified Health Centers in Puerto Rico during 2020
APHA 2022 Annual Meeting and Expo
Introduction: Puerto Rico's network of Federally Qualified Health Centers (FQHCs) which consists of 22 centers with 86 satellite clinics is the backbone of the island’s primary health care system. Therefore, it is extremely important to study the effect of the COVID19 pandemic on their delivery of services and the adaptation strategies they implemented to continue operations. The research objectives were to identify, measure and describe the effect of the pandemic on the FQHCs’ continuity of operations, financial stability and strategies implemented. Finally, we sought to develop recommendations to strengthen the FQHCs’ continuity of operations for future emergencies.
Methods: A mixed research methodology was utilized in which quantitative and qualitative approaches were combined. From the 21 FQHCs that qualified for the study, 17 or 81.0% provided the research team with data on service utilization, patients served, staff, operating costs and revenue received from 2018 to 2020. Moreover, individual and groups interviews were conducted with patients, members of the Board of Directors, community leaders, clinical staff, and senior management in a sample of seven FQHCs. We then conducted a triangulation of the data and information collected from both components.
Results: Puerto Rico’s FQHCs demonstrated great flexibility, adaptability, and innovative capacity during the response to the pandemic. The primary health care services provided by the FQHCs played an important role in assisting, supporting, and mitigating the impact of COVID19 on the health of thousands of individuals, vulnerable families, and communities around the island.
Conclusions: While there is clearly much work to be done
to overcome this public health challenge, the current moment offers an opportunity for Puerto Rico’s local and state political leaders to use the creativity, innovations, and lessons learned from the FQHCs’ response to this emergency to maintain and strengthen an equitable primary health care system that is resilient and accessible in the future.
Abstract
Reimagining mobile health during the COVID-19 pandemic: A unique partnership between an academic institution and the automotive industry
APHA 2022 Annual Meeting and Expo
Introduction to problem being addressed: When COVID-19 cases started to rise in the United States, most of the testing efforts were housed in stationary locations. Healthcare systems set up services at their locations and other entities morphed large parking lots into mass drive-through testing sites. Although these stationary testing sites were able to provide services to many individuals, others faced barriers that limited their ability to access these services.
Description of evidence and theory used to inform program development and implementation: During the first wave of the COVID-19 pandemic, the city of Detroit had one of the highest rates of mortality in the United States. One of the first populations adversely impacted were first responders. Wayne State University (WSU), an urban academic institution in the heart of Detroit, partnered with Wayne Health, a medical provider, and Arab Community Center for Economic and Social Services (ACCESS) to offer COVID-19 screening to first responders at drive-through sites. As testing rates started to decline, Ford X, a Ford Motor Company program, reached out to WSU to discuss how to modify current testing efforts to make them mobile.
Description of program activities and outcomes: WSU staff worked alongside Ford X to design new mobile health units that followed COVID-19 precautions. Historically, mobile health units (MHU) have been large recreational vehicles that individuals enter to receive care. Entering a unit was not an option as there would be limited air flow and sanitary concerns. As a team, Ford Transit Vans were transformed into mobile health units that could easily be deployed to correctional facilities, police and fire departments, and tribal law enforcement entities. Between April 13, 2020, and June 5, 2020, the Wayne Health Mobile Units were deployed to 29 first responder sites and performed over 3,500 tests. Ford X conducted routine staff interviews to evaluate the MHU features while prototypes were in use. By December 2020, Ford Motor company released a new line of MHUs. Since then, the partnership has continued and additional modifications to the units have been made to accommodate more services.
Conclusions: The COVID-19 pandemic brought many new partners together to develop and implement innovative approaches for health care delivery that did not perpetuate further transmission of the virus. MHUs can provide services as well as eliminate accessibility barriers.
Recommendations for practice: Be open to new and unique partnerships to allow for innovative approaches to addressing public health issues.