A Multi-Site Evaluation of Primary Care Accessibility and Utilization during COVID-19 - ABSTRACT
The objective of the proposed research is to evaluate how patient access and utilization of primary care was
disrupted by COVID-19 across three healthcare systems, with a focus on patients with chronic conditions. Our
rigorous evaluation has three aims. Aim 1 is to determine whether patients were able to access primary care
and, for those who did access care, identification of the modalities to access care (in-person, telehealth (video
or phone), asynchronous communication, or multiple modalities). Further, we will identify subpopulations that
were disproportionately affected including and may not have been able to access care at all. Aim 2 is to identify
barriers and facilitators to digital health access across three sites. Aim 3 is to evaluate how the modality used
to access primary care, or the lack of access to primary care, during COVID-19 impacts future healthcare
access and utilization for patients with chronic conditions, and other at-risk populations.
The research effort is a unique collaborative between MedStar Health, Stanford Health Care, and
Intermountain Healthcare. This project utilizes the extensive expertise of the diverse research team which
includes data scientists, human factors experts, informaticists, health disparities researchers and clinical
experts in digital health. The proposal is directly aligned with AHRQ’s priority area of making health care
accessible and safer. To achieve aims one and three we will use rigorous data science and informatics
methods. To achieve aim 2, we will use a mixed methods approach that includes interviews of subject matter
experts and patients from each of the three sites with a socio-technical systems model as the foundation for
our interviews.
Contributions from this research will include a detailed understanding of access modalities that are most
frequently used, patient populations that may be disproportionately impacted by COVID-19, and identification
of barriers and facilitators to digital health models of care. Our rigorous dissemination plan includes
communication of results to policymakers and advocacy groups, clinical leaders and other organizations that
serve to improve clinical practice, as well as academic audiences. Results from aim 1 will be available within 4-
6 months of project start and the entire project will be completed in two years.