Hospital Systems Serving Health Disparity Populations (HSSHDPs) deliver needed services to racial and
ethnic minorities and other underserved communities. HSSHDPs may experience long-term effects of natural
and man-made disasters that in turn could affect health outcomes for the populations they serve. The COVID-
19 pandemic has affected virtually every US healthcare system and, therefore, provides a unique opportunity
to study the effects of large-scale and long-term stressors on under-resourced systems serving vulnerable
patient populations. Using the framework of the disaster management cycle (mitigation, preparedness,
response, and recovery), this project proposes to conduct a mixed methods study of the long-term effects of
COVID-19 on US hospitals across four critical domains (quality, workforce, finances, and innovation), with a
special focus on HSSHDPs and on the health disparity populations they serve.
This project will be the first major national investigation of the effects of a national disaster on HSSHDPs.
This rigorous mixed methods study will be significant in identifying HSSDHPS most and least affected by the
COVID-19 pandemic and will deepen the understanding of the contributing factors that led to successes and
challenges. The study will identify actionable best practices and challenges to HSSHDPs' operations before,
during and after the COVID-19 pandemic. The specific aims of this study are:
Aim 1. Describe the long-term effects of COVID-19 on hospitals and the perceived usefulness of
disaster management planning activities (including interactions with Coalitions). In partnership with the
American Hospital Association and America's Essential Hospitals a nationally representative survey of 2000
hospitals will be conducted to examine variation by HSSHDP status and other characteristics.
Aim 2. Analyze changes (before, during, and after the COVID-19 pandemic, 2018-2023) in hospital-
level quality, service levels, and finances, and in patient-level outcomes. Using secondary data sources,
the study will focus on differences among HSSHDPs, and for context, compare HSSHDPs with non-HSSHDPs.
Aim 3. Explore the challenges faced by HSSHDPs during the pandemic and the strategies pursued
to overcome them. The study will include 12 in-depth case studies, using purposive sampling to select
HSSHDPs and non-HSSHDPs with and without major effects due to COVID-19. Semi-structured interviews
with stakeholders will be used to more fully understand existing structures, challenges, interactions with
Coalitions, and other disaster management strategies.
Aim 4. Develop prioritized policy recommendations to enhance resilience of our most critical public
health systems for future disasters to protect the health of our most vulnerable populations and the
facilities that serve them. A national Delphi consensus panel in conjunction with the National Academy of
Science Engineering and Medicine will be conducted.
