How Has the Pandemic Reshaped Health Care?

Black background with 2 images. One image is a slice of pie with the text, "Practice innovations for equity (PIE)." The other is a cupcake with the text, "Crisis Advancing Knowledge for Equity (CAKE)"

The CHI Center has been awarded two grants from the National Institutes of Health to explore the ways in which the COVID-19 pandemic is reshaping health care delivery and the quality and equity of care.

The Practice Innovations for Equity (PIE) study focuses on how care has changed for people with multiple chronic conditions. Crisis Advancing Knowledge for Equity (CAKE) explores the effects of practice changes on the primary care workforce and the patient population as a whole. The studies will also identify emerging strategies that may help improve the delivery and equity of health care.

This research is being conducting in conjunction with OCHIN, a nonprofit health care innovation organization with a network of community health center practices caring for more than 2.6 million patients nationwide.

The PIE and CAKE studies use mixed research methods designed to gain insights into evolving national health care trends, while “putting a face” on practice change.  This includes a time series analysis that begins in 2019, in which researchers examine, month by month, how the delivery of health care, patient outcomes, equity of care, and stability of the health care workforce are changing. The result is a series of “snapshots” of health care at more than 200 community health center practices around the country during a five-year period.

Based on the quantitative time series analysis, researchers are purposively selecting practices to participate in the qualitative arm of the studies. This includes interviews and direct observation of practice to gain detailed understanding of practice change and promising innovations in health care delivery.

Among the questions the researchers are exploring are,

  • How is telehealth being used?
  • What are the effects of telehealth visits, targeted outreach, growing attention to social drivers of health, and other innovations on quality and equity of care for patients?
  • How are practice staffing, stress, and financial viability changing, and what are the effects on patients and clinicians?
  • What level of stress have health care workers experienced?
  • In addition to the pandemic, what natural experiments are affecting practices, care delivery, and patient outcomes?

According to Kurt Stange, CHI Center Director and co-principal investigator with Nicole Cook, PhD, of OCHIN, the PIE and CAKE studies represent a rare opportunity.

“COVID-19 has taken a real toll on people, and it’s led to an unprecedented degree of change in primary care practices. At the same time," he stated, “it presents a unique learning opportunity."

"We have the chance to use the pandemic for shared learning. If we act on that learning, the fruits of the pandemic do not have to be entirely negative. We’re excited to have the chance to understand the effects of this natural experiment on patients, practices, workforce, and health care equity.”