Novel, High-Impact Studies Evaluating Health System and Healthcare Professional Responsiveness to COVID-19

PROJECT SUMMARY FOR PEOPLE ARE PRIMARY Background: We are experiencing an event unlike any in living history. The global pandemic, referred to as "COVID-19", has become a one-of-a-kind stress test on health care systems around the world. The size, scope, and speed of this pandemic has created an imperative for rapid dissemination of data and findings. The response of US primary care practices to COVID-19 is a large-scale natural experiment of the capacity of primary care to meet the majority of people's needs. And yet, at the start the pandemic in the US, there was no one organization, federal agency, or national dataset able to provide real-time on-the-ground data regarding the experiences of primary care practices or their patients. Purpose: On March 13, 2020, as the US declared COVID-19 a national emergency, our team created a national research Collaboratory and launched the "Quick COVID-19 Primary Care Survey" (C19 Survey) to fill that gap. The Pilot C19 Survey began as a clinician-based weekly national survey to monitor the response, challenges, and capacity of US primary care practices during the COVID-19 pandemic. After 4 weeks, we launched a complementary patient-based C19 Survey. People Are Primary would allow the C19 Surveys to continue beyond the Pilot stage. We will examine the responses, challenges, and capacity of primary care practices in order to evaluate the resilience and adaptive decision- making required during the pandemic. Drawing on both patients and clinicians, we will examine the rapid adoption of digital health by primary care as well as the positive and negative consequences of digital health on 1) access to care across varied settings, 2) patient and clinician care delivery experiences, and 3) the interaction of digital health with relationships between primary care patients and primary care teams. Methods: This is a mixed-methods learning evaluation with an exploratory sequential design. Regular surveys will be distributed to identified clinician and patient groups throughout the 2-year study period. These will begin weekly and will evolve into biweekly and then monthly surveys in response to changes in the natural evolution of the pandemic and subsequent primary care practice response. The research team will engage in weekly rapid learning cycles that complete data collection, analysis, dissemination, and adjustment to survey instrument within a 7-day period. The team will also use bimonthly deep learning cycles to develop time series and trend- based analysis, offering a more extended conversation of these findings and their implications for the long-term stability and strengthening of the US primary care platform. Benefit: The COVID-19 pandemic has exposed the costs of chronic and fragmented under-investment in primary care. Examination of the rapid adoption of digital health and its impact on patient and clinician experiences of care during the pandemic can inform a much needed strategy to 1) stop the immediate threat of primary care collapse, 2) identify practice and funding strategies able to stabilize primary care practices, and 3) enable the long term strengthening of primary care.