Social Networks in Medical Homes and Impact on Patient Care and Outcomes

This application is being submitted in response to PA-20-070. The COVID-19 pandemic has exposed the vulnerabilities in the current health care system in the United States (U.S.), including its weak infrastructure with limited capacity and a shortage of health care workers (HCWs). Policymakers and administrators have been faced with the challenge of rapidly increasing the capacity of the health care system by recruiting recently graduated, out-of-state, or retired HCWs from various professions to care for the high volumes of patients infected by COVID-19. HCWs had to take on new roles to manage an unfamiliar disease with little disease-specific evidence or treatment options. Stresses caused by the high demand, concerns of being infected or infecting family members, and lack of adequate personal protective equipment further exacerbate already existing high rates of stress and burnout among HCWs. Burned-out clinicians are more likely to be involved in adverse safety incidents, including exposure to infectious diseases. To date, little is known about stress, burnout, and safety concerns of HCWs during the COVID-19 pandemic or how HCWs cope with them. Also, while stress and burnout among physicians and nurses are receiving some attention, little is known about how other essential HCWs (e.g., medical assistants, social workers) who comprise about half of the U.S. healthcare workforce face these negative outcomes. The overarching aim of the parent study (RO1HS025937) is to understand the underlying attributes of optimal teams to inform team design to strengthen primary care and better serve chronically ill patients. The data collection for the parent study (scheduled for May 2020)postponed due to COVID-19 is estimated to resume in the fall of 2020. This delay allows us to add new and valid COVID-19 related measures as a part of this supplement without affecting the progress of the parent study. In this supplement, we will: Aim 1. Assess health care team member behaviors (i.e., coping strategies)and outcomes (i.e., stress, burnout, and safety) and their impact on team networks (i.e., communication, advice sharing, trust, support, and problem solving). Aim 2. Investigate the impact of health care team member behaviors (i.e., coping strategies) on outcomes (i.¢., stress, burnout, and safety). Aim 3. Explore perceptions of health care team members about COVID-19 related behaviors and outcomes through in-depth qualitative interviews. We will collect data from all HCWs from clinics in New York City, the U.S. epicenter of the COVID-19 crisis. This timely supplement has the potential to make clinical and policy contributions by producing evidence about HCW behaviors and outcomes during the COVID-19 crisis and meets the criteria of PA-20-070. It expands the scope of the active parent RO1 (funded until 01/31/2024) and allows our team to add new measures and also collect rich qualitative data to produce high impact comprehensive knowledge. Our findings will lay a foundation for future studies to develop interventions at the individual-, team-, and practice-levels to better prepare HCWs to cope with stress and burnout and also enhance safety during and beyond crises.