This one-year Revision Supplement to the parent project (“PROMIS Lab: Partnership in Resilience for Medication Safety” or “PROMIS Lab”) is to meet immediate needs to help address timely health system and healthcare professional response to the COVID-19 public health crisis. Our research is to evaluate the impact from two broad disruptions to primary care delivery in the response to the COVID-19 public health crisis. One is the inabilities or reluctance to visit primary clinics, resulting in delayed or missed care. Another is the use of telehealth modalities, to reduce exposure to pathogens. However, certain visits (e.g., blood test) must be performed in person, while balancing patient needs and COVID-19 associated social distancing rules. We refer to the different types of visits as multiple engagement modalities. Both types of disruptions have direct impact on patient safety, presumably negatively. The proposed research in the Revision Supplement is urgently needed. Primary care clinics face unprecedented disruption brought by the COVID-19 public health crisis. Understanding the impact of the crisis on patient safety provide evidence to gaps and to best practices to ensure patient safety. We will target underserved populations with health disparity, as such populations have experienced disproportionally higher mortalities from COVID-19 while they are subjected to technology and logistics associated barriers exacerbated by social determinants of health. The specific aim of the Revision Supplement is to evaluate the impact of engagement modalities, such as telehealth, on healthcare access and safety during COVID-19 Pandemic. Based on the evaluation, we will synthesize findings into practice guidelines to support primary care clinics and organizations in responding to unique challenges posed by the pandemic. We will achieve the aim with four subaims: (a).Characterize disruptions and adaptation due to COVID-19 in primary care delivery by reviewing administrative and clinical data, (b).Assess barriers and facilitators in primary care delivery due to COVID-19 by conducting qualitative interview studies with frontline clinicians and administrators, (c).Evaluate patient engagement using telehealth visit modalities using post-visit surveys by targeting patients with known risk factors for medication safety concerns, and (d).Develop guidance to primary care clinics on ways to improve safety to mitigate the impact of the COVID-19pandemic, through expert panels and simulation modeling of different scheduling practices for various modalities of patient visits. The proposed Supplement research activities are designed to be highly feasible with the short, one-year timeline, to be accomplished in parallel and in conjunction of the parent project. The proposed activities capitalize on the clinical partners and research expertise in the parent project PROMIS Lab, and will use similar methodologies, to evaluate patient safety across different types of clinics and patient populations, in part due to the adoption and usage of different patient engagement modalities.

This project is to evaluate the impact on patient safety from disruptions to primary care delivery in the response to the COVID-19 public health crisis. The project will target risks to patient safety among underserved populations with health disparity, as such populations have experienced disproportionally higher mortalities from COVID-19 while they are subjected to technology and logistics associated barriers exacerbated by social determinants of health. Based on the evaluation, we will synthesize findings into practice guidelines to support primary care clinics and organizations in responding to unique challenges posed by the pandemic.