This section covers two additional topics that are of interest to AHRQ and are relevant for primary care researchers and clinicians: COVID-19 and Patient Safety. While most of the grants related to these topic areas are already included in the key topic areas covered in the previous section, the grants included in this section did not fit into any of the key topic areas.
COVID-19
Both primary care practice and primary care research experienced unprecedented disruptions due to the COVID-19 public health emergency. During the height of the pandemic, many primary care practices understandably needed to put their full focus on providing care for patients, keeping their workforce safe, and surviving financially. This frequently meant that practice-based research was either delayed or severely curtailed during this time.52 At the same time, however, the COVID-19 pandemic created new primary care relevant research questions and opportunities, including understanding the impacts of telehealth use on healthcare access, utilization, safety, and equity. New challenges have emerged for primary care and primary care research in the wake of COVID-19, including addressing the health impacts of social isolation, finding effective treatments for people living with long COVID, and dealing with increased shortages and burnout across the primary care workforce.
AHRQ supported the nation’s response to COVID-19 through ongoing work in practice improvement, health systems research, and data and analytics.53 AHRQ’s specific response to COVID-19, included research grant awards, several blog posts by AHRQ leadership, and many relevant publications.
Grants with a focus on health equity are indicated with this icon.
Grants
A total of 11 AHRQ primary care grants funded in FYs 2021 and 2022 examine issues related to COVID-19. Four of these grants are COVID-19 Research Grant Awards, funded specifically to “explore essential questions about the delivery of healthcare” during the pandemic.54 Among these four grants, described in the table below, two are new research projects [both R01s (Research Projects)], and two are supplemental funding to existing grants with a focus on COVID-19 [both R18s (Research Demonstration and Dissemination Projects)]. The additional seven primary care grants looking at issues related to COVID-19 are described in other topic area sections in this report [Practice and Quality Improvement (2), Health Equity (2), Healthcare Systems and Infrastructure (1), Digital Healthcare (1), and Person-Centered Care (1)]. A full table of the 11 COVID-19 related grants is included in Appendix C: COVID-19.
A Multi-Site Evaluation of Primary Care Accessibility and Utilization during COVID-19 (R01) |
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PIs: Raj M. Ratwani and Ethan A. Booker Organization: Medstar Health Research Institute Examines the impact of COVID-19 disruptions on access and utilization of primary care for patients in three healthcare systems. The study looks at which patients received care via which modalities (in-person, telehealth, or both); what subpopulations were disproportionately affected by disruptions in care; and the barriers and facilitators to telehealth across the three sites. |
| Quality, Safety, Value: Impact of Sudden Shif t to Telehealth Due to COVID-19 Within Nurse-Led Care Models Located in Colorado Rural and Urban Communities (R01) |
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PI: Amy J. Barton Organization: University of Colorado Denver; School of Nursing Examines the impact of the sudden shift to telehealth for behavioral health, primary and prenatal care, and home visitation appointments, as a response to the COVID-19 pandemic, on innovative nurse-led care models used to provide care throughout Colorado. The research team considers utilization, both intended and unintended patient outcomes, as well as provider and patient experiences. |
| Integrating Patient-Reported Outcomes into Routine Primary Care: Monitoring Asthma Between Visits (R18) |
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PI: Robert Samuel Rudin Organization: RAND Corporation This supplemental project enhances a mobile health intervention for home monitoring of asthma symptoms between primary care visits by adding COVID-19 symptom screening and information. This supplemental project to an existing grant enhances a mobile health intervention for home monitoring of asthma symptoms with COVID-19 symptom screening and information. [Read about the parent study, with the same name as this supplemental grant, in the Digital Healthcare section of this report]. |
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PI: Yan Xiao Organization: University of Texas Arlington This supplemental grant evaluates the impact of changes in visit modalities due to COVID-19, such as the use of telehealth on access and safety. Based on the findings of this evaluation, the research team will develop practice guidelines to help primary care clinics provide safe and equitable care during disruptions brought on by the pandemic. [Read about the parent study PROMIS Learning Lab: Partnership in Resilience for Medication Safety in the Healthcare Systems and Infrastructure section of this report]. |
Initiatives and Resources
AHRQ funded the development of materials and resources to support primary care clinicians and researchers during COVID-19, and shared their lessons learned. As described below, this includes key take-aways from a primary care learning community, as well as learnings from the EvidenceNOW: Managing Unhealthy Alcohol Use initiative.
AHRQ’s Primary Care COVID-19 Learning Community
AHRQ initiated a learning community in late 2020 to bring together the primary care community as it dealt with COVID-19, for the purpose of facilitating shared learning and peer support and surfacing promising responses. Participants included 250 professionals, including clinicians and other team members, researchers, policy makers, advocates, quality improvement professionals, and representatives from primary care-related organizations. The learning community came together through eight virtual meetings held across an 11-month period. In addition to expert presentations and panel discussions on select topics, each meeting included small or large group discussions for participants to share their experiences from the field.
Insights from the learning community, including lessons learned and primary care innovations in response to the pandemic, have been distilled in the summary publication Primary Care’s Challenges and Responses in the Face of the COVID-19 Pandemic: Insights from AHRQ’s Learning Community.
Conducting Primary Care Research During COVID-19
The EvidenceNOW: Managing Unhealthy Alcohol Use initiative (described in the Practice and Quality Improvement section of this report) was launched in 2019, shortly before COVID-19 disruptions upended the projects’ research plans and timelines. The initiative leaders and grantees shared their challenges and lessons learned about conducting primary care research during this difficult time through publications, a webinar, and a blog.
Insights from the learning community, including lessons learned and primary care innovations in response to the pandemic, have been distilled in the summary publication Primary Care’s Challenges and Responses in the Face of the COVID-19 Pandemic: Insights from AHRQ’s Learning Community.
- Implementing Screening and Treatment of Unhealthy Alcohol Use During COVID-19—this blog by Sebastian Tong, MD MPH—a family physician who had been serving as a Senior Staff Fellow at AHRQ, describes both the increased difficulty with conducting practice-based research during COVID-19, as well as the importance of screening for and treating unhealthy alcohol use during this time of increased stress and social isolation.
- Primary Care Research During the COVID-19 Pandemic: Perspectives from AHRQ’s Unhealthy Alcohol Use Grantees—this webinar from March 2021, featuring two AHRQ grantees, discusses challenges and solutions during COVID-19 related to recruiting practices and maintaining their engagement, as well as data collection and human subjects’ protections.
- Primary Care Research Is Hard to Do During COVID-19: Challenges and Solutions—this article outlines challenges faced across 15 research projects, and strategies to address these challenges. The authors recommended that researchers and funders embrace pragmatic and adaptive designs.
- Barriers to Recruiting Primary Care Practices for Implementation Research During COVID-19: A Qualitative Study of Practice Coaches from the Stop Unhealthy (STUN) Alcohol Use Now Trial—this article examines the barriers and facilitators for practice- based research during the COVID-19 pandemic through interviews with practice facilitators.
