Long-Term Effects of COVID-19-induced Health Care Delivery Changes on Patient & Workforce Processes & Outcomes in Safety Net Practices Caring for Health Disparity Populations ABSTRACT / PROJECT SUMMARY Primary care provides more than half of all outpatient visits ― 500 million each year ― with only 30% of the healthcare workforce and <6% of national healthcare expenditure, informed by only 0.2% of the NIH research budget. Healthcare systems based on primary care have healthier populations, greater equity, and lower costs. Our ongoing national practice and patient surveys show that the pandemic and resulting ongoing health care system and social changes are having a devastating effects on the primary care workforce and its ability to integrate and personalize care in a fragmented, impersonal, inequitable healthcare system. Yet, amidst the COVID-19 natural disaster, ongoing primary care innovations provide hope for advancing equity for health disparity populations. We have a unique opportunity to study the effects of the pandemic in a national network of 926 community health centers serving >2.6 million patients from health disparity populations. The proposed study will: 1) Identify changes in health care delivery to health disparity populations in community health centers in response to the continuing practice, social and policy changes launched by the COVID-19 pandemic; 2) Assess the longitudinal impact of these practice changes on care quality in health disparity populations; 3) Examine the ongoing effects of these changes on community health center workforce stability; 4) Identify promising strategies to improve healthcare equity after a natural disaster & varied human response. In response to PA-20-172: Long-Term Effects of Disasters on Health Care Systems Serving Health Disparity Populations, we will conduct a time series analysis of practice changes and associated patient and workforce outcomes initiated by the COVID-19 pandemic and the ongoing changes stimulated by it. Monthly analyses will examine longitudinal changes in practice processes, patient outcomes, and workforce stability for health disparity and other at-risk populations. For a five-year period going back to January 2020 ― the month of the first known COVID-19 case in the US and the start of responding public health and practice changes ― we will analyze and publicly report, on a monthly basis, practice changes and patient outcomes, to rapidly inform decision making about primary care of health disparity populations. Subgroup analyses will examine differences across 26 states that have had different societal responses to the pandemic. The findings from these quantitative analyses of millions of patients being seen in hundreds of community health centers also will be used to identify a purposive sample of exemplars and contrasting practices for in-depth case studies of practice innovations that show promise in reducing healthcare disparities. Findings will generate vital ne...