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1.
JAMA Netw Open ; 5(1): e2142046, 2022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34982158

RESUMO

Importance: The COVID-19 pandemic has had a distinct spatiotemporal pattern in the United States. Patients with cancer are at higher risk of severe complications from COVID-19, but it is not well known whether COVID-19 outcomes in this patient population were associated with geography. Objective: To quantify spatiotemporal variation in COVID-19 outcomes among patients with cancer. Design, Setting, and Participants: This registry-based retrospective cohort study included patients with a historical diagnosis of invasive malignant neoplasm and laboratory-confirmed SARS-CoV-2 infection between March and November 2020. Data were collected from cancer care delivery centers in the United States. Exposures: Patient residence was categorized into 9 US census divisions. Cancer center characteristics included academic or community classification, rural-urban continuum code (RUCC), and social vulnerability index. Main Outcomes and Measures: The primary outcome was 30-day all-cause mortality. The secondary composite outcome consisted of receipt of mechanical ventilation, intensive care unit admission, and all-cause death. Multilevel mixed-effects models estimated associations of center-level and census division-level exposures with outcomes after adjustment for patient-level risk factors and quantified variation in adjusted outcomes across centers, census divisions, and calendar time. Results: Data for 4749 patients (median [IQR] age, 66 [56-76] years; 2439 [51.4%] female individuals, 1079 [22.7%] non-Hispanic Black individuals, and 690 [14.5%] Hispanic individuals) were reported from 83 centers in the Northeast (1564 patients [32.9%]), Midwest (1638 [34.5%]), South (894 [18.8%]), and West (653 [13.8%]). After adjustment for patient characteristics, including month of COVID-19 diagnosis, estimated 30-day mortality rates ranged from 5.2% to 26.6% across centers. Patients from centers located in metropolitan areas with population less than 250 000 (RUCC 3) had lower odds of 30-day mortality compared with patients from centers in metropolitan areas with population at least 1 million (RUCC 1) (adjusted odds ratio [aOR], 0.31; 95% CI, 0.11-0.84). The type of center was not significantly associated with primary or secondary outcomes. There were no statistically significant differences in outcome rates across the 9 census divisions, but adjusted mortality rates significantly improved over time (eg, September to November vs March to May: aOR, 0.32; 95% CI, 0.17-0.58). Conclusions and Relevance: In this registry-based cohort study, significant differences in COVID-19 outcomes across US census divisions were not observed. However, substantial heterogeneity in COVID-19 outcomes across cancer care delivery centers was found. Attention to implementing standardized guidelines for the care of patients with cancer and COVID-19 could improve outcomes for these vulnerable patients.


Assuntos
COVID-19/epidemiologia , Neoplasias/epidemiologia , Pandemias , População Rural , Vulnerabilidade Social , População Urbana , Idoso , Causas de Morte , Censos , Feminino , Instalações de Saúde , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Razão de Chances , Sistema de Registros , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Análise Espacial , Estados Unidos/epidemiologia
4.
PLoS One ; 17(1): e0260836, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34995283

RESUMO

In the era of open data, Poisson and other count regression models are increasingly important. Still, conventional Poisson regression has remaining issues in terms of identifiability and computational efficiency. Especially, due to an identification problem, Poisson regression can be unstable for small samples with many zeros. Provided this, we develop a closed-form inference for an over-dispersed Poisson regression including Poisson additive mixed models. The approach is derived via mode-based log-Gaussian approximation. The resulting method is fast, practical, and free from the identification problem. Monte Carlo experiments demonstrate that the estimation error of the proposed method is a considerably smaller estimation error than the closed-form alternatives and as small as the usual Poisson regressions. For counts with many zeros, our approximation has better estimation accuracy than conventional Poisson regression. We obtained similar results in the case of Poisson additive mixed modeling considering spatial or group effects. The developed method was applied for analyzing COVID-19 data in Japan. This result suggests that influences of pedestrian density, age, and other factors on the number of cases change over periods.


Assuntos
COVID-19/epidemiologia , Humanos , Japão/epidemiologia , Cadeias de Markov , Modelos Estatísticos , Método de Monte Carlo , Distribuição Normal , Distribuição de Poisson , Análise de Regressão , SARS-CoV-2/patogenicidade , Análise Espacial , Análise Espaço-Temporal
5.
Proc Natl Acad Sci U S A ; 119(2)2022 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-34983870

RESUMO

Pooled testing increases efficiency by grouping individual samples and testing the combined sample, such that many individuals can be cleared with one negative test. This short paper demonstrates that pooled testing is particularly advantageous in the setting of pandemics, given repeated testing, rapid spread, and uncertain risk. Repeated testing mechanically lowers the infection probability at the time of the next test by removing positives from the population. This effect alone means that increasing frequency by x times only increases expected tests by around [Formula: see text] However, this calculation omits a further benefit of frequent testing: Removing infections from the population lowers intragroup transmission, which lowers infection probability and generates further efficiency. For this reason, increasing testing frequency can paradoxically reduce total testing cost. Our calculations are based on the assumption that infection rates are known, but predicting these rates is challenging in a fast-moving pandemic. However, given that frequent testing naturally suppresses the mean and variance of infection rates, we show that our results are very robust to uncertainty and misprediction. Finally, we note that efficiency further increases given natural sampling pools (e.g., workplaces, classrooms) that induce correlated risk via local transmission. We conclude that frequent pooled testing using natural groupings is a cost-effective way to provide consistent testing of a population to suppress infection risk in a pandemic.


Assuntos
Programas de Rastreamento/economia , Programas de Rastreamento/métodos , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Teste para COVID-19 , Análise Custo-Benefício , Humanos , Vigilância da População , Prevalência , SARS-CoV-2/isolamento & purificação , Incerteza
7.
Sci Rep ; 12(1): 273, 2022 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-34997001

RESUMO

The coronavirus pandemic has disproportionally impacted racial and ethnic minority communities in the United States. Patterns of these disparities may be changing over time as outbreaks occur in different communities. Utilizing electronic health record data from the US Department of Veterans Affairs (VA), we estimated odds ratios, stratified by time period and region, for testing positive among 1,313,402 individuals tested for SARS-CoV-2 between February 12, 2020 and August 16, 2021 at VA medical facilities. We adjusted for personal characteristics (sex, age, rural/urban residence, VA facility) and a wide range of clinical characteristics that have been evaluated in prior SARS-CoV-2 reports and could potentially explain racial/ethnic disparities in SARS-CoV-2. Our study found racial and ethnic disparities for testing positive were most pronounced at the beginning of the pandemic and decreased over time. A key finding was that the disparity among Hispanic individuals attenuated but remained elevated, while disparities among Asian individuals reversed by March 1, 2021. The variation in racial and ethnic disparities in SARS-CoV-2 positivity by time and region, independent of underlying health status and other demographic characteristics in a nationwide cohort, provides important insight for strategies to prevent further outbreaks.


Assuntos
COVID-19/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Rural , SARS-CoV-2/isolamento & purificação , Estados Unidos/epidemiologia , População Urbana , Adulto Jovem
10.
Pediatrics ; 149(1)2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34972222

RESUMO

A physician workforce that reflects the patient population is associated with improved patient outcomes and promotes health equity. Notwithstanding, racial and ethnic disparities persist within US medical schools, making some individuals underrepresented in medicine (URM). We sought to increase the percentage of URM residents who matched into our pediatric residency programs from a baseline of 5% to 35% to achieve demographic parity with our patients. We developed a multifaceted approach using multiple iterative tests of change, with the primary strategy being increased visibility of URM trainees and faculty to residency applicants. Strategies included applicant interviews with URM faculty, interview dinners with URM residents, visibility at academic conferences for URM trainees, development of targeted marketing materials, and a visiting student program supported by networking with URM residents. The primary outcome measure was the percentage of matched residents in the categorical pediatrics, child neurology, and medical genetics training programs who identified as URM. The percentage of URM residents increased to 16% (6 of 37) in 2018, 26% (11 of 43) in 2019, 19% (8 of 43) in 2020, and 21% (9 of 43) in 2021 (a four-year average of 22% URM residents; P = .0002). This progress toward a more representative residency program was met by challenges, such as pipeline concerns, the minority tax, and recruitment during a pandemic. We were able to implement small, low-resource strategies that had a large cumulative impact and could be implemented in other residency programs. Specific tactics and challenges encountered are discussed in this special article.


Assuntos
Internato e Residência/organização & administração , Grupos Minoritários/estatística & dados numéricos , Pediatria/educação , Desenvolvimento de Programas , COVID-19/epidemiologia , Equidade em Saúde , Humanos , Internato e Residência/estatística & dados numéricos , Pandemias , Pediatras/provisão & distribuição , Estados Unidos/epidemiologia
14.
J Cyst Fibros ; 20 Suppl 3: 1-2, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34930534

RESUMO

The findings of this body of work are presented in the eight articles included in this supplement. The impact and perspectives of adult and pediatric care teams and patient/families are covered with special attention to mental health care, the financial and personnel impacts within care programs, the experiences of vulnerable and underrepresented patient populations, and implementation of remoting monitoring. Commentaries from colleagues provide a broader perspective, offering reflections on the findings and their implications regarding the future CF care model.


Assuntos
COVID-19 , Fibrose Cística , Prestação Integrada de Cuidados de Saúde/organização & administração , Atenção à Saúde/tendências , Telemedicina , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Continuidade da Assistência ao Paciente , Fibrose Cística/epidemiologia , Fibrose Cística/terapia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Humanos , Inovação Organizacional , SARS-CoV-2 , Telemedicina/organização & administração , Telemedicina/normas , Estados Unidos/epidemiologia
15.
J Cyst Fibros ; 20 Suppl 3: 16-20, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34930535

RESUMO

BACKGROUND: Chronic care delivery models faced unprecedented financial pressures, with a reduction of in-person visits and adoption of telehealth during the COVID-19 pandemic. We sought to understand the reported financial impact of pandemic-related changes to the cystic fibrosis (CF) care model. METHODS: The U.S. CF Foundation State of Care surveys fielded in Summer 2020 (SoC1) and Spring 2021 (SoC2) included questions for CF programs on the impact of pandemic-related restrictions on overall finances, staffing, licensure, and reimbursement of telehealth services. Descriptive analyses were conducted based on program type. RESULTS: Among the 286 respondents (128 pediatric, 118 adult, 40 affiliate), the majority (62%) reported a detrimental financial impact to their CF care program in SoC1, though fewer (42%) reported detrimental impacts in SoC2. The most common reported impacts in SoC1 were redeployment of clinical staff (68%), furloughs (52%), hiring freezes (51%), decreases in salaries (34%), or layoffs (10%). Reports of lower reimbursement for telehealth increased from 30% to 40% from SoC1 to SoC2. Projecting towards the future, only a minority (17%) of program directors in SoC2 felt that financial support would remain below pre-pandemic levels. CONCLUSIONS: The COVID-19 pandemic resulted in financial strain on the CF care model, including challenges with reimbursement for telehealth services and reductions in staffing due to institutional changes. Planning for the future of CF care model needs to address these short-term impacts, particularly to ensure a lack of interruption in high-quality multi-disciplinary care.


Assuntos
COVID-19 , Continuidade da Assistência ao Paciente , Fibrose Cística , Acesso aos Serviços de Saúde , Modelos Organizacionais , Telemedicina , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Custos e Análise de Custo , Fibrose Cística/economia , Fibrose Cística/epidemiologia , Fibrose Cística/terapia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde , Humanos , Inovação Organizacional , Admissão e Escalonamento de Pessoal/organização & administração , Mecanismo de Reembolso/tendências , SARS-CoV-2 , Telemedicina/economia , Telemedicina/métodos , Estados Unidos/epidemiologia
16.
J Cyst Fibros ; 20 Suppl 3: 23-28, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34930537

RESUMO

BACKGROUND: The COVID-19 pandemic forced cystic fibrosis (CF) care programs to rapidly shift from in-person care delivery to telehealth. Our objective was to provide a qualitative exploration of facilitators and barriers to: 1) implementing high-quality telehealth and 2) navigating reimbursement for telehealth services. METHODS: We used data from the 2020 State of Care CF Program Survey (n=286 U.S. care programs) administered in August-September to identify two cohorts of programs, with variation in telehealth quality (n=12 programs) and reimbursement (n=8 programs). We conducted focus groups and semi-structured interviews with CF program directors and coordinators in December 2020, approximately 9 months from onset of the pandemic. We used the Consolidated Framework for Implementation Research to identify facilitators and barriers of implementation, and inductive thematic analysis to identify facilitators and barriers of reimbursement. RESULTS: Factors differentiating programs with greater and lower perceived telehealth quality included telehealth characteristics (perceived advantage over in-person care, cost, platform quality); external influences (needs and resources of those served by the CF program), characteristics of the CF program (compatibility with workflows, relative priority, available resources); characteristics of team members (individual stage of change), and processes for implementation (engaging patients and teams). Reimbursement barriers included documentation to optimize billing; reimbursement of multi-disciplinary team members, remote monitoring, and telephone-only telehealth; and lower volume of patients. CONCLUSIONS: A number of factors are associated with successful implementation and reimbursement of telehealth. Future efforts should provide guidance and incentives that support telehealth delivery and infrastructure, share best practices across CF programs, and remove barriers.


Assuntos
COVID-19 , Barreiras de Comunicação , Fibrose Cística , Transmissão de Doença Infecciosa/prevenção & controle , Acesso aos Serviços de Saúde , Participação do Paciente , Telemedicina , Adulto , Atitude do Pessoal de Saúde , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Fibrose Cística/epidemiologia , Fibrose Cística/psicologia , Fibrose Cística/terapia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Humanos , Determinação de Necessidades de Cuidados de Saúde , Participação do Paciente/métodos , Participação do Paciente/psicologia , Pesquisa Qualitativa , Melhoria de Qualidade , Mecanismo de Reembolso , SARS-CoV-2 , Telemedicina/economia , Telemedicina/métodos , Telemedicina/normas , Estados Unidos/epidemiologia
17.
J Cyst Fibros ; 20 Suppl 3: 3-8, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34930539

RESUMO

BACKGROUND: Novel therapies have dramatically changed cystic fibrosis (CF) and innovative care delivery systems are needed to meet future patient needs. Telehealth has been shown to be an efficient and desirable form of care delivery. The COVID-19 pandemic caused a rapid shift to telehealth, and this presented a unique opportunity to study facilitators, barriers, and satisfaction with this mode of care delivery. We aim to report survey methods, demographics and telehealth use among CF care programs, patients, and families during the pandemic. METHODS: CF programs completed two surveys between July 29 and September 18, 2020, and between April 19 and May 19, 2021. Patients and families completed a similar survey between August 31 and October 30, 2020. The surveys addressed topics assessing the pandemic's financial impact, telehealth modes and experiences, licensure and reimbursement issues, health screening, and remote monitoring. Quantitative data were analyzed with descriptive statistics and were compared to the CF Foundation Patient Registry. RESULTS: Most programs (278 at timepoint one and 274 at timepoint two) provided telehealth during the pandemic. The percent of visits containing either telephone or video components changed from 45% to 25% over the time periods. Additionally, 424 patients and families from various ages and backgrounds responded to the survey and 81% reported having a telehealth visit. CONCLUSIONS: The pandemic accelerated telehealth adoption and these datasets are a valuable source for exploring telehealth barriers and facilitators, the quality-of-care experience, financial and workforce implications, the impact on underrepresented populations, and implications for coverage and reimbursement.


Assuntos
COVID-19 , Fibrose Cística , Acesso aos Serviços de Saúde , Telemedicina , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Controle de Doenças Transmissíveis/métodos , Barreiras de Comunicação , Continuidade da Assistência ao Paciente , Custos e Análise de Custo , Fibrose Cística/epidemiologia , Fibrose Cística/psicologia , Fibrose Cística/terapia , Feminino , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Humanos , Masculino , Inovação Organizacional , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde , SARS-CoV-2 , Telemedicina/organização & administração , Telemedicina/normas , Estados Unidos/epidemiologia
18.
J Cyst Fibros ; 20 Suppl 3: 41-46, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34930542

RESUMO

BACKGROUND: During the COVID-19 pandemic, CF centers shifted to a telehealth delivery model. Our study aimed to determine how people with CF (PwCF) and their families experienced telehealth and assessed its quality and acceptability for future CF care. METHODS: The CF Patient and Family State of Care Survey (PFSoC) was fielded from August 31-October 30, 2020. The PFSoC explored themes of overall telehealth quality, ease of use, desirability, and preference for a future mix of in-person and telehealth care. Demographic covariates considered included: gender, age, CFTR modulator status, and region of residence. RESULTS: 424 PwCF and parents of PwCF responded (47% parents). Most (81%) reported a telehealth visit which included a MD/APP and nurse team members. 91% found telehealth easy to use, and 66% reported similar/higher quality than in-person care. One-third (34%) reported the highest desire for future telehealth care, with 45% (n =212) desiring 50% or more of visits conducted via telehealth. Adults were more likely than parents to report highest desire for future telehealth (64% vs. 36%). Respondents who perceived telehealth as similar/higher quality were more likely to desire future telehealth compared to those who perceived telehealth as lower quality (96% vs. 50%). Mixed methods analysis revealed themes affecting perceptions of telehealth. CONCLUSIONS: PwCF desire for future telehealth was influenced by perception of quality and age. Several themes emerged that need to be explored as telehealth is adapted into the CF chronic care model, especially when thinking about integration into pediatric care.


Assuntos
COVID-19 , Barreiras de Comunicação , Comportamento do Consumidor/estatística & dados numéricos , Fibrose Cística , Transmissão de Doença Infecciosa/prevenção & controle , Telemedicina , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Fibrose Cística/epidemiologia , Fibrose Cística/psicologia , Fibrose Cística/terapia , Saúde da Família , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Humanos , Modelos Organizacionais , Participação do Paciente/métodos , Participação do Paciente/psicologia , Pediatria/métodos , Pediatria/tendências , Melhoria de Qualidade , Qualidade da Assistência à Saúde/tendências , SARS-CoV-2 , Telemedicina/métodos , Telemedicina/organização & administração , Telemedicina/normas , Estados Unidos/epidemiologia
19.
J Cyst Fibros ; 20 Suppl 3: 49-54, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34930543

RESUMO

BACKGROUND: Due to the COVID-19 pandemic, there was an uptake of telehealth in cystic fibrosis care. Previous studies show disparities in telehealth use based on socioeconomic status (SES). We aimed to: (1) understand telehealth use and perceptions and (2) identify the facilitators and barriers to telehealth use among people with CF and their families (PwCF) from diverse racial/ethnic and socioeconomic backgrounds. METHODS: We conducted an analysis of the 2020 Cystic Fibrosis State of Care surveys completed by PwCF (PFSoC), CF Care Programs (SoC1) and the CF Foundation Patient Registry (CFFPR). RESULTS: A total of 424 PwCF and 286 programs responded to the PFSoC and SoC1. Among PwCF, 90% self-identified as White, 6% as Hispanic/Latino, and 2% as Black. Racial/ethnic minorities were less likely to have had a telehealth visit (p=.015). This difference was pronounced among the Hispanic/Latino population (p<.01). Telehealth use did not differ by health insurance and was similarly offered independent of financial status. Compared to PwCF who denied financial constraints, those who reported financial difficulties found telehealth more difficult to use (p=.018) and were less likely to think that their concerns (p=.010) or issues that mattered most to them (p=.020) were addressed during telehealth. Programs perceived lack of technology, language barriers, and home conditions as barriers to telehealth in vulnerable populations. CONCLUSION: PFSoC and SoC1 identified differences in telehealth use and care perceptions by ethnicity, race, and socioeconomic characteristics. Further studies are needed to understand how telehealth can change access to CF care in diverse subpopulations.


Assuntos
COVID-19 , Barreiras de Comunicação , Fibrose Cística , Saúde das Minorias , Telemedicina , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Fibrose Cística/economia , Fibrose Cística/etnologia , Fibrose Cística/psicologia , Fibrose Cística/terapia , Estresse Financeiro/etnologia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/normas , Humanos , Saúde das Minorias/etnologia , Saúde das Minorias/normas , Saúde das Minorias/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Inovação Organizacional , SARS-CoV-2 , Fatores Socioeconômicos , Telemedicina/organização & administração , Telemedicina/normas , Estados Unidos/epidemiologia , Populações Vulneráveis/estatística & dados numéricos
20.
J Cyst Fibros ; 20 Suppl 3: 57-63, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34930544

RESUMO

BACKGROUND: Cystic fibrosis (CF) programs and people with CF (PwCF) employed various monitoring methods for virtual care during the COVID-19 pandemic. This paper characterizes experiences with remote monitoring across the U.S. CF community. METHODS: The CF Foundation (CFF) sponsored distribution of home spirometers (April 2020 to May 2021), surveys to PwCF and CF programs (July to September 2020), and a second program survey (April to May 2021). We used mixed methods to explore access, use, and perspectives regarding the use of remote monitoring in future care. RESULTS: By October 2020, 13,345 spirometers had been distributed, and 19,271 spirometers by May 2021. Programs (n=286) estimated proportions of PwCF with home devices increased over seven months: spirometers (30% to 70%), scales (50% to 70%), oximeters (5% to 10%) with higher estimates in adult programs for spirometers and oximeters. PwCF (n=378) had access to scales (89%), followed by oximeters (48%) and spirometers (47%), often using scales and oximeters weekly, and spirometers monthly. Over both surveys, some programs had no method to collect respiratory specimens for cultures associated with telehealth visits (47%, n=132; 41%, n=118). Most programs (81%) had a process for phlebotomy associated with a telehealth visit, primarily through off-site labs. Both PwCF and programs felt future care should advance remote monitoring and recommended improvements for access, training, and data collection systems. CONCLUSIONS: PwCF and programs experienced unprecedented access to remote monitoring and raised its importance for future care. Improvements to current systems may leverage these shared experiences to augment future care models.


Assuntos
COVID-19 , Fibrose Cística , Equipamentos e Provisões/provisão & distribuição , Serviços de Assistência Domiciliar , Monitorização Fisiológica/métodos , Espirometria , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Fibrose Cística/diagnóstico , Fibrose Cística/epidemiologia , Fibrose Cística/terapia , Atenção à Saúde/organização & administração , Atenção à Saúde/tendências , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Serviços de Assistência Domiciliar/organização & administração , Serviços de Assistência Domiciliar/normas , Humanos , Modelos Organizacionais , Determinação de Necessidades de Cuidados de Saúde , Oximetria/instrumentação , Oximetria/métodos , Melhoria de Qualidade , SARS-CoV-2 , Espirometria/instrumentação , Espirometria/métodos , Telemedicina/métodos , Telemedicina/normas , Estados Unidos/epidemiologia
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