RAPID COVID-19: Sociotechnical Systems and Complexity Reduction: Enhancing Access to Digital Essential Services for Low-Income Communities during a Public Health Crisis

RAPID COVID-19：社会技术系统和复杂性降低：在公共卫生危机期间增强低收入社区获得数字基本服务的机会

• 批准号: 2031662
• 负责人: Tiffany Veinot
• 金额: $ 19.99万
• 依托单位: Regents of the University of Michigan - Ann Arbor
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=2031662&HistoricalAwards=false
• 关键词: RAPID; COVID; 19; Sociotechnical; Systems

This RAPID research will assess and develop remedies for the problems low-income Americans have using online systems for communicating with clinicians and getting accurate and timely medical advice from them, especially crucial during the current crisis. The COVID-19 pandemic has resulted in disruptions in the usual operations of healthcare services. However, such services are more essential now than ever; consequently, many organizations have rapidly transitioned to providing them digitally. Yet, these efforts are impeded by the lack of preexisting socio-technical infrastructures. It is also unclear what role the complexity of tasks, systems, resource requirements, and overall processes plays in the ability of low-income users to use such services, and whether they may benefit from service digitization. This is critical to understand in low income communities where many residents have limited access to broadband Internet and newer devices, and have fewer digital literacy skills. Consequently, they are more likely to experience barriers to digital service use. This is cause for concern since health informatics research has shown that technologies that increase effort for health-related activities can widen socioeconomic inequalities in health. However, past human-computer interaction research suggests that intermediaries such as non-profit organizations and family members can mitigate such barriers in low-income contexts. In line with NSF RAPID goals, the study will gather ephemeral data concerning the challenges faced by a cadre of first-time, low-income telehealth users. It will also gather information concerning technology intermediation during this crisis, including ad-hoc and temporary solutions that may soon disappear or fade from memory, and will disseminate results quickly in order to reduce harm to low-income Americans during this health crisis. This project aims to address these difficulties and prevent unequal benefit through sociotechnical design for complexity reduction, including use of technology intermediaries. Study Aim 1 is to assess the complexity of telehealth services for low-income residents of the Detroit metropolitan area, and create methods for simplification. This will involve heuristic evaluation, remote user evaluation of existing telehealth services with low-income Metro Detroiters, and design of a "simplified process intervention." Aim 2 is to develop a novel intervention for access to essential telehealth services in which trained masters students will serve as intermediaries for federally-qualified health center (FQHC) patients as they access telehealth - many for the first time. Design of this intervention will build on insights from interviews with formal and informal technology intermediaries for Metro Detroiters, and people who have used intermediaries. Aim 3 involves a pilot evaluation of the interventions from Aims 1 and 2. Interviews, observations, and surveys will assess patient response to the interventions, and intermediary work. Electronic health record and telehealth platform data will be used to evaluate impact on health care access in the form of call quality and length. The research will also investigate potential differences based on patient demographics. This project involves collaborations among university researchers, a Metropolitan Detroit-based FQHC with six clinical locations, and a nonprofit organization focused on economic opportunity for Detroit residents.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.

这项快速的研究将评估和制定疗法，以解决低收入美国人使用在线系统与临床医生进行交流并从中获得准确，及时的医疗建议，尤其是在当前危机期间至关重要的问题。 COVID-19大流行导致医疗服务通常运营的中断。但是，这种服务现在比以往任何时候都更为重要。因此，许多组织已迅速过渡到以数字方式提供它们。然而，由于缺乏已经存在的社会技术基础设施，这些努力阻碍了这些努力。还不清楚任务，系统，资源需求和整体流程的复杂性在低收入用户使用此类服务​​的能力以及是否可以从服务数字化中受益。这对于了解许多居民获得宽带互联网和更新设备并且具有更少数字扫盲技能的低收入社区至关重要。因此，他们更有可能遇到数字服务的障碍。这是引起关注的原因，因为健康信息学研究表明，增加与健康相关活动努力的技术可以扩大健康中的社会经济不平等。但是，过去的人类互动研究表明，非营利组织和家庭成员等中介机构可以在低收入环境中缓解此类障碍。 根据NSF快速目标，该研究将收集有关首次低收入远程医疗使用者干部所面临的挑战的短暂数据。它还将收集有关这场危机中技术中介的信息，包括可能很快就会消失或从记忆中消失的临时解决方案，并将迅速传播结果，以减少对这场健康危机期间对低收入美国人的伤害。该项目旨在解决这些困难，并通过社会技术设计降低复杂性，包括使用技术中介机构，以防止不平等的收益。研究目标1是评估底特律大都会地区低收入居民的远程医疗服务的复杂性，并创建简化方法。这将涉及启发式评估，低收入底特律对现有远程医疗服务的远程用户评估以及“简化过程干预”的设计。 AIM 2是开发一种新的干预措施，以获取基本远程医疗服务，在该服务中，受过训练的硕士学生将作为联邦合格健康中心（FQHC）患者的中介机构，因为他们是第一次获得远程医疗 - 许多。这种干预措施的设计将基于对底特律地铁和使用中介人的正式和非正式技术中介机构的访谈的见解。 AIM 3涉及对目标1和2的干预措施的试点评估。访谈，观察和调查将评估患者对干预措施的反应以及中介工作。电子健康记录和远程医疗平台数据将以呼叫质量和长度的形式评估对医疗保健访问的影响。这项研究还将根据患者人口统计研究研究潜在的差异。该项目涉及大学研究人员之间的合作，这是一项基于底特律大都会的FQHC，拥有六个临床地点，以及一个非营利组织，专注于底特律居民的经济机会。该奖项反映了NSF的法定任务，并被认为是通过使用该基金会的知识分子和更广泛影响的评估来评估CRITERIA CRITERIA CRITERIA的评估。