SCC-PG: Optimizing sociotechnical interventions for healthcare access using community sensing

卫生保健系统越来越多地认识到健康的社会决定因素（SDOH）在影响个人获得促进健康的资源和生活环境的能力方面的至关重要性。SDOH的一个要素是交通不便，指的是在个人和社区一级缺乏可靠的交通，每年约有360万人无法及时获得医疗服务，对有色人种、农村社区、残疾人和低收入人口的影响尤为严重。在卫生系统寻求干预措施以减少TD导致的卫生不平等之际，将社会和卫生数据与决策、干预措施设计和影响评估整合和联系起来的过程变得至关重要。为了解决这些差距，SCC-PG项目将通过利用行业合作伙伴关系、新颖的数据收集和计算方法以及利益相关者的参与，长期推进基于数据的时间和地点响应式TD解决方案和其他SDOH干预措施。通过整合社区和个人层面的数据来衡量TD，本研究将展示创新的资源分配模型，最终减少获得医疗保健的交通障碍，提高卫生公平性。虽然TD是公认的阻碍医疗保健获取的障碍，但其定义、影响和相关干预措施的调查和实施都是零散的。了解这些关系有助于设计定制的干预措施，以减少TD造成的健康差异。卫生保健系统目前依赖于粗糙的数据，不能充分捕捉社区内SDOH需求的时空变化。数据源之间的互操作性以及如何将SDOH数据纳入决策也不清楚。通过规划拨款，我们的工作将1)通过广泛的利益相关者参与，促进对环境保护的社会生态学理论的了解；2)开发社区感知方法，解决缺乏粒度TD/SDOH数据的问题，以便进行全面分析；3)在北卡罗来纳州6个县的移动诊所试点项目中，展示了将多层次TD/SDOH数据整合到决策优化框架中的效果。我们的社会技术方法为基于系统的框架奠定了基础，以智能、可持续和整体的方式解决SDOH问题。这项工作的目的是改善个人和社区的福祉，侧重于能够显著改善人口健康和公平的初级预防和上游减少风险战略。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

Healthcare systems are increasingly recognizing the critical importance of the social determinants of health (SDOH) in impacting an individual’s ability to access health-promoting resources and living environments. One element of SDOH, transportation disadvantage (TD), refers to the absence of reliable transportation at the individual and community level, preventing an estimated 3.6 million people per year from accessing timely medical care, disproportionately impacting people of color, rural communities, disabled people, and low-income populations. The process of integrating and connecting social and health data to decision making, intervention design, and impact evaluation become critical as health systems seek interventions to lessen health inequity attributable to TD. To address these gaps, this SCC-PG project will advance data-informed time and place-responsive TD solutions and other SDOH interventions in the long term by leveraging industry partnerships, novel data collection and computational methods, and stakeholder engagement. By integrating community and individual level data to measure TD, this research will demonstrate innovative resource allocation models, ultimately reducing transportation barriers to healthcare access and improving health equity. While TD is a recognized barrier to healthcare access, its definition, impacts, and associated interventions are investigated and implemented in a fragmented manner. Understanding these relationships can support the design of customized interventions to reduce health disparities resulting from TD. Healthcare systems currently rely on coarse data that do not adequately capture spatial and temporal variations of SDOH needs within communities. Interoperability between data sources and how SDOH data will be incorporated into decision-making is also unclear. Through the planning grant, our work will 1) advance knowledge on socioecological theories of TD through extensive stakeholder engagement; 2) develop community sensing methods to address lack of granular TD/SDOH data to enable comprehensive analysis; and 3) demonstrate the integration of multilevel TD/SDOH data into optimization frameworks for decision-making for a mobile clinic pilot project in 6 North Carolina counties. Our sociotechnical approach lays the foundation for a systems-based framework to address SDOH in a smart, sustainable, and holistic manner. This work aims to improve the well-being of individuals and communities by focusing on primary prevention and upstream risk reduction strategies that can significantly improve population health and equity.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.