Intensifying Community Referrals for Health: The SINCERE Intervention to Address COVID-19 Health Disparities

加强社区健康转诊：解决 COVID-19 健康差异的真诚干预

• 批准号: 10405565
• 负责人: Andrea Schneider Wallace
• 金额: $ 74.28万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-14 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10405565
• 关键词: 2019-nCoV; Accident and Emergency department; Address; Age; Anxiety; Behavior; COVID testing; COVID-19; COVID-19 health disparity; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; COVID-19 prevention; COVID-19 susceptibility; Characteristics; Charge; Clinic; Clinic Visits; Clinical; Communities; Community Services; Computer software; Country; Data; Drops; Emergency Care; Emergency Department patient; Emergency department visit; Emotional; Environment; Ethnic Origin; Food; Gender; Goals; Health; Health Services Accessibility; Health Status; Health system; Hospitalization; Housing; Individual; Information Specialists; Intervention; Interview; Language; Location; Measures; Mental Depression; Methods; Modeling; Motivation; Outcome; Patients; Personal Satisfaction; Play; Policies; Population; Preventive; Process; Protocols documentation; Psyche structure; Public Health; Quarantine; Race; Randomized; Reporting; Research; Resources; Role; Rural; SARS-CoV-2 transmission; Sampling; Services; Site; Social Distance; System; Technology; Telephone; Testing; Transportation; Underserved Population; United States National Institutes of Health; Vaccines; base; behavioral economics; community based service; coping; coronavirus disease; cost; data exchange; disadvantaged population; effectiveness evaluation; efficacy study; experience; follow-up; health care availability; health disparity; health disparity populations; health information technology; health service use; improved; meetings; outreach; patient engagement; patient screening; post-COVID-19; pragmatic trial; programs; referral services; response; screening; screening services; service providers; social; social determinants; socioeconomic disadvantage; transmission process; treatment arm; treatment as usual; underserved community

PROJECT SUMMARY In an effort to slow transmission of the 2019 novel coronavirus (COVID-19, or COVID), communities worldwide have implemented strict quarantine policies. While these efforts appear to be having a positive public health impact, they are negatively impacting economies, limiting personal resources for both COVID+ and non- COVID infected patients, and exacerbating health disparities. Community service providers report steady increases in calls for resources (e.g., for food, housing, transportation) during the COVID-19 pandemic, particularly from underserved and underrepresented communities, and additional strain is being placed on health systems. There is a critical need to identify how to overcome community service access barriers during COVID-19, particularly for underserved communities. Our program of research has successfully leveraged existing, low-cost technology to conduct social needs screening during busy emergency department (ED) care, follow-up by United Way 211’s community referral service, and data exchange between systems, suggesting it may be a solution for understanding and meeting the needs of vulnerable and underserved patients during the COVID-19 pandemic. However, findings from our recent sample of approximately 5000 patients screened for social needs during ED visits and qualitative data from service providers, 211 community information specialists, ED Staff, and patients reveal that effectively addressing social needs and connecting to community service providers requires thoughtful, targeted approaches in order to develop relationships among patients and those involved in screening and outreach. Using a pragmatic trial approach in a sample of 1500 patients screened for social needs in ED and community-based and mobile COVID testing sites, the objective of this real world efficacy (NIH stage 3) study is to determine whether community service use for those with social needs improves general and COVID-related health outcomes, and whether random assignment to intensive follow-up and collaborative goal setting helps overcome barriers to community service use. We hypothesize that patients who use community services to meet social needs will experience improvement in general and COVID-specific health outcomes, and that patients randomized to a collaborative goal setting process with a 211 information specialist will have greater community service use. Given the unknown timeframe for social distancing measures needed during the months or years ahead, it is critical to broadly understand the barriers to, and facilitators of, COVID-19 prevention; and of how to address effects on social, mental, and physical wellbeing among COVID-19 vulnerable and socioeconomically disadvantaged populations.

项目总结 为了减缓2019年新型冠状病毒(新冠肺炎)的传播，世界各地的社区 实施了严格的检疫政策。虽然这些努力似乎对公众健康产生了积极的影响 影响，它们正在对经济产生负面影响，限制了COVID+和非 COVID感染患者，并加剧了健康差距。社区服务提供商报告稳定 新冠肺炎大流行期间对资源(例如，食物、住房、交通)的需求增加， 特别是来自服务不足和代表性不足的社区，正在施加额外的压力 卫生系统。迫切需要确定如何克服获得社区服务的障碍 新冠肺炎，特别是对于服务不足的社区。我们的研究计划成功地利用了 现有的低成本技术可在繁忙的急诊科(ED)护理期间进行社交需求筛选， 后续通过联合之路211‘S社区转诊服务，以及系统之间的数据交换，建议 可能是一种解决方案，以了解和满足弱势和服务不足的患者在 新冠肺炎大流行。然而，我们最近对大约5000名患者进行了筛查，结果显示 急诊期间的社会需求和服务提供者提供的定性数据，211个社区信息 专家、急诊科工作人员和患者透露，有效地满足社会需求并与社区建立联系 服务提供者需要深思熟虑、有针对性的方法来发展患者之间的关系 以及那些参与筛查和外展的人。在1500例患者样本中使用务实试验方法 在ED和基于社区的和流动的COVID测试点筛查社会需求，目的是 真实世界效能(美国国立卫生研究院第三阶段)的研究是确定社区服务是否适用于那些有社交能力的人 需要改善一般和与COVID相关的健康结果，以及随机分配到强化治疗 后续行动和协作目标设定有助于克服社区服务使用的障碍。我们假设 使用社区服务满足社会需求的患者将得到总体改善和 COVID特定的健康结果，患者随机参加一个协作的目标设定过程， 211信息专员将有更大的社区服务用途。考虑到社交网络的未知时间框架 对于未来几个月或几年所需的距离措施，广泛了解障碍是至关重要的 预防新冠肺炎；以及如何解决对社会、心理和身体的影响 新冠肺炎弱势群体和社会经济弱势群体的福祉。