Evidence based Interventions to address Structure, System and Population Inequities in COVID-19 Screening

这项建议的目的是确定个人、社区(人口)和相关的结构性因素 新英格兰北部(NNE)的新冠肺炎测试率较低，重点是服务不足和 弱势群体。我们的研究包括几个在医学和/或社会上易受伤害的新冠肺炎 人口：社会脆弱性高的社区；居住在社区的老年人；个人 已知的医疗合并症会增加严重新冠肺炎的风险，特别是农村和偏远地区 社区。在分析上，我们将首先定性地估计个人、人口和结构因素 与新冠肺炎检测的较高或较低概率相关联 Payer索赔两个州的数据，拥有州级新冠肺炎测试数据和疾控中心VULNERABLE 社区指数。我们还将评估在西北地区新冠肺炎测试中差异的地理空间分布 使用地理信息系统方法检查测试中心密度和距离等因素 测试率。我们将利用佛蒙特州和缅因州在结构上的差异来确定系统级别 因素，包括提供商可访问性、测试可用性和提供商支付规则。我们的主要成果将是 年服务不足和弱势人群中的新冠肺炎检测、住院和超额死亡率 不会的。我们将通过焦点小组来加强定量分析，以确定测试的其他障碍。我们 将与弱势群体中的个人开展多个焦点小组，以确定新冠肺炎的障碍 测试。 一旦我们确定了造成障碍的个人、社区(人口)和结构性因素 新冠肺炎检测和超额死亡率，我们将通过两种不同的方式测试潜在的干预措施，首先，我们将 在NNE的弱势社区和 对全国有代表性的农村成年人样本进行测试，以使用假设增加测试的最优策略 场景。第二，利用农村通信网测试定向通信的效果 使用最佳通信策略来促进增加测试，并在通信发生变化时进行测试 个人行为和减少健康差距。这项研究将与 佛蒙特州和缅因州卫生部以及众多社区合作伙伴。

The purpose of this proposal is to identify individual, community (population) and structural factors associated with lower rates of Covid-19 testing in Northern New England (NNE), with a focus on underserved and vulnerable populations. Our study includes several COVID-19 medically and/or socially vulnerable populations: communities with high levels of social vulnerability; community-dwelling older adults; individuals with medical comorbidities known to increase risk of severe COVID-19 and, particularly, rural and remote communities. Analytically, we will first qualitatively estimate individual, population and structural factors associated with higher or lower probability of having been tested for COVID-19 by combine comprehensive all- payer claims data across two states with state-level COVID-19 testing data and the CDC vulnerable community index. We will also assess the geospatial distribution of disparities in COVID-19 testing in NNE using geographic information system methods to examine factors like testing center density and distance on testing rates. We will exploit differences in structure between Vermont and Maine to identify system level factors, including provider accessibility, testing availability and provider payment rules. Our key outcomes will be COVID-19 testing, hospitalizations and excess mortality among underserved and vulnerable populations in NNE. We will augment the quantitative analysis with focus groups to identify additional barriers to testing. We will conduct multiple focus groups with individuals from vulnerable populations to identify barriers to COVID-19 testing. Once we have identified the individual, community (population) and structural factors that create barriers to COVID-19 testing and excess mortality, we will test potential interventions in two different ways, First, we will develop and deploy a Discrete Choice Experiment (DCE) both in vulnerable communities in NNE and in a nationally representative sample of rural adults to test optimal strategies to increase testing using hypothetical scenarios. Second, we will test the effect of targeted communication using a rural communication network using optimal communication strategies to facilitate increased testing and test if the communications change individual behavior and reduce health disparities. This study will be conducted in partnership with the Department of Health in both Vermont and Maine and numerous community partners.