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

解决 COVID-19 筛查中的结构、系统和人口不平等问题的循证干预措施

• 批准号: 10447381
• 负责人: Jan Kirk Carney
• 金额: $ 61.9万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-18 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10447381
• 关键词: Address; Adult; American; Behavior; Behavioral; Black, Indigenous, People of Color; COVID-19; COVID-19 disparity; COVID-19 pandemic; COVID-19 screening; COVID-19 testing; COVID-19 treatment; Caring; Centers for Disease Control and Prevention (U.S.); Communication; Communities; Community Health Aides; Complex; Data; Databases; Decision Making; Elderly; Evidence based intervention; Excess Mortality; Focus Groups; Geographic Information Systems; Grant; Health; Health Personnel; Health system; Healthcare; Home; Hospitalization; Individual; Inequality; Inpatients; Intervention; Location; Maine; Measures; Medical; Methods; Modeling; New England; Outcome; Patients; Policies; Population; Predictive Factor; Probability; Provider; Public Health; Qualitative Methods; Ramp; Reduce health disparities; Research; Resources; Risk; Rural; Rural Community; Rural Health; Rural Population; Sampling; Source; Structure; System; Testing; Underserved Population; Vermont; Vulnerable Populations; Work; bed capacity; care delivery; comorbidity; density; design; disadvantaged population; experience; experimental study; health communication; indexing; innovation; medical vulnerability; payment; remote communities; severe COVID-19; social; social vulnerability; vaccine delivery; vulnerable community

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.

本提案的目的是确定与此相关的个人、社区（人口）和结构因素 北方新英格兰（NNE）的COVID-19检测率较低，重点是服务不足和 弱势群体。我们的研究包括几个COVID-19医学和/或社会弱势群体 人口：社会脆弱程度高的社区;居住在社区的老年人;个人 患有已知会增加严重COVID-19风险的医学合并症，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体、人口和结构因素 与接受联合收割机全面检测COVID-19的可能性较高或较低相关， 支付者声称两个州的数据与州一级的COVID-19检测数据和CDC脆弱 群落指数我们还将评估NNE COVID-19测试中差异的地理空间分布 利用地理信息系统的方法，检查因素，如测试中心的密度和距离， 测试率。我们将利用佛蒙特州和缅因州之间的结构差异来识别系统级 因素，包括提供商的可访问性，测试可用性和提供商的支付规则。我们的主要成果将 在服务不足和脆弱人群中进行COVID-19检测，住院治疗和死亡率过高， NNE。我们将通过焦点小组来增加定量分析，以确定测试的其他障碍。我们 将与来自弱势群体的个人进行多个焦点小组讨论，以确定COVID-19的障碍 试验. 一旦我们确定了造成障碍的个人、社区（人口）和结构性因素， COVID-19检测和超额死亡率，我们将以两种不同的方式测试潜在的干预措施，首先，我们将 开发和部署离散选择实验（DCE）在脆弱的社区在NNE和 农村成年人的全国代表性样本，以测试最佳策略，以增加测试使用假设 场景其次，我们将利用农村通信网络测试定向传播的效果 使用最佳的通信策略，以促进增加测试和测试，如果通信改变 个人行为和减少健康差距。这项研究将与 佛蒙特州和缅因州的卫生部以及许多社区合作伙伴。