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: 10552032
• 负责人: Jan Kirk Carney
• 金额: $ 60.96万
• 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 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10552032
• 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; Communication; Communities; Community Health Aides; Complex; Data; Databases; Decision Making; Disparity; Disparity population; 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; Remote management; Research; Resources; Risk; Rural; Rural Community; Rural Health; Rural Population; Sampling; Source; Structure; System; Testing; Underserved Population; Vermont; Vulnerable Populations; Work; barrier to testing; bed capacity; care delivery; community-level factor; comorbidity; density; design; experience; experimental study; health communication; indexing; innovation; medical vulnerability; payment; remote communities; severe COVID-19; social; social vulnerability; structural determinants; 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.

这项建议的目的是确定个人、社区（人口）和有关的结构因素