SCALE UP Utah II: Community-Academic Partnership to Address COVID-19 Testing and Vaccination Among Utah Community Health Centers

SCALE UP Utah II：社区学术合作以解决犹他州社区健康中心的 COVID-19 检测和疫苗接种问题

• 批准号: 10444656
• 负责人: GUILHERME DEL FIOL
• 金额: $ 114.64万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10444656
• 关键词: Address; Adopted; Adoption; Adult; Area; COVID-19; COVID-19 pandemic effects; COVID-19 testing; COVID-19 vaccination; Characteristics; Clinic; Clinical Sciences; Collaborations; Communities; Community Health; Community Health Aides; Data; Data Analytics; Diagnostic Reagent Kits; Disease; Disease Outbreaks; Event; Grant; Health; Health Sciences; Healthcare Systems; Home; Hour; Human; Individual; Infrastructure; Institutes; Intervention; Latino; Latino Population; Native Americans; Neighborhood Health Center; Outcome; Patients; Phase; Population; Populations at Risk; Poverty; Primary Health Care; Process; RADx Underserved Populations; Research; Resource-limited setting; Resources; Risk; Running; Rural; Rural Population; Site; Surveys; System; Target Populations; Telephone; Testing; Text Messaging; Time; Touch sensation; Translational Research; Underserved Population; Uninsured; Universities; Utah; Vaccinated; Vaccination; Variant; Work; cohort; contextual factors; coronavirus disease; cost; design; digital; ethnic minority; experience; flexibility; frontier; health care settings; health communication; health inequalities; health information technology; health management; home test; implementation science; intervention effect; low socioeconomic status; novel; outcome prediction; outreach; pandemic disease; patient oriented; patient outreach; population health; racial and ethnic; rapid test; response; scale up; testing uptake; unvaccinated; uptake; vaccine acceptance

PROJECT SUMMARY/ABSTRACT Racial/ethnic minority, low socioeconomic status (SES), and rural populations suffer profound health inequi- ties across a wide variety of diseases and conditions, as well as a disproportionate burden of the negative health consequences of the COVID-19 pandemic. As of June 2021, the cumulative COVID case rate in Utah per 100,000 was 10,803 among Whites vs. 17,541 among Latinos. The positivity rate was 14% among Whites vs. 24% among Latinos. Similar disparities persist across the nation regarding vaccination rates between urban vs. rural, high vs. low SES, and White vs. non-White populations. Low vaccination rates leave underserved popula- tions at risk for local outbreaks, and more contagious and severe variants. Thus, interventions targeting these populations at the interplay between testing and vaccination are critical for pandemic control. Not only do un- derserved populations experience profound health inequities, but there is also a critical digital divide between high and low resource healthcare systems. Low resource settings are far less likely to adopt Health Information Technology approaches, and often do not have the capacity to implement large scale population health man- agement (PHM) efforts utilizing data analytics and automated patient outreach. Community Health Centers (CHCs) are optimal settings for implementing these PHM interventions to increase the uptake of COVID-19 testing and vaccination among underserved populations. Eleven Utah CHC systems are participating in SCALE-UP II. Their 38 primary care clinics serve over 112,000 unique underserved patients annually. Sup- ported by a RADx-UP Phase I grant (SCALE-UP Utah), we have established a flexible text messaging outreach and patient navigation infrastructure with CHCs to increase testing and vaccine uptake. SCALE-UP II will lev- erage this infrastructure as well as long standing partnerships among the University of Utah Clinical and Translational Science Institute, Association for Utah Community Health, CHCs across the entire state, and the Utah Department of Health. SCALE-UP II will investigate three PHM interventions at the interplay between COVID-19 vaccination and testing: 1) Text Messaging (TM) – bidirectional text messaging with a one-touch response to connect patients to vaccination or mail at-home rapid test kits at no cost for use as needed, 2) Con- versational Agent (CA) – automated, scripted and interactive agent used to mimic human interaction to offer access to at-home rapid test kits, 3) Patient Navigation (PN) – phone call from a community health worker to help address hesitancy and access barriers, and to offer at-home rapid test kits. Two types of PN will be tested: Reactive PN (RPN) will reach out only to those patients who reply YES to a TM/CA message. Proactive PN (PPN) will reach out to all patients, including those who do not reply to a TM/CA message. The specific aims are to 1) Conduct a 2 (TM vs. CA) X 3 (No PN vs. RPN vs. PPN) factorial design assessing intervention effects on testing uptake among unvaccinated adults 2) Examine factors associated with at-home testing and vaccina- tion uptake over time.

项目概要/摘要 少数种族/族裔、低社会经济地位 (SES) 和农村人口遭受着严重的健康不平等 多种疾病和状况之间的联系，以及负面健康带来的不成比例的负担 COVID-19 大流行的后果。截至 2021 年 6 月，犹他州的累计新冠肺炎病例数 100,000 是白人中的 10,803 人，而拉丁裔中是 17,541 人。白人与白人的阳性率为 14%。 拉丁裔中这一比例为 24%。全国城市与乡村之间的疫苗接种率也存在类似的差异。 农村、高社会经济地位与低社会经济地位以及白人与非白人人口。疫苗接种率低导致民众得不到充分服务 存在局部爆发风险以及传染性更强、更严重的变种的风险。因此，针对这些的干预措施 人口检测和疫苗接种之间的相互作用对于控制大流行至关重要。不仅不 应得的人口经历着严重的健康不平等，但不同群体之间也存在着严重的数字鸿沟 高资源和低资源医疗保健系统。资源匮乏的环境采用健康信息的可能性要小得多 技术手段接近，但往往不具备实施大规模人口健康管理的能力。 利用数据分析和自动化患者服务进行管理（PHM）工作。社区卫生服务中心 (CHC) 是实施这些 PHM 干预措施以增加 COVID-19 吸收率的最佳场所 在服务不足的人群中进行检测和疫苗接种。犹他州 11 个 CHC 系统正在参与 扩大规模 II。他们的 38 个初级保健诊所每年为超过 112,000 名服务不足的患者提供服务。支持- 由 RADx-UP 第一阶段拨款 (SCALE-UP Utah) 移植，我们建立了灵活的短信服务 和 CHC 的患者导航基础设施，以增加检测和疫苗接种。 SCALE-UP II 将提升 建立这一基础设施以及犹他大学临床和实验室之间的长期合作伙伴关系 转化科学研究所、犹他州社区健康协会、全州的 CHC 以及 犹他州卫生部。 SCALE-UP II 将调查三种 PHM 干预措施之间的相互作用 COVID-19 疫苗接种和测试：1) 短信 (TM) – 一键式双向短信 响应将患者连接到疫苗接种或免费邮寄家庭快速检测套件以供根据需要使用，2）Con- versational Agent (CA) – 自动化、脚本化和交互式代理，用于模仿人类交互以提供服务 获得家庭快速检测套件，3) 患者导航 (PN) – 社区卫生工作者致电 帮助解决犹豫和获取障碍，并提供家庭快速检测套件。将测试两种类型的 PN： 反应性 PN (RPN) 将仅联系那些对 TM/CA 消息回复“是”的患者。主动PN (PPN) 将联系所有患者，包括那些未回复 TM/CA 消息的患者。具体目标 1) 进行 2（TM 与 CA）X 3（无 PN、RPN 与 PPN）析因设计来评估干预效果 未接种疫苗的成年人的检测情况 2) 检查与家庭检测和疫苗接种相关的因素 随着时间的推移吸收。