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.

项目摘要/摘要 种族/族裔少数民族，低社会经济地位（SES）和农村人口遭受深远的健康状况 跨多种疾病和疾病的关系，以及不成比例的负面健康状况 19009大流行的后果。截至2021年6月，犹他州的累积共同案例率 在白人中，有100,000是10,803，而拉丁美洲人中的17,541。白人与白人之间的阳性率为14％。 拉丁美洲人中有24％。全国各地的类似差距在城市与城市与疫苗接种率方面持续存在。 乡村，高与低SE，白色与非白人人群。低疫苗接种率留下了未服务的人口 面临当地暴发的风险，以及更具传染性和严重的变体。那是针对这些的干预措施 测试和疫苗接种之间相互作用的种群对于大流行控制至关重要。不仅不 当之无愧的人口经历了深刻的健康不平等，但数字鸿沟也有关键的数字鸿沟 高和低资源保健系统。资源设置低得多的可能采用健康信息 技术方法，通常没有能力实施大规模的人口健康管理 使用数据分析和自动化患者外展的Agement（PHM）努力。社区卫生中心 （CHC）是实施这些PHM干预措施以增加COVID-19的最佳设置 在服务不足的人群中进行测试和疫苗接种。 11个犹他州CHC系统正在参与 扩展II。他们的38个初级保健诊所每年为112,000多名独特的患者服务。 su 在Radx-Up阶段I赠款（犹他州的扩大）上，我们建立了灵活的文本消息外展 以及使用CHC的患者导航基础设施，以增加测试和疫苗的摄取。扩大II将会 在犹他大学临床和 翻译科学研究所，犹他州社区卫生协会，整个州的CHC，以及 犹他州卫生部。扩展II将研究在相互作用的三种PHM干预措施 COVID-19疫苗接种和测试：1）文本消息传递（TM） - 双向文本消息传递 响应将患者连接到疫苗接种或邮寄家庭快速测试套件，无需使用，2） 使用版本代理（CA） - 自动化，脚本和交互式代理，用于模仿人类互动以提供 访问在家快速测试套件，3）患者导航（PN） - 社区卫生工作者的电话 帮助解决犹豫和访问障碍，并提供在家快速测试套件。将测试两种类型的PN： 反应性PN（RPN）只会接触到那些对TM/CA消息回答的患者。主动PN （PPN）将与所有患者联系，包括那些未回复TM/CA消息的患者。具体目标 到1）进行2（TM与CA）X 3（无PN与RPN与PPN）阶乘设计评估干预效果 在未接种疫苗的成年人中测试摄取2）检查与家庭测试和疫苗相关的因素 随着时间的推移吸收。