Intensifying Community Referrals for Health: The SINCERE Intervention to Address COVID-19 Health Disparities

加强社区健康转诊：解决 COVID-19 健康差异的真诚干预

• 批准号: 10248618
• 负责人: Andrea Schneider Wallace
• 金额: $ 69.78万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-14 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10248618
• 关键词: 2019-nCoV; Accident and Emergency department; Address; Affect; Age; Anxiety; Behavior; COVID testing; COVID-19; COVID-19 health disparity; COVID-19 pandemic; COVID-19 prevention; COVID-19 susceptibility; Characteristics; Charge; Clinic; Clinic Visits; Clinical; Communities; Community Services; Computer software; Country; Data; Drops; Emergency Care; Emergency Department patient; Emergency department visit; Emotional; Environment; Ethnic Origin; Food; Gender; Goals; Health; Health Services Accessibility; Health Status; Health system; Hospitalization; Housing; Individual; Information Specialists; Intervention; Interview; Language; Location; Measures; Mental Depression; Methods; Modeling; Motivation; Outcome; Patients; Personal Satisfaction; Play; Policies; Population; Preventive; Process; Protocols documentation; Psyche structure; Public Health; Quarantine; Race; Randomized; Reporting; Research; Resources; Role; Rural; SARS-CoV-2 transmission; Sampling; Services; Site; Social Distance; System; Technology; Telephone; Testing; Transportation; Underserved Population; United States National Institutes of Health; Vaccines; base; behavioral economics; community based service; coping; coronavirus disease; cost; data exchange; disadvantaged population; economic impact; effectiveness evaluation; efficacy study; experience; follow-up; health care availability; health disparity; health disparity populations; health information technology; health service use; improved; meetings; outreach; patient engagement; patient screening; pragmatic trial; programs; referral services; response; screening; screening services; service providers; social; social determinants; socioeconomic disadvantage; transmission process; treatment arm; treatment as usual; underserved community

PROJECT SUMMARY In an effort to slow transmission of the 2019 novel coronavirus (COVID-19, or COVID), communities worldwide have implemented strict quarantine policies. While these efforts appear to be having a positive public health impact, they are negatively impacting economies, limiting personal resources for both COVID+ and non- COVID infected patients, and exacerbating health disparities. Community service providers report steady increases in calls for resources (e.g., for food, housing, transportation) during the COVID-19 pandemic, particularly from underserved and underrepresented communities, and additional strain is being placed on health systems. There is a critical need to identify how to overcome community service access barriers during COVID-19, particularly for underserved communities. Our program of research has successfully leveraged existing, low-cost technology to conduct social needs screening during busy emergency department (ED) care, follow-up by United Way 211’s community referral service, and data exchange between systems, suggesting it may be a solution for understanding and meeting the needs of vulnerable and underserved patients during the COVID-19 pandemic. However, findings from our recent sample of approximately 5000 patients screened for social needs during ED visits and qualitative data from service providers, 211 community information specialists, ED Staff, and patients reveal that effectively addressing social needs and connecting to community service providers requires thoughtful, targeted approaches in order to develop relationships among patients and those involved in screening and outreach. Using a pragmatic trial approach in a sample of 1500 patients screened for social needs in ED and community-based and mobile COVID testing sites, the objective of this real world efficacy (NIH stage 3) study is to determine whether community service use for those with social needs improves general and COVID-related health outcomes, and whether random assignment to intensive follow-up and collaborative goal setting helps overcome barriers to community service use. We hypothesize that patients who use community services to meet social needs will experience improvement in general and COVID-specific health outcomes, and that patients randomized to a collaborative goal setting process with a 211 information specialist will have greater community service use. Given the unknown timeframe for social distancing measures needed during the months or years ahead, it is critical to broadly understand the barriers to, and facilitators of, COVID-19 prevention; and of how to address effects on social, mental, and physical wellbeing among COVID-19 vulnerable and socioeconomically disadvantaged populations.

项目摘要 为了减缓2019年新型冠状病毒（COVID-19，或COVID）的传播，全球社区 实施了严格的隔离政策虽然这些努力似乎对公众健康产生了积极的影响， 影响，它们对经济产生了负面影响，限制了COVID+和非COVID+的个人资源。 新冠病毒感染的患者，并加剧健康差距。社区服务提供商报告稳定 资源需求的增加（例如，在COVID-19大流行期间， 特别是来自服务不足和代表性不足的社区， 卫生系统。迫切需要确定如何克服社区服务准入障碍， COVID-19，特别是对服务不足的社区。我们的研究计划成功地利用了 现有的低成本技术在忙碌科（艾德）护理繁忙期间进行社会需求筛查， 联合之路211的社区转介服务的后续行动，以及系统之间的数据交换，建议 这可能是一个解决方案，以了解和满足弱势和服务不足的病人在 2019冠状病毒病大流行。然而，我们最近对大约5000名患者进行了筛查， 艾德访问期间的社会需求和服务提供者的定性数据，211社区信息 专家、艾德工作人员和患者表明，有效地满足社会需求并与社区建立联系， 服务提供者需要周到的、有针对性的方法来发展患者之间的关系 以及参与筛查和外展的人员。在1500例患者样本中使用务实的试验方法 在艾德、社区和移动的COVID检测点进行社会需求筛查， 真实的世界效能（NIH第3阶段）研究是为了确定社区服务是否适用于那些有社会 需要改善一般和COVID相关的健康结果，以及是否随机分配到密集 后续行动和协作目标的制定有助于克服利用社区服务的障碍。我们假设 使用社区服务以满足社会需求的患者总体上会有所改善， 特定于新冠病毒的健康结果，患者随机接受协作目标设定过程，并由 211信息专家将有更多的社区服务用途。鉴于社交媒体的未知时间表 在未来的几个月或几年中需要采取的距离措施，关键是要广泛了解这些障碍 以及如何解决对社会、精神和身体的影响 2019冠状病毒病易感人群和社会经济弱势群体的福祉。