Predicting Diabetic Retinopathy from Risk Factor Data and Digital Retinal Images

全国和加州的非洲裔美国人和拉丁裔社区不仅承担着不成比例的COVID-19阳性病例和死亡负担，而且由于各种尚未充分研究的原因，他们也没有参加COVID-19检测。这可能对安全网卫生保健机构产生深远影响，因为脆弱的患者需要临床程序来预防重大发病率，但由于害怕检测和/或感染COVID-19，他们拒绝接受这种可能挽救生命的程序。洛杉矶县卫生服务部（LACDHS）是美国第二大公共运营的县安全医疗保健系统，每年为超过75万名患者提供服务。在这个资源不足、需求高的环境中，及时获得医疗保健一直是拉美裔和非裔美国患者面临的挑战。鉴于当前的大流行，对患者进行COVID-19检测已成为提供关键程序性护理的重要第一步。然而，人们对患者拒绝COVID-19检测的一系列原因知之甚少。为此，我们建议探索COVID-19程序前检测的障碍，并为来自这些社区的LACDHS社区卫生工作者（chw）提供COVID-19专项培训，以有效解决：a)主要目标是增加对个体患者的COVID-19检测，次要目标是b)及时促进安全网卫生系统所需的程序性护理，以及c)在这些社区建立持续的公共卫生存在，以建立信任并为未来与COVID-19相关的关键需求做好准备。训练有素的卫生保健员可以帮助更有效地克服COVID-19检测的障碍，包括不信任的历史障碍，提供COVID-19健康教育，帮助解决健康的社会决定因素，并帮助提高技术素养，以改善患者在远程医疗环境中获得检测和护理的机会。该提案采用多学科混合方法，包括无监督机器学习和定性访谈，系统地探索在脆弱的安全网患者中进行COVID-19检测的障碍和促进因素。然后，我们将以临床为基础，对种族/语言匹配的chw进行培训，以实施一项假设驱动的干预措施，该干预措施包括六个组班和六个个性化的非裔美国人和拉丁裔安全网患者。本研究有以下具体目的：目标1-利用机器学习方法评估参与或拒绝进行COVID-19检测的非洲裔美国人和拉丁裔安全网患者是否存在特征；目标2 -对拒绝或接受COVID检测的非洲裔美国人和拉丁裔患者进行深入访谈，以探索影响患者情况和担忧的背景、行为和态度因素；目标3：根据目标1和目标2的信息，开发、实施和预测试一项CHW干预措施，在非裔美国人和拉丁裔安全网患者中采用随机对照设计，评估CHW假设驱动的干预措施对信任、自我效能和参与COVID-19检测的意愿的影响。

African American and Latinx communities nationally and in California not only bear a disproportionate burden of COVID-19 positive cases and deaths but are also not taking part in COVID-19 testing for a wide range of understudied reasons. This can have profound implications in safety net health care settings where vulnerable patients, who are in need of clinical procedures to prevent significant morbidity, are refusing such potentially lifesaving procedures because of fear of COVID-19 testing and/or contracting COVID-19. The Los Angeles County Department of Health Services (LACDHS) is the second largest publicly operated county safety net health care system in the United States, serving more than 750,000 patients annually. Timely access to health care in this under-resourced, high-need setting has been an ongoing challenge for its majority Latinx and African American patients. With the current pandemic, COVID-19 testing for patients has become an essential first step in the provision of critical procedural care. However, the range of reasons why patients refuse COVID-19 testing is little understood. To this end, we propose to explore the obstacles to COVID-19 pre-procedural testing and provide COVID-19 specific training to LACDHS Community Health Workers (CHWs) from these same communities to effectively address: a) the primary goal of increasing COVID-19 testing for individual patients, and the secondary goals of b) facilitating needed procedural care in a timely manner for the safety net health system, and c) developing a sustained public health presence in these communities to build trust and preparedness for critical COVID-19 related future needs. Trained CHWs can help to more effectively overcome obstacles to COVID-19 testing, including historical barriers of mistrust, provide COVID-19 health education, help address social determinants of health and help facilitate technological literacy to improve patient access to testing and care in a telehealth environment. The proposal uses a multidisciplinary, mixed-methods approach including unsupervised machine learning and qualitative interviews to systematically explore barriers and facilitators to COVID-19 testing among vulnerable safety net patients. We will then train clinically based, ethnically/linguistically matched CHWs to implement a hypothesis-driven intervention consisting of six group classes and six personalized patient encounters with African American and Latinx safety net patients. This study has the following specific aims: Aim 1- Utilize machine learning methods to assess whether there are characteristics that define African American and Latinx safety-net patients who engage in or refuse COVID-19 testing; Aim 2 - Conduct in-depth interviews with African American and Latinx patients who either declined or accepted COVID testing to explore contextual, behavioral, and attitudinal factors shaping patient circumstances and concerns; Aim 3 - Develop, implement, and pre-test a CHW intervention with the information from Aims 1 and 2, utilizing a randomized control design among African American and Latinx safety net patients to assess the effect of the CHW hypothesis-driven intervention on trust, self-efficacy, and intent to participate in COVID-19 testing.