Administrative Core

行政核心

• 批准号: 10267382
• 负责人: Marcella Nunez-Smith
• 金额: $ 374.03万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-22 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10267382
• 关键词: 2019-nCoV; Academia; Address; Adherence; Adopted; Adoption; Ambulatory Care; Award; COVID-19; COVID-19 pandemic; Caribbean region; Chronic; Clinical; Clinical Protocols; Cohort Studies; Collaborations; Communities; Consent; Contact Tracing; Data; Data Collection; Diagnosis; Diagnostic tests; Diffusion; Earthquakes; Effectiveness; Ensure; Epidemic; Equipment and Supplies; Estrogen receptor positive; Evaluation; Experimental Designs; Federally Qualified Health Center; Future; Goals; Governing Board; Guidelines; Health; Health Policy; Health Promotion and Education; Healthcare Systems; Home environment; Hurricane; Hybrids; Incidence; Individual; Influenza; Infrastructure; Interruption; Intervention; Knowledge; Laboratories; Measures; Medical; Modeling; Monitor; Network Infrastructure; Notification; Nursing Homes; Outcome; Outcomes Research; Participant; Patients; Process; Protocols documentation; Public Health; Puerto Rico; Quarantine; Recommendation; Reporting; Research; Research Design; Research Personnel; Research Project Grants; Resources; Risk; Sampling; Science; Series; Social Work; Societies; Subgroup; Technology; Testing; Time; Training; Trust; Underserved Population; United States National Institutes of Health; United States Virgin Islands; Vaccines; Viral; Virus; Vulnerable Populations; Work; base; burden of illness; community based participatory research; community organizations; data harmonization; data sharing; design; effectiveness implementation study; experience; follow-up; food insecurity; health disparity; high risk; implementation strategy; improved; interest; meetings; member; mortality disparity; multi-component intervention; pandemic disease; population based; precision medicine; primary outcome; recruit; social; social health determinants; uptake

COVID-19 has created an unparalleled health crisis across the globe that has ravaged underserved and vulnerable populations in the US, including in the territories of Puerto Rico (PR) and the U.S. Virgin Islands (USVI). While testing for COVID-19 has increased in the Caribbean territories, it is still deeply inadequate. The USVI and PR have experienced barriers to wide-spread testing, including an overall shortage of testing equipment and supplies, which has led to a sharp increase in cases since early July. Data from our Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS) indicate nearly 61% of our population-based random sample (n=3000) has at least one chronic condition, making them high risk for severe complications from COVID-19. We propose to enhance and amplify the COVID-19 diagnostic testing cascade in the USVI and PR by utilizing community-based assets— Federally Qualified Health Centers (FQHCs) and their community organization (CBO) partners—to address barriers to full participation in the testing continuum from diagnosis through to self-isolation and quarantine. We will partner with 3 FQHCs—one in PR and two in USVI—and CBO partners for each. We will provide FQHCs with protocols for diagnosis and follow-up and will procure new testing technologies to make testing more efficient. CBOs connected to the FQHCs will help reach underserved community members not currently being tested, such as those with elevated medical risk, those living without homes, or those living in congregate settings such as nursing homes. After notification of a positive result, we will support FQHCs to provide ambulatory care for active clinical monitoring at home and will deploy a screener for social determinants of health. CBO partners will connect patients with social needs to resources to support quarantine and self-isolation recommendations. We will additionally assess the diffusion and uptake of FDA authorized and approved testing technologies across existing and emerging testing models. We will utilize a rigorous quasi-experimental approach to focus on assessing our implementation outcomes. Specifically, we will employ a hybrid III implementation-effectiveness study design. The primary implementation outcome will be reach—a measure of the amount of testing that is being done in the community— using an interrupted time series design (ITS). Other outcomes of interest include adoption of new testing technologies, fidelity to the intervention, its acceptability, and its effectiveness. We will deploy the RE-AIM framework to guide the evaluation of the intervention. Throughout the project period, we will collaborate with the RADx-Up Coordination and Data Collection Center (CDCC) across all activities, including harmonizing data collection and procuring new COVID-19 testing technologies. We will also work closely with the Community Engagement domain to enhance the experience of our participating stakeholder partners. Finally, the enhanced diagnostic testing cascade will improve reach, access, uptake, and effectiveness for underserved and vulnerable communities in the USVI and PR. This will strengthen the capacity of each stakeholder organization to contribute to vaccine distribution networks for influenza now and a SARS-CoV-2 vaccine in the future.

COVID-19 在全球范围内造成了前所未有的健康危机，严重影响了服务不足和弱势群体 美国境内的人口，包括波多黎各 (PR) 和美属维尔京群岛 (USVI) 领土上的人口。尽管 加勒比地区的 COVID-19 检测有所增加，但仍然严重不足。 USVI 和 PR 有 广泛测试遇到障碍，包括测试设备和用品总体短缺，这 导致7月初以来病例急剧增加。来自我们东加勒比健康结果研究的数据 网络队列研究 (ECS) 表明，近 61% 的基于人群的随机样本 (n=3000) 至少 一种慢性疾病，使他们患上 COVID-19 严重并发症的风险很高。我们建议加强和 利用基于社区的资产，扩大美属维尔京群岛和波多黎各州的 COVID-19 诊断测试级联—— 联邦合格健康中心 (FQHC) 及其社区组织 (CBO) 合作伙伴 — 解决障碍 充分参与从诊断到自我隔离和隔离的测试过程。我们将合作 拥有 3 个 FQHC（一个在 PR，两个在 USVI）以及每个 CBO 合作伙伴。我们将为 FQHC 提供以下协议： 诊断和随访，并将采购新的检测技术，使检测更加高效。连接的 CBO 向 FQHC 提供服务将有助于接触目前尚未接受检测的服务不足的社区成员，例如那些患有 那些无家可归的人或居住在疗养院等聚集环境中的人，医疗风险较高。 收到阳性结果通知后，我们将支持 FQHC 提供门诊护理以进行积极的临床监测 在家中部署健康社会决定因素筛查仪。 CBO 合作伙伴将患者与社交媒体联系起来 需要资源来支持隔离和自我隔离建议。我们还将额外评估 FDA 授权和批准的测试技术在现有和新兴测试中的传播和采用 模型。我们将利用严格的准实验方法来重点评估我们的实施情况 结果。具体来说，我们将采用混合 III 实施效果研究设计。初级 将达到实施结果——社区中正在进行的测试数量的衡量标准—— 使用中断时间序列设计（ITS）。其他令人感兴趣的成果包括采用新的测试 技术、干预的忠诚度、可接受性和有效性。我们将部署 RE-AIM 指导干预评估的框架。在整个项目期间，我们将与 RADx-Up 协调和数据收集中心 (CDCC) 涵盖所有活动，包括协调数据 收集和采购新的 COVID-19 检测技术。我们还将与社区密切合作 参与领域，以增强我们参与的利益相关者合作伙伴的体验。最后，增强版 诊断测试级联将提高服务不足和弱势群体的覆盖面、可及性、采用率和有效性 美属维尔京群岛和波多黎各的社区。这将加强每个利益相关者组织为以下目标做出贡献的能力： 现在的流感疫苗分发网络和未来的 SARS-CoV-2 疫苗。