Bridging the evidence-to-practice gap: Evaluating practice facilitation as a strategy to accelerate translation of a systems-level adherence intervention into safety net practices

摘要 新冠肺炎揭示了在服务不足的社区中长期存在的显著差距。当前 数据仍然显示，美国黑人和拉丁裔人的住院率是他们的4倍 比白人还多。针对服务不足人群的快速诊断(RADx-UP)计划 支持对美国国立卫生研究院各个奖项的补充，以确定新冠肺炎检测的决定因素 服务不足的人群。对于这项提议，我们将利用NIMHD资助的项目在 纽约大学朗格尼健康中心的家庭健康中心(FHC)，这是一个由纽约市联邦合格的健康中心组成的网络 它为超过12.5万名低收入和种族和民族多元化的患者提供服务。在当前的应用程序中，我们 提出一项三阶段社区参与研究，将采用多管齐下、顺序混合的方法 设计(即，一种方法建立在另一种方法的基础上)，以获得对 推动黑人和拉丁裔患者接受新冠肺炎检测(和未来疫苗接种)的多水平因素 (主要成果)，以及参与安全网保健系统提供的后续护理。第一阶段将包括 共分三步：在第1步中，我们将利用功能完善的电子健康记录数据库(~75%为Black 和Latinx)，以检查与接受正面与 在食品和药物控制中心接受护理的400名黑人和拉丁裔患者中，新冠肺炎聚合酶链式反应阴性。我们会 还可以使用经过验证的自我报告在此样本中捕获测试的社区级和结构级决定因素 测量(例如，NIH PhenX工具包)。在步骤2中，我们将比较三名患者的这些多水平因素 分组：第1组--检测呈阳性并接受了后续护理和/或服务的患者；第2组--患者 检测呈阳性但没有接受跟进护理和/或服务的患者；以及第三组-符合条件的患者 用于检测(根据症状和可能的暴露)，但没有进行检测。在第3步中，我们将聘用 预测性建模以正确识别高危患者(组3)。在第2阶段，我们将合并来自 使用定性数据的前一阶段(即，人种学观察、文件分析和焦点小组 与FHC工作人员、提供者、管理员、患者和社区成员)，以捕获组织(例如，FHC 员工/提供者的态度以及与患者的沟通、组织文化)和道德问题(例如，数据 透明度和隐私)，以阐明与以下内容相关的重要社会、文化和背景因素 接受新冠肺炎测试和潜在的疫苗。最后，在第三阶段，与我们的社区合作 监督工作组，我们将整合阶段1和阶段2的数据，以改进、测试和传播定制的工具包和 道德治理准则(例如，临床试验透明度和数据隐私)。这些工具包将被设计成 增加对新冠肺炎检测和疫苗研究的知识和意识，并将广泛推广 在初级保健机构、当地社区、纽约市立大学和RADX-UP协调和数据收集机构中传播 中心。

ABSTRACT COVID-19 has shed light on the significant and long-standing disparities in underserved communities. Current data still show hospitalization rates among Black and Latinx individuals in the United States are 4 times greater than that of Whites. The Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP) initiative supports supplements to individual NIH awards to identify the determinants of COVID-19 testing among underserved populations. For this proposal, we will leverage the infrastructure of a NIMHD-funded project in the Family Health Centers (FHCs) of NYU Langone Health, a network of federally qualified health centers in NYC that serves over 125,000 low-income and racially and ethnically diverse patients. In the current application, we propose a three-phase community-engaged study that will employ a multipronged, sequential mixed methods design (i.e., one methodology builds on the findings of the other) to gain a comprehensive understanding of the multilevel factors that drive uptake of testing (and future vaccination) for COVID-19 of Black and Latinx patients (primary outcome), and participation in follow-up care offered by safety-net health systems. Phase 1 will consist of three steps: In step 1, we will leverage a well-characterized electronic health record database (~75% Black and Latinx) to examine differences in the individual-level factors associated with receiving a positive versus negative PCR test for COVID-19 among 400 Black and Latinx patients who receive care at the FHCs. We will also capture the community- and structural-level determinants of testing in this sample using validated self-report measures (e.g., NIH PhenX Tool Kit). In step 2, we will compare these multilevel factors across three patient groups: Group 1- patients who tested positive and received follow-up care and/or services; Group 2- patients who tested positive but did not receive follow-up care and/or services; and Group 3- patients who were eligible for testing (based on symptoms and probable exposure), but did not get tested. In step 3, we will employ predictive modeling to correctly identify patients at high-risk (group 3). In Phase 2, we will combine data from the previous phase with qualitative data (i.e., ethnographic observations, document analyses, and focus groups with FHC staff, providers, administrators, patients and community members) to capture organizational (e.g., FHC staff/provider attitudes and communications with patients, organizational culture) and ethical issues (e.g., data transparency and privacy) to shed light on important social, cultural, and contextual factors associated with uptake of COVID-19 testing and potential vaccine. Finally, in Phase 3, in collaboration with our Community Oversight Task Force, we will integrate Phase 1 and 2 data to refine, test, and disseminate tailored toolkits and ethical governance guidelines (e.g. clinical trials transparency and data privacy). These toolkits will be designed to increase knowledge and awareness of COVID-19 testing and vaccine research and will be widely disseminated among the FHCs, local community, NYULH, and the RADx-UP Coordination and Data Collection Center.