SCALE UP Utah II: Community-Academic Partnership to Address COVID-19 Testing and Vaccination Among Utah Community Health Centers

项目摘要/摘要 种族/少数民族、低社会经济地位(SES)和农村人口遭受严重的健康不平等 联系广泛的各种疾病和状况，以及不成比例的负面健康负担 新冠肺炎大流行的后果。截至2021年6月，犹他州每年的COVID累计发病率 在白人中，10万人为10,803人，而在拉丁裔中为17,541人。白人与白人之间的阳性率为14%。 在拉丁裔中的比例为24%。在城市和城市之间的疫苗接种率方面，全国各地仍然存在类似的差距 农村、高SES和低SES，以及白人和非白人人口。低接种率使未得到充分服务的人群- 面临局部暴发的风险，以及更具传染性和更严重的变种。因此，针对这些人的干预 处于检测和疫苗接种之间相互作用的人群对大流行控制至关重要。不仅不会- 受到虐待的人群经历了严重的健康不平等，但也存在着严重的数字鸿沟 高、低资源的医疗保健系统。低资源设置采用健康信息的可能性要小得多 技术手段单一，往往没有能力实现大规模的人口健康人-- 利用数据分析和自动患者外展的管理(PHM)工作。社区卫生中心 (CHC)是实施这些PHM干预措施以增加对新冠肺炎的吸纳的最佳环境 在服务不足的人群中进行检测和接种疫苗。11个犹他州CHC系统将参加 扩大规模II.他们的38个初级保健诊所每年为超过11.2万名服务不足的独特患者提供服务。SUP- 在RADx-Up阶段I拨款(纵向扩展犹他州)的支持下，我们建立了灵活的短信外展 和患者导航基础设施与CHC，以增加检测和疫苗接种。扩大规模II将达到- 破坏这一基础设施以及犹他大学临床和医疗中心之间的长期合作关系 翻译科学研究所，犹他州社区健康协会，全州的社区卫生中心，以及 犹他州卫生局。放大II将调查三种PHM干预措施 新冠肺炎接种和检测：1)短信(TM)--一键双向短信 响应将患者连接到疫苗接种或在家中邮寄快速检测试剂盒，根据需要免费使用，2)注意- 交叉代理(CA)-自动化、脚本化和交互式代理，用于模拟要提供的人工交互 访问家庭快速测试套件，3)患者导航(PN)-社区卫生工作者的电话呼叫 帮助解决犹豫不决和访问障碍，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)将只联系那些对TM/CA消息回答是的患者。主动式PN (PPN)将联系所有患者，包括那些没有回复TM/CA消息的患者。具体目标 1)进行2(TM与CA)×3(无PN与RPN与PPN)析因设计，评估干预效果 对未接种疫苗的成年人进行检测2)检查与家庭检测和疫苗接种相关的因素- 随着时间的推移摄取。

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.