Predicting Diabetic Retinopathy from Risk Factor Data and Digital Retinal Images

全国和加利福尼亚州的非裔美国人和拉丁裔社区不仅承担着新冠肺炎阳性病例和死亡的不成比例的负担，而且由于各种未被充分研究的原因而没有参加新冠肺炎检测。这可能对安全网医疗保健环境产生深远影响，在这种情况下，由于担心新冠肺炎检测和/或感染新冠肺炎，脆弱的患者拒绝这种潜在的挽救生命的程序，这些患者需要临床程序以防止显著的发病率。洛杉矶县卫生服务部(LACDHS)是美国第二大公共运营的县安全网医疗保健系统，每年为超过75万名患者提供服务。在这个资源不足、需求旺盛的环境中，及时获得医疗保健一直是其占多数的拉丁裔和非裔美国人患者面临的持续挑战。在当前的大流行中，为患者进行新冠肺炎检测已成为提供危重程序性护理的重要第一步。然而，人们对患者拒绝新冠肺炎检测的一系列原因知之甚少。为此，我们建议探索新冠肺炎术前检测的障碍，并为来自这些社区的LACDHS社区卫生工作者(CHW)提供新冠肺炎专项培训，以有效地解决：a)增加对个别患者的新冠肺炎检测的主要目标，以及b)促进安全网医疗体系所需的程序性护理的次要目标，以及c)在这些社区发展持续的公共卫生存在，以建立信任并为未来与新冠肺炎相关的关键需求做好准备。经过培训的CHW可以帮助更有效地克服新冠肺炎检测的障碍，包括历史上的不信任障碍，提供新冠肺炎健康教育，帮助解决健康的社会决定因素，并帮助促进技术素养，以改善远程医疗环境中患者获得检测和护理的机会。该提案使用了包括无监督机器学习和定性访谈在内的多学科、混合方法，系统地探索了在脆弱的安全网患者中进行新冠肺炎测试的障碍和促进者。然后，我们将培训基于临床、种族/语言匹配的CHW，以实施假设驱动的干预，该干预包括六个小组课程和六个个性化的患者与非裔美国人和拉丁裔安全网患者的会面。本研究有以下具体目标：目标1-利用机器学习方法评估是否存在定义从事或拒绝新冠肺炎检测的非洲裔美国人和拉丁裔安全网患者的特征；目标2-对拒绝或接受冠状病毒检测的非洲裔美国人和拉丁裔患者进行深入访谈，以探索影响患者环境和关注的背景、行为和态度因素；目标3-利用来自目标1和目标2的信息，在非裔美国人和拉美裔安全网患者中采用随机对照设计，开发、实施和预测CHW干预措施，以评估CHW假说驱动的干预措施对信任、自我效能和参与新冠肺炎测试意愿的影响。

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.