Evidence based Interventions to address Structure, System and Population Inequities in COVID-19 Screening

解决 COVID-19 筛查中的结构、系统和人口不平等问题的循证干预措施

基本信息

批准号：
10447381
负责人：
Jan Kirk Carney
金额：
$ 61.9万
依托单位：
UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-01-18 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10447381
关键词：
Address Adult American Behavior Behavioral Black, Indigenous, People of Color COVID-19 COVID-19 disparity COVID-19 pandemic COVID-19 screening COVID-19 testing COVID-19 treatment Caring Centers for Disease Control and Prevention (U.S.)Communication Communities Community Health Aides Complex Data Databases Decision Making Elderly Evidence based intervention Excess Mortality Focus Groups Geographic Information Systems Grant Health Health Personnel Health system Healthcare Home Hospitalization Individual Inequality Inpatients Intervention Location Maine Measures Medical Methods Modeling New England Outcome Patients Policies Population Predictive Factor Probability Provider Public Health Qualitative Methods Ramp Reduce health disparities Research Resources Risk Rural Rural Community Rural Health Rural Population Sampling Source Structure System Testing Underserved Population Vermont Vulnerable Populations Work bed capacity care delivery comorbidity density design disadvantaged population experience experimental study health communication indexing innovation medical vulnerability payment remote communities severe COVID-19 social social vulnerability vaccine delivery vulnerable community

项目摘要

The purpose of this proposal is to identify individual, community (population) and structural factors associated with lower rates of Covid-19 testing in Northern New England (NNE), with a focus on underserved and vulnerable populations. Our study includes several COVID-19 medically and/or socially vulnerable populations: communities with high levels of social vulnerability; community-dwelling older adults; individuals with medical comorbidities known to increase risk of severe COVID-19 and, particularly, rural and remote communities. Analytically, we will first qualitatively estimate individual, population and structural factors associated with higher or lower probability of having been tested for COVID-19 by combine comprehensive all- payer claims data across two states with state-level COVID-19 testing data and the CDC vulnerable community index. We will also assess the geospatial distribution of disparities in COVID-19 testing in NNE using geographic information system methods to examine factors like testing center density and distance on testing rates. We will exploit differences in structure between Vermont and Maine to identify system level factors, including provider accessibility, testing availability and provider payment rules. Our key outcomes will be COVID-19 testing, hospitalizations and excess mortality among underserved and vulnerable populations in NNE. We will augment the quantitative analysis with focus groups to identify additional barriers to testing. We will conduct multiple focus groups with individuals from vulnerable populations to identify barriers to COVID-19 testing. Once we have identified the individual, community (population) and structural factors that create barriers to COVID-19 testing and excess mortality, we will test potential interventions in two different ways, First, we will develop and deploy a Discrete Choice Experiment (DCE) both in vulnerable communities in NNE and in a nationally representative sample of rural adults to test optimal strategies to increase testing using hypothetical scenarios. Second, we will test the effect of targeted communication using a rural communication network using optimal communication strategies to facilitate increased testing and test if the communications change individual behavior and reduce health disparities. This study will be conducted in partnership with the Department of Health in both Vermont and Maine and numerous community partners.

该提案的目的是确定相关的个人、社区（人口）和结构因素新英格兰北部 (NNE) 的 Covid-19 检测率较低，重点关注服务不足和弱势群体。我们的研究包括一些在医学上和/或社会上处于弱势的 COVID-19 人群：社会脆弱性较高的社区；社区居住的老年人；个人患有已知会增加严重 COVID-19 风险的医疗合并症，尤其是农村和偏远地区社区。分析上，我们首先定性估计个体、人口和结构因素通过综合综合所有因素，与接受 COVID-19 检测的概率较高或较低相关两个州的付款人索赔数据以及州级 COVID-19 检测数据和 CDC 脆弱性社区指数。我们还将评估 NNE 地区 COVID-19 检测差异的地理空间分布使用地理信息系统方法来检查考试中心密度和距离等因素测试率。我们将利用佛蒙特州和缅因州之间的结构差异来确定系统级别因素，包括提供商可访问性、测试可用性和提供商付款规则。我们的主要成果将服务不足和弱势群体中的 COVID-19 检测、住院治疗和超额死亡率北东北。我们将通过焦点小组来加强定量分析，以确定测试的其他障碍。我们将与弱势群体中的个人进行多次焦点小组讨论，以确定应对 COVID-19 的障碍测试。一旦我们确定了构成障碍的个人、社区（人口）和结构性因素， COVID-19 检测和超额死亡率，我们将以两种不同的方式测试潜在的干预措施，首先，我们将在 NNE 和北部地区的弱势社区开发和部署离散选择实验 (DCE) 具有全国代表性的农村成年人样本，以测试使用假设增加测试的最佳策略场景。其次，我们将利用农村通信网络来测试定向通信的效果使用最佳通信策略来促进增加测试并测试通信是否发生变化个人行为并减少健康差异。这项研究将与佛蒙特州和缅因州卫生部以及众多社区合作伙伴。