SCALE-UP Utah: A Community-Academic Partnership to Address COVID-19 Among Community Health Centers

Organization
Abstract

Racial/ethnic minority, low socioeconomic status (SES) and rural populations suffer profound health inequities across a wide variety of diseases and conditions, as well as a disproportionate burden of the negative health consequences of the COVID-19 pandemic. Latinos make up ~14% of the Utah population compared to ~28 of Utah’s COVID-19 cases, and the case rate is over 3-fold higher in neighborhoods characterized by high compared with low deprivation. The case rate in Utah per 100,000 is 2,362 among Whites versus 6,859 among Latinos, 7,623 among Pacific Islanders, 3,204 among African Americans, and 2,916 among Native Americans. Community Health Centers (CHCs) provide comprehensive care to underserved populations (i.e., low SES, racial/ethnic minority, and rural) and are optimal settings for addressing screening and uptake of COVID-19 testing. In Utah, CHCs serve over 160,000 patients annually and have a patient population that is 49% Latino, 9% American Indian, 67% under the federally poverty level, and 49% uninsured.
SCALE-UP Utah is a state-wide, pragmatic, multilevel intervention study conducted with 12 Utah CHCs, 39 clinics, and 115,000 patients. The project coordinates and synergizes existing infrastructure and resources across the state, as well as strengthens infrastructure and data networks for rapid deployment of new COVID-19 screening, testing, and vaccination programs. The goal of SCALE-UP Utah is to increase the reach, uptake, and sustainability of COVID-19 screening and testing among underserved populations by implementing and evaluating three practical, feasible, and scalable multi-level interventions in Utah CHCs. The objectives of SCALE-UP Utah are to: 1) Implement and evaluate clinic and population health management interventions for increasing the uptake of COVID-19 testing among CHC patients across Utah, and 2) Examine implementation effectiveness outcomes, as well as characteristics of both clinics and patients that may influence intervention effects and implementation outcomes. SCALE-UP Utah interventions leverage widely adopted health information technology at the point of care, and population health management interventions (i.e., text messaging, and patient navigation). The project employs a rapid cycle research approach in which interventions are tested on a small scale, using short time frames (e.g., <1 month) and iterative evaluation cycles. A critical aspect of these rapid-research cycles is that change can be quickly tested on a small scale, and then disseminated to other clinics/patients. The interventions will be readily available for adoption by other low-resource healthcare settings; and, the data will advance population health and implementation science.

Authors
Chelsey
Schlechter
Research Instructor