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

ABSTRACTCOVID-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 greaterthan that of Whites. The Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP) initiativesupports supplements to individual NIH awards to identify the determinants of COVID-19 testing amongunderserved populations. For this proposal, we will leverage the infrastructure of a NIMHD-funded project in theFamily Health Centers (FHCs) of NYU Langone Health, a network of federally qualified health centers in NYCthat serves over 125,000 low-income and racially and ethnically diverse patients. In the current application, wepropose a three-phase community-engaged study that will employ a multipronged, sequential mixed methodsdesign (i.e., one methodology builds on the findings of the other) to gain a comprehensive understanding of themultilevel 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 consistof three steps: In step 1, we will leverage a well-characterized electronic health record database (~75% Blackand Latinx) to examine differences in the individual-level factors associated with receiving a positive versusnegative PCR test for COVID-19 among 400 Black and Latinx patients who receive care at the FHCs. We willalso capture the community- and structural-level determinants of testing in this sample using validated self-reportmeasures (e.g., NIH PhenX Tool Kit). In step 2, we will compare these multilevel factors across three patientgroups: Group 1- patients who tested positive and received follow-up care and/or services; Group 2- patientswho tested positive but did not receive follow-up care and/or services; and Group 3- patients who were eligiblefor testing (based on symptoms and probable exposure), but did not get tested. In step 3, we will employpredictive modeling to correctly identify patients at high-risk (group 3). In Phase 2, we will combine data fromthe previous phase with qualitative data (i.e., ethnographic observations, document analyses, and focus groupswith FHC staff, providers, administrators, patients and community members) to capture organizational (e.g., FHCstaff/provider attitudes and communications with patients, organizational culture) and ethical issues (e.g., datatransparency and privacy) to shed light on important social, cultural, and contextual factors associated withuptake of COVID-19 testing and potential vaccine. Finally, in Phase 3, in collaboration with our CommunityOversight Task Force, we will integrate Phase 1 and 2 data to refine, test, and disseminate tailored toolkits andethical governance guidelines (e.g. clinical trials transparency and data privacy). These toolkits will be designedto increase knowledge and awareness of COVID-19 testing and vaccine research and will be widelydisseminated among the FHCs, local community, NYULH, and the RADx-UP Coordination and Data CollectionCenter.