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

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 vs. ~40% of Utah's COVID-19 cases, and the case rate is over 3-fold higher in neighborhoods characterized by high vs. low deprivation. The case rate in Utah per 100,000 is 665 among Whites vs. 3,503 among Latinos, 3,470 among Pacific Islanders, 1,727 among African Americans, and 1,569 among Native Americans. Community Health Centers (CHCs) are optimal settings for addressing the screening and uptake of COVID-19 testing among underserved populations. Twelve Utah CHC systems participated in SCALE-UP Utah. Their 39 primary care clinics served over 115,000 unique patients annually (37% Latino, 11% Native American, 61% <100% poverty level, 51% uninsured, and 49% of clinics are in rural/frontier areas). SCALE-UP Utah was a state-wide, pragmatic, multilevel intervention study. The long-term objective was to increase the reach, uptake, and sustainability of COVID-19 screening and testing among underserved populations. The team had existing infrastructure and shovel ready clinic and population health management (PHM) interventions ready for implementation. SCALE-UP Utah built on long standing, funded partnerships, and implemented and evaluated three practical, feasible, scalable multi-level interventions to increase COVID-19 screening and uptake in Utah CHCs. Interventions leveraged widely adopted Health Information Technology (HIT) at the point of care, text messaging, and patient navigation. SCALE-UP Utah coordinated and synergized existing infrastructure and resources across the state, as well as strengthened infrastructure and data networks for rapid deployment of new screening and testing protocols, vaccination programs, etc. The project employed a rapid cycle research approach in which interventions were tested on a small scale, using short time frames (e.g., <1 month) and cyclical evaluation cycles. A critical aspect of these rapid-research cycles was that change can be quickly tested on a small scale, and then disseminated to other clinics/patients. The interventions were readily available for adoption by other low-resource healthcare settings; and, the data advanced population health and implementation science. The specific aims were: 1. Implement and evaluate clinic and PHM interventions for increasing the uptake of COVID-19 testing among CHC patients across Utah. 2. Examine implementation effectiveness outcomes, as well as characteristics of both clinics and patients that may influence intervention effects and implementation outcomes.