PDF(Pubmed)
Abstract：
OBJECTIVE: To investigate Covid-19 vaccination as a potential secondary public health benefit of case management for Medicaid beneficiaries with health and social needs.
METHODS: The CommunityConnect case management program for Medicaid beneficiaries is run by Contra Costa Health, a county safety net health system in California. Program enrollment data were merged with comprehensive county vaccination records.
METHODS: Individuals with elevated risk of hospital and emergency department use were randomized each month to a case management intervention or usual care. Interdisciplinary case managers offered coaching, community referrals, healthcare connections, and other support based on enrollee interest and need. Using survival analysis with intent-to-treat assignment, we assessed rates of first-dose Covid-19 vaccination from December 2020 to September 2021. In exploratory sub-analyses we also examined effect heterogeneity by gender, race/ethnicity, age, and primary language.
UNASSIGNED: Data were extracted from county and program records as of September 2021, totaling 12,866 interventions and 25,761 control enrollments.
RESULTS: Approximately 58% of enrollees were female and 41% were under age 35. Enrollees were 23% White, 12% Asian/Pacific Islander, 20% Black/African American, and 36% Hispanic/Latino, and 10% other/unknown. Approximately 35% of the intervention group engaged with their case manager. Approximately 56% of all intervention and control enrollees were vaccinated after 9 months of analysis time. Intervention enrollees had a higher vaccination rate compared to control enrollees (adjusted hazard ratio [aHR]: 1.06; 95% confidence interval [CI]: 1.02-1.10). In sub-analyses, the intervention was associated with stronger likelihood of vaccination among males and individuals under age 35.
CONCLUSIONS: Case management infrastructure modestly improved Covid-19 vaccine uptake in a population of Medicaid beneficiaries that over-represents social groups with barriers to early Covid-19 vaccination. Amidst mixed evidence on vaccination-specific incentives, leveraging trusted case managers and existing case management programs may be a valuable prevention strategy.
METHODS: The CommunityConnect case management program for Medicaid beneficiaries is run by Contra Costa Health, a county safety net health system in California. Program enrollment data were merged with comprehensive county vaccination records.
METHODS: Individuals with elevated risk of hospital and emergency department use were randomized each month to a case management intervention or usual care. Interdisciplinary case managers offered coaching, community referrals, healthcare connections, and other support based on enrollee interest and need. Using survival analysis with intent-to-treat assignment, we assessed rates of first-dose Covid-19 vaccination from December 2020 to September 2021. In exploratory sub-analyses we also examined effect heterogeneity by gender, race/ethnicity, age, and primary language.
UNASSIGNED: Data were extracted from county and program records as of September 2021, totaling 12,866 interventions and 25,761 control enrollments.
RESULTS: Approximately 58% of enrollees were female and 41% were under age 35. Enrollees were 23% White, 12% Asian/Pacific Islander, 20% Black/African American, and 36% Hispanic/Latino, and 10% other/unknown. Approximately 35% of the intervention group engaged with their case manager. Approximately 56% of all intervention and control enrollees were vaccinated after 9 months of analysis time. Intervention enrollees had a higher vaccination rate compared to control enrollees (adjusted hazard ratio [aHR]: 1.06; 95% confidence interval [CI]: 1.02-1.10). In sub-analyses, the intervention was associated with stronger likelihood of vaccination among males and individuals under age 35.
CONCLUSIONS: Case management infrastructure modestly improved Covid-19 vaccine uptake in a population of Medicaid beneficiaries that over-represents social groups with barriers to early Covid-19 vaccination. Amidst mixed evidence on vaccination-specific incentives, leveraging trusted case managers and existing case management programs may be a valuable prevention strategy.
摘要：
目的：调查Covid-19疫苗接种作为具有健康和社会需求的医疗补助受益人病例管理的潜在次要公共卫生福利。
方法：针对医疗补助受益人的CommunityConnect案例管理计划由ContraCostaHealth运营，加州的一个县安全网卫生系统。计划招募数据与县疫苗接种综合记录合并。
方法：每个月将住院和急诊科使用风险升高的个体随机分配到病例管理干预或常规护理中。跨学科案例经理提供指导，社区推荐,医疗保健连接，以及基于登记者兴趣和需求的其他支持。使用生存分析和意向治疗分配，我们评估了2020年12月至2021年9月的第一剂Covid-19疫苗接种率。在探索性子分析中，我们还检查了性别的效应异质性，种族/民族,年龄,和主要语言。
■数据是从截至2021年9月的县和计划记录中提取的，总计12,866项干预措施和25,761项控制注册。
结果：大约58%的参与者是女性，41%的参与者年龄在35岁以下。入学率为23%的白人，12%亚洲/太平洋岛民，20%黑人/非洲裔美国人,和36％的西班牙裔/拉丁裔，10%其他/未知。大约35％的干预组与他们的病例经理联系。在9个月的分析时间后，所有干预和对照参与者中约有56％接种了疫苗。与对照参与者相比，干预参与者的疫苗接种率更高（调整后的风险比[aHR]：1.06；95％置信区间[CI]：1.02-1.10）。在子分析中，该干预措施与男性和35岁以下人群接种疫苗的可能性更高相关.
结论：病例管理基础设施适度改善了医疗补助受益人群体中Covid-19疫苗的吸收，这些受益人过度代表了社会群体，阻碍了早期Covid-19疫苗接种。在关于疫苗接种特定激励措施的混合证据中，利用可信的案例管理器和现有的案例管理程序可能是一个有价值的预防策略。
方法：针对医疗补助受益人的CommunityConnect案例管理计划由ContraCostaHealth运营，加州的一个县安全网卫生系统。计划招募数据与县疫苗接种综合记录合并。
方法：每个月将住院和急诊科使用风险升高的个体随机分配到病例管理干预或常规护理中。跨学科案例经理提供指导，社区推荐,医疗保健连接，以及基于登记者兴趣和需求的其他支持。使用生存分析和意向治疗分配，我们评估了2020年12月至2021年9月的第一剂Covid-19疫苗接种率。在探索性子分析中，我们还检查了性别的效应异质性，种族/民族,年龄,和主要语言。
■数据是从截至2021年9月的县和计划记录中提取的，总计12,866项干预措施和25,761项控制注册。
结果：大约58%的参与者是女性，41%的参与者年龄在35岁以下。入学率为23%的白人，12%亚洲/太平洋岛民，20%黑人/非洲裔美国人,和36％的西班牙裔/拉丁裔，10%其他/未知。大约35％的干预组与他们的病例经理联系。在9个月的分析时间后，所有干预和对照参与者中约有56％接种了疫苗。与对照参与者相比，干预参与者的疫苗接种率更高（调整后的风险比[aHR]：1.06；95％置信区间[CI]：1.02-1.10）。在子分析中，该干预措施与男性和35岁以下人群接种疫苗的可能性更高相关.
结论：病例管理基础设施适度改善了医疗补助受益人群体中Covid-19疫苗的吸收，这些受益人过度代表了社会群体，阻碍了早期Covid-19疫苗接种。在关于疫苗接种特定激励措施的混合证据中，利用可信的案例管理器和现有的案例管理程序可能是一个有价值的预防策略。
