1_PatientPop

1. Identify and prioritize the population to be tested

Decision makers

Consideration

Identify a leader tasked with determining the population to be tested who uses data and seeks broad input from partners.

Voices from the Field

“Our medical director, epidemiologist … release … guidance around who should be tested each week”
“…municipalities at all levels… [are] partners … in designating certain specific populations to be tested…”
“Everybody should have an equity officer that is thinking about who is most likely to be impacted … and then there should have been really focused testing in those places”
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Patient prioritization is evolving

Consideration

When tests are limited, make sure populations that need them most are able to access them.

Definitions of priority populations may need to evolve as test availability changes.

Voices from the Field

“Now the challenge is to refine our testing because now we're having supply chain issues …our ability to test and give good service and launch new methodologies is all being challenged by the vast number of tests that we're doing. So now we have to refine who we’re testing and that’s a challenge that’s very different than what it was in the very beginning.”
“As of this week, we've developed a list of high-risk populations … we want people to know we're not taking away supply from high-risk populations … we're doing outreach to employers, long-term care facilities, hospitals, SNFs, where we believe that this can be a value add to them … if nursing home staff can't get access to testing then, you know, we're not doing the full job that we want to do here.”
“I think early testing really missed the people who were being most impacted … for those people who had to continue to go to work during shelter in place and are now highly impacted … our focus has been on ensuring that testing is available and accessible to those communities.”
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Using data to guide prioritization

Consideration

Prioritization guided by clear data will benefit your population as well as help mitigate political pressures to test in certain areas.

Identify areas most impacted by COVID-19.

Collect racial and ethnic data in order to identify disparities in infection rates and access to testing.

Apply a social vulnerability index to identify priority areas.

Identify persons that already struggle with access to healthcare.

Integrating data into composite scores and matrices may be a good way to organize data.

Voices from the Field

“We created a priority matrix that we could update every two weeks that would look at where we have low testing rates based on population, where we have high case prevalence, and then we used a social vulnerability index that we created based on poverty, so where we have a high social vulnerability score. And so, we rank order those areas … to make sure we were focusing where the need was greatest when we were standing up sites…it also helped protect us a little bit from the political pressures of, you know, a mayor from one of the suburbs would call me and ask about testing sites and I would send them the matrix and how we're making our decisions and where his community was in that. That seemed to help navigate.”
“We basically ranked every community by five variables [% tested; % positive; % non-white; mortality rate; poverty rate] and created a percentile and ranked them all from zero to hundred in each of those characteristics… to develop a composite score.”
“As we started to see real high volume in a couple of our areas, we were able to go look and see where those people were traveling from and based on their zip code identify that we had a large area of the state that was traveling out of their home area … so we opened up three more sites that kind of surrounded those areas to help target those areas ….”
“We now have across the region a number of the community health centers and others doing targeted testing for the regions most impacted based on hospitalization and death data….”
“The appointment of our vehicles based on mapping information as to where the highest density of caseloads is overlaid with socially determined information that comes from things like American community survey and our own work, we do on geospatial information around chronic disease risk.”
“All of our testing sites are selected based on the vulnerability index with the HHS COVID responder dashboard.”
“We really wanted to make sure we accessed neighborhoods that had an inability to get access to care…We put it in neighborhoods that are harder to get through. One of them has … a lot of historically, like project housing and so forth and harder to get to site. One … is where our predominantly immigrant population of Hispanic ethnicity and Arabic ethnicity… we made certain assumptions that those were areas that needed it and sure enough one is in the middle of where 40% of our cases are showing up…”
“We mapped where we were seeing positives based on the patient ZIP Code and we found sort of the little clusters… we identified where there’s gaps in testing…”
“In the very beginning we weren’t collecting race, ethnicity and language data. I think that should be done at the very beginning and be very consistent about that because I think that's very important information. I think we could've jumped on testing vulnerable populations a lot faster as we were rushing to get the testing sites up. I think we could have been located in more vulnerable communities where I think we were seeing some of these hotspots and I think that would've been effective.”
“… they have an equity officer assigned to their emergency operations centers. That equity officer noticed really early in the COVID 19 response that the Latinx community was showing up with much more hospitalizations than there were in the general population…”
“In an ideal world we would get down to census tract or neighborhood level predictive modeling of where we’re seeing some increase, spread, or increase of cases and then we can mobilize and go into those communities.”
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Asymptomatic screening for workplaces and schools

Consideration

OSCTCs are getting increasing pressure to support back-to-work and back-to-school clearance, but capacity-based prioritizations may not support testing these populations.  

OSCTCs can share prioritization matrices with employers and schools.  

Pooled testing may be a cost saving option to consider. 

Voices from the Field

“And the other big thing that was causing unnecessary demand was employers requiring a negative test for people to come to work. And so, we got some very clear messaging out there for employers. You do not need to do tests for clearance for work -- the CDC released that guidance.”