No abstract

Significance Language discordance has been shown to contribute to social disparities in healthcare. Contact tracing is essential to combating COVID-19, but language differences between contact tracers and patients have hindered its efficacy. We demonstrate a general method for leveraging machine learning and administrative data to maximize the impact of bilingual contact tracers and level language differences. We evaluate in a randomized controlled trial the impact of language matching on high-volume contact tracing in Santa Clara County, CA, and show that it reduces time spent and improves engagement with contact tracers. These results illustrate the advantages of utilizing bilingual personnel over third-party interpreters in improving social services.

COVID-19 exposed and exacerbated health disparities, and a core challenge has been how to adapt pandemic response and public health in light of these disproportionate health burdens. Responding to this challenge, the County of Santa Clara Public Health Department designed a model of “high-touch” contact tracing that integrated social services with disease investigation, providing continued support and resource linkage for clients from structurally vulnerable communities. We report results from a cluster randomized trial of 5,430 cases from February to May 2021 to assess the ability of high-touch contact tracing to aid with isolation and quarantine. Using individual-level data on resource referral and uptake outcomes, we find that the intervention, randomized assignment to the high-touch program, increased the referral rate to social services by 8.4% (95% confidence interval, 0.8%-15.9%) and the uptake rate by 4.9% (-0.2%-10.0%), with the most pronounced increases in referrals and uptake of food assistance. These findings demonstrate that social services can be effectively combined with contact tracing to better promote health equity, demonstrating a novel path for the future of public health.

AI THEME ISSUE: How can health care organizations ensure that there is accountability of algorithms for accuracy, bias, and the wide range of unintended consequences when deployed in real-world settings? A machine-learning system for Covid-19 contact tracing serves as a model to scope out, develop, interrogate, and assess an algorithmic solution that produces improvements in care, mitigates risk, and enables evaluation by many stakeholders.