Download PDF
Appl Clin Inform 2024; 15(01): 129-144
DOI: 10.1055/s-0044-1779258
Research Article

Improving Vaccine Equity: How Community Engagement and Informatics Facilitate Health System Outreach to Underrepresented Groups

Serena J. Xie
1   Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
,
Nicholas R. Mah
2   Department of Shared Services, Enterprise Access and Innovation, UW Medicine, University of Washington, Seattle, Washington, United States
,
Lisa Chew
3   Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, University of Washington Medicine, Seattle, Washington, United States
,
Julia Ruud
4   Department of Performance Improvement, University of Washington, Seattle, Washington, United States
,
Jennifer Hernandez
5   Ambulatory & Allied Care Services, Harborview Medical Center, University of Washington Medicine, Seattle, Washington, United States
,
Jessica Lowery
5   Ambulatory & Allied Care Services, Harborview Medical Center, University of Washington Medicine, Seattle, Washington, United States
,
Andrea L. Hartzler
1   Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Background Given the inequities in access to health care resources like COVID-19 vaccination, health systems should carefully consider how to reach underrepresented groups. Reflecting on vaccine rollout efforts holds insight on the role of community engagement and informatics support in promoting health equity.

Objectives This study aimed to assess the effectiveness of four outreach strategies deployed by University of Washington (UW) Medicine in improving vaccine equity over traditional vaccine scheduling online or by phone, we report on appointment scheduling and completion of appointments (i.e., vaccine administration) through (1) automated outreach to individuals from underrepresented groups, (2) temporary “pop-up” clinics in neighborhoods highly impacted by COVID-19, (3) vulnerable population clinics, and (4) mobile vaccine vans.

Methods We conducted a 6-month retrospective analysis of electronic health records (EHR) to describe the sociodemographic characteristics of individuals who scheduled appointments using the outreach strategies and characteristics associated with a greater likelihood of vaccine administration based on appointment completion. To help explain trends in the EHR data, we engaged 10 health system leaders and staff who spearheaded the outreach strategies in follow-up conversations to identify qualitative insights into what worked and why.

Results Compared with traditional scheduling, all outreach strategies except vulnerable population clinics had higher vaccine appointment completion rates, including automated outreach (N = 3,734 [94.7%], p < 0.001), pop-up clinics (N = 4,391 [96.0%], p < 0.001), and mobile vans (N = 4,198 [99.1%], p < 0.001); and lower cancellation rates, including automated outreach (N = 166 [1.1%], p < 0.001), pop-up clinics (N = 155 [0.6%], p < 0.001), and mobile vans (N = 0 [0%], p < 0.001). Qualitative insights emphasized ongoing community partnerships and information resources in successful outreach.

Conclusion Vaccine equity outreach strategies improved the proportion of patients who scheduled and completed vaccination appointments among populations disproportionately impacted by COVID-19. Engaging community partners and equity-focused informatics tools can facilitate outreach. Lessons from these outreach strategies carry practical implications for health systems to amplify their health equity efforts.

Keywords

health equity - COVID-19 vaccines - community–institutional relations - social vulnerability - outcome and process assessment - vulnerable populations - electronic health records and systems - consumer health informatics

Protection of Human Subjects

This analysis was reviewed by the Institutional Review Board at University of Washington and determined exempted (IRB ID STUDY00013550).




Publication History

Received: 19 September 2022

Accepted: 22 December 2023

Article published online:
14 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Bibbins-Domingo K. This time must be different: disparities during the COVID-19 pandemic. Ann Intern Med 2020; 173 (03) 233-234
    CrossrefPubMedGoogle Scholar
  • 2 Cohen-Cline H, Li HF, Gill M. et al. Major disparities in COVID-19 test positivity for patients with non-English preferred language even after accounting for race and social factors in the United States in 2020. BMC Public Health 2021; 21 (01) 2121
    CrossrefPubMedGoogle Scholar
  • 3 Dasgupta S, Bowen VB, Leidner A. et al. Association between Social Vulnerability and a county's risk for becoming a COVID-19 hotspot - United States, June 1-July 25, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (42) 1535-1541
    CrossrefPubMedGoogle Scholar
  • 4 Al Rifai M, Jain V, Khan SU. et al. Social vulnerability and COVID-19: An analysis of CDC data. Prog Cardiovasc Dis 2022; 73: 91-93
    CrossrefPubMedGoogle Scholar
  • 5 Reitsma MB, Goldhaber-Fiebert JD, Salomon JA. Quantifying and benchmarking disparities in COVID-19 vaccination rates by race and ethnicity. JAMA Netw Open 2021; 4 (10) e2130343
    CrossrefPubMedGoogle Scholar
  • 6 Salmon D, Opel DJ, Dudley MZ, Brewer J, Breiman R. Reflections on governance, communication, and equity: challenges and opportunities in COVID-19 vaccination. Health Aff (Millwood) 2021; 40 (03) 419-425
    CrossrefPubMedGoogle Scholar
  • 7 Rosenstrom ET, Mele J, Ivy JS. et al. Can vaccine prioritization reduce disparities in COVID-19 burden for historically marginalized populations?. PNAS Nexus 2022; 1 (01) pgab004
    CrossrefPubMedGoogle Scholar
  • 8 Gonzalez CJ, Meltzer K, Jabri A. et al. Development of a practice-based community outreach intervention to prevent inequities in COVID-19 vaccinations. Am J Med Qual 2022; 37 (04) 348-355
    CrossrefPubMedGoogle Scholar
  • 9 Stephens AB, Wynn CS, Hofstetter AM. et al. Effect of electronic health record reminders for routine immunizations and immunizations needed for chronic medical conditions. Appl Clin Inform 2021; 12 (05) 1101-1109
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Bratic JS, Cunningham RM, Belleza-Bascon B, Watson SK, Guffey D, Boom JA. Longitudinal evaluation of clinical decision support to improve influenza vaccine uptake in an Integrated Pediatric Health Care Delivery System, Houston, Texas. Appl Clin Inform 2019; 10 (05) 944-951
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Balzarini F, Frascella B, Oradini-Alacreu A. et al. Does the use of personal electronic health records increase vaccine uptake? A systematic review. Vaccine 2020; 38 (38) 5966-5978
    CrossrefPubMedGoogle Scholar
  • 12 McDonald S, Basit MA, Toomay S. et al. Rolling up the sleeve: equitable, efficient, and safe COVID-19 mass immunization for Academic Medical Center employees. Appl Clin Inform 2021; 12 (05) 1074-1081
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Pryor GE, Marble K, Velasco FT, Lehmann CU, Basit MA. COVID-19 mass vaccination resource calculator. Appl Clin Inform 2021; 12 (04) 774-777
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Shaheen AW, Ciesco E, Johnson K, Kuhnen G, Paolini C, Gartner G. Interactive, on-line visualization tools to measure and drive equity in COVID-19 vaccine administrations. J Am Med Inform Assoc 2021; 28 (11) 2451-2455
    CrossrefPubMedGoogle Scholar
  • 15 Cutrona SL, Golden JG, Goff SL. et al. Improving rates of outpatient influenza vaccination through EHR portal messages and interactive automated calls: a randomized controlled trial. J Gen Intern Med 2018; 33 (05) 659-667
    CrossrefPubMedGoogle Scholar
  • 16 Bruckhaus AA, Abedi A, Salehi S. et al. COVID-19 vaccination dynamics in the US: coverage velocity and carrying capacity based on socio-demographic vulnerability indices in California. J Immigr Minor Health 2022; 24 (01) 18-30
    CrossrefPubMedGoogle Scholar
  • 17 Diaz D, Chacko S, Sperling A. et al. Assessment of digital and community-based outreach interventions to encourage COVID-19 vaccination uptake in an underserved community. JAMA Netw Open 2022; 5 (06) e2217875
    CrossrefPubMedGoogle Scholar
  • 18 Press VG, Huisingh-Scheetz M, Arora VM. Inequities in technology contribute to disparities in COVID-19 vaccine distribution. JAMA Health Forum 2021; 2 (03) e210264
    CrossrefPubMedGoogle Scholar
  • 19 Stern RJ, Rafferty HF, Robert AC. et al. Concentrating vaccines in neighborhoods with high covid-19 burden. NEJM Catal 2021; DOI: 10.1056/CAT.21.0056.
    CrossrefPubMedGoogle Scholar
  • 20 Grange ES, Neil EJ, Stoffel M. et al. Responding to COVID-19: The UW Medicine Information Technology Services Experience. Appl Clin Inform 2020; 11 (02) 265-275
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Washington State Department of Health (WA DOH). Washington's COVID-19 Vaccination Phases Infographic. Accessed November 18, 2023 at: https://doh.wa.gov/sites/default/files/legacy/Documents/1600/coronavirus//VaccinationPhasesInfographic.pdf
    PubMedGoogle Scholar
  • 22 Flanagan BE, Hallisey EJ, Adams E, Lavery A. Measuring community vulnerability to natural and anthropogenic hazards: The Centers for Disease Control and Prevention's Social Vulnerability Index. J Environ Health 2018; 80 (10) 34-36
    PubMedGoogle Scholar
  • 23 Washington Office of Financial Management. Washington State Small Area Estimate Program. WAOFM SAEP Population Estimates WFL1. Accessed November 18, 2023 at: https://geo.wa.gov/maps/377b5263afbd44a09017d4c8491538a4/about
    PubMedGoogle Scholar
  • 24 Saldana J. The Coding Manual for Qualitative Researchers. Thousand Oaks, CA: SAGE Publications Limited; 2021
    Google Scholar
  • 25 Cresswell JWPC, Vicki L. Designing and Conducting Mixed Methods Research. Thousand Oaks, CA: Sage Publications; 2018
    Google Scholar
  • 26 Yu SWY, Hill C, Ricks ML, Bennet J, Oriol NE. The scope and impact of mobile health clinics in the United States: a literature review. Int J Equity Health 2017; 16 (01) 178
    CrossrefPubMedGoogle Scholar
  • 27 Unertl KM, Schaefbauer CL, Campbell TR. et al. Integrating community-based participatory research and informatics approaches to improve the engagement and health of underserved populations. J Am Med Inform Assoc 2016; 23 (01) 60-73
    CrossrefPubMedGoogle Scholar
  • 28 Whitelaw S, Mamas MA, Topol E, Van Spall HGC. Applications of digital technology in COVID-19 pandemic planning and response. Lancet Digit Health 2020; 2 (08) e435-e440
    CrossrefPubMedGoogle Scholar
  • 29 Cartier Y, Fichtenberg C, Gottlieb LM. Implementing Community Resource Referral Technology: Facilitators and Barriers Described by Early Adopters: a review of new technology platforms to facilitate referrals from health care organizations to social service organizations. Health Aff 2020; 39 (04) 662-669
    CrossrefPubMedGoogle Scholar
  • 30 Internal Revenue Service. SOI Tax Stats – Individual income Tax Statistics – Zip Code Data (SOI). Accessed November 18, 2023 at: https://www.irs.gov/statistics/soi-tax-stats-individual-income-tax-statistics-zip-code-data-soi
    PubMedGoogle Scholar
  • 31 Bureau of Labor Statistics. Overview of BLS Wage Data by Area and Occupation. Accessed November 18, 2023 at: https://www.bls.gov/bls/blswage.htm
    PubMedGoogle Scholar
  • 32 National Center for Education Statistics. Concentration of Public School Students Eligible for Free or Reduced-Price Lunch. Accessed November 18, 2023 at: https://nces.ed.gov/programs/coe/indicator/clb/free-or-reduced-price-lunch
    PubMedGoogle Scholar
  • 33 Federal Bureau of Investigation. Crime in the U.S. Accessed November 18, 2023 at: https://ucr.fbi.gov/crime-in-the-u.s
    PubMedGoogle Scholar
  • 34 United States Census Bureau. American Community Survey. Accessed November 18, 2023 at: https://www.census.gov/programs-surveys/acs
    PubMedGoogle Scholar
  • 35 Kind AJ, Jencks S, Brock J. et al. Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med 2014; 161 (11) 765-774
    CrossrefPubMedGoogle Scholar
  • 36 Opportunity Nation and Child Trends. Opportunity Index. Accessed November 18, 2023 at: https://opportunityindex.org/
    PubMedGoogle Scholar
  • 37 CDC. The Social Vulnerability Index (SVI): Interactive Map. Accessed November 18, 2023 at: https://www.atsdr.cdc.gov/placeandhealth/svi/interactive_map.html
    PubMedGoogle Scholar
  • 38 Kind AJH, Buckingham WR. Making neighborhood-disadvantage metrics accessible - the neighborhood atlas. N Engl J Med 2018; 378 (26) 2456-2458
    CrossrefPubMedGoogle Scholar
  • 39 Graffigna G, Barello S. How does patient engagement work in a real-world setting? Recommendations, caveats, and challenges from a psychosocial perspective. Patient Educ Couns 2022; 105 (12) 3567-3573
    CrossrefPubMedGoogle Scholar