Local COVID-19 infection rates are down, vaccination rates continue to inch up, and the state is reopening. UCSF Health has taken an equity-minded population health approach to vaccine outreach and continues to refine their efforts based on valuable lessons learned.
Equity can’t wait.
Communities hardest hit by COVID-19 are the same ones that have consistently encountered vaccination barriers. According to a Los Angeles Times analysis of California COVID-19 vaccination data, 52 percent of White Californians had received at least one dose of the vaccine as of May 20th, compared to 36 and 35 percent of Black/African American and Latinx residents, respectively.1
Soon after adults age 65 and older were eligible to be vaccinated, analysis of vaccination rates among UCSF Health patients revealed disparities, with Black/African American and Latinx patients being less likely to be vaccinated than patients in most other racial-ethnic groups. The UCSF Health Equity Council’s COVID Equity Workgroup partnered with the UCSF Health Office of Population Health (OPH) to address these disparities by proactively contacting eligible patients from historically under-vaccinated communities. Building on prior successful experiences with flu vaccine outreach, the COVID Equity and OPH team launched a substantive outreach effort in March 2021, marking the start of a three-month campaign that would yield impressive results.
More technology isn’t always the answer.
Technology literacy rates are lowest among adults age 65 and older, yet California’s public vaccine registration system, MyTurn.ca.gov, was both web-based and notoriously glitchy.2 UCSF Health’s equity outreach strategy was intentionally low-tech and designed to mitigate digital barriers. In order to supplement UCSF Health’s vaccine appointment scheduling via MyChart, OPH developed an automated phone call campaign to contact eligible Black/African American and Latinx patients whose records did not include documentation of COVID-19 vaccination despite being eligible for the vaccine. This approach emphasized population health principles of proactively analyzing and acting on data for a large group of patients, rather than reactively addressing patient needs one patient at a time. Call recipients could select from a menu of options, including requesting to schedule a vaccine appointment through UCSF Health, or asking to speak with someone about questions they might have about the vaccine.
OPH’s diverse health care navigators and centralized scheduling team tracked the call response dashboard and led follow-up efforts to schedule vaccine appointments and address patients’ remaining questions. Guided by culturally-sensitive scripting co-developed by UCSF leaders with deep experience in health equity work, including Dr. Alicia Fernández, Director of the UCSF Latinx Center of Excellence, and Dr. Malcolm John, Director of the UCSF Black Health Initiative, OPH navigators worked to address questions and concerns about the vaccine, in English and Spanish, when patients requested more personalized assistance. By the middle of June, OPH staff had scheduled 1,238 vaccine appointments, roughly 80 percent of which were for Black/African American and Latinx patients. The team noted that among the community members they reached, scheduling logistics – not vaccine hesitancy – appeared to be the most significant obstacle.
Collaboration is key.
OPH’s COVID-19 vaccine outreach was a multi-disciplinary effort featuring cross-team collaboration. Pilar Collins, project manager for the COVID Equity Workgroup, spearheaded outreach planning and operations; Kristin Gagliardi and her OPH team managed reporting to identify priority populations, as well as telephonic outreach; Tasha Toliver’s OPH hotline navigators and centralized scheduling team managed scheduling and led the essential one-on-one follow-up conversations central to this effort, ultimately connecting patients with Kim Murphy and her team overseeing the San Francisco City College vaccination site. No one group could have done it alone.
Looking back, the team working on this project credits its success to being proactive, population-minded, and equity-focused. And while technology is useful for data tracking and reporting, Dr. Kevin Grumbach, chair of the COVID Equity Workgroup, reflects, “It’s time to be humbler about its power to solve all our problems.” Connecting with people in a way that was accessible and felt respectful made all the difference.
1 Greene, S. and Lin II, R-G. (2021, May 24). Latino, Black Californians ramp up vaccinations but lag far behind Asian, white residents. Los Angeles Times.
2 U.S. Department of Education, National Center for Education Statistics, Program for the International Assessment of Adult Competencies (PIAAC), U.S. PIAAC 2017, U.S. PIAAC 2012/2014
