Evaluation of COVID-19 vaccine implementation in a large safety net health system

Jennifer C Chen; Griselda Gutierrez; Rachel Kamran; Jill Terry; Armenui Telliyan; Camilo Zaks; Savanna L Carson; Arleen Brown; Karen Kim

doi:10.3389/frhs.2023.1152523

Evaluation of COVID-19 vaccine implementation in a large safety net health system

Front Health Serv. 2023 Jun 5:3:1152523. doi: 10.3389/frhs.2023.1152523. eCollection 2023.

Authors

Jennifer C Chen^{1

2}, Griselda Gutierrez^{3

4}, Rachel Kamran⁵, Jill Terry^{6

7}, Armenui Telliyan^{8

9}, Camilo Zaks¹⁰, Savanna L Carson¹¹, Arleen Brown¹¹, Karen Kim^{12

13}

Affiliations

¹ Ambulatory Care Network, Los Angeles County Department of Health Services, Los Angeles, CA, United States.
² Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
³ Harbor-UCLA Medical Center, Los Angeles County Department of Health Services, Los Angeles, CA, United States.
⁴ Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
⁵ Fielding School of Public Health Graduate Program, University of California, Los Angeles, CA, United States.
⁶ Pharmacy Affairs, Los Angeles County Department of Health Services, Los Angeles, CA, United States.
⁷ Adjunct Faculty, USC School of Pharmacy, Los Angeles, CA, United States.
⁸ Adjunct Nursing Faculty, Glendale Community College, Glendale, CA, United States.
⁹ Adjunct Nursing Faculty, West Coast University, Los Angeles, CA, United States.
¹⁰ Division of Street Medicine, Keck School of Medicine of USC, Los Angeles, CA, United States.
¹¹ Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
¹² Population Health Management, Los Angeles County Department of Health Services, Los Angeles, CA, United States.
¹³ Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.

Abstract

Objectives: To evaluate rapid COVID-19 vaccine clinic implementation from January-April 2021 in the Los Angeles County Department of Health Services (LACDHS), the second-largest US safety net health system. During initial vaccine clinic implementation, LACDHS vaccinated 59,898 outpatients, 69% of whom were Latinx (exceeding the LA County Latinx population of 46%). LACDHS is a unique safety net setting to evaluate rapid vaccine implementation due to system size, geographic breadth, language/racial/ethnic diversity, limited health staffing resources, and socioeconomic complexity of patients.

Methods: Implementation factors were assessed through semi-structured interviews of staff from all twelve LACDHS vaccine clinics from August-November 2021 using the Consolidated Framework for Implementation Research (CFIR) and themes analyzed using rapid qualitative analysis.

Results: Of 40 potential participants, 25 health professionals completed an interview (27% clinical providers/medical directors, 23% pharmacist, 15% nursing staff, and 35% other). Qualitative analysis of participant interviews yielded ten narrative themes. Implementation facilitators included bidirectional communication between system leadership and clinics, multidisciplinary leadership and operations teams, expanded use of standing orders, teamwork culture, use of active and passive communication structures, and development of patient-centered engagement strategies. Barriers to implementation included vaccine scarcity, underestimation of resources needed for patient outreach, and numerous process challenges encountered.

Conclusion: Previous studies focused on robust advance planning as a facilitator and understaffing and high staff turnover as barriers to implementation in safety net health systems. This study found facilitators that can mitigate lack of advance planning and staffing challenges present during public health emergencies such as the COVID-19 pandemic. The ten identified themes may inform future implementations in safety net health systems.

Keywords: COVID-19; communication; equity; implementation; integrated delivery of health care; leadership; vaccine; vaccine distribution.

Grants and funding

This paper was supported by NIH/NHLBI CEAL grant #21-312-0217571-66106l and NIH/NCATS grant #UL1TR001881.