Developing a Community-Oriented and Place-Based Strategy to Improve COVID-19 Vaccine Accessibility

OBJECTIVE: To address the challenges of inequitable access to the COVID-19 vaccines, Kaiser Permanente Southern California developed a community-oriented and geographic vaccine strategy combining clinical data, community data, and predictive models to identify ZIP codes requiring increased resources to achieve equitable vaccine receipt. STUDY DESIGN: This is a quality-improvement implementation study. METHODS: The authors developed hot-spot maps for southern California service areas to assist clinicians in identifying specific ZIP codes to increase vaccination efforts. Data inputs for these hot spots included COVID-19 incidence, hospitalization, ecologic variables of social determinants of health, and predictive models of vaccine penetrance. Partnering with community organizations, vaccine penetrance was improved by targeting hot spots with pop-up clinics, mobile health vehicle visits, extending facility hours, and sending tailored text messages. RESULTS: By the end of 2021, Kaiser Permanente Southern California achieved a 70% vaccination rate in 83% of 670 ZIP codes it serves, resulting in a total vaccination rate of 81% in 2021. Further, more than 2 out of 3 individuals receiving a vaccine through the hot-spot guided mobile health vehicle were Hispanic or Black. The hot-spotting approach produced a refreshed monthly dashboard of hot spots in 7 counties covering over 670 ZIP codes to help decision makers better understand and improve vaccination in targeted communities. CONCLUSION: The hot-spot methodology produced monthly lists of ZIP codes requiring additional health-care resources and vaccination strategies. This was a feasible place-based approach to mitigating disparities in vaccine uptake in historically disinvested communities that may be readily applied to other areas of care.