Funded Projects

Vaccine Equity for Native-Hawaiian/Pacific-Islander Children

Project Year

2024

City & State

Murray, Utah

Program Name

CATCH Implementation

Topic

Health Disparities

Program Description

Problem:   The US Centers for Disease Control recently reported on disparities by race and ethnicity for early childhood vaccines across the United States (Hill, 2023).  As part of Intermountain Health system-wide pediatric population health analyses, we reviewed data for early childhood vaccines looking at overall rates and stratifying by Race and Ethnicity.  We identified a statistically significant and clinically important disparity in early childhood vaccines for Native Hawaiian & Pacific Islander (NHPI) children.  We found that the rate of up-to-date status at age 24 months old for NHPI children was 40.7% compared to 58.6% for the rest of the population.  We shared these concerning findings with the Utah Department of Health.  They reported a similar disparity in our state vaccine registry.  For children between the ages of 24-35 months in the year 2022, 47.5% of NHPI children were up to date compared to 72.7% for the rest of the population overall.  Surprisingly, limited research currently exists on early childhood vaccine disparities for the NHPI population.  Samoa et al. recently reported on a national survey on attitudes of NH/PI adults related to vaccine hesitancy (Samoa, 2022). However, this study focused primarily on the COVID 19 vaccine, not early childhood vaccines.    We discussed our data with the Utah Pacific Islander Health Coalition (UPIHC).  Using the Donabedian Structure, Process, Outcome framework for health services delivery, we co-developed a plan to improve early childhood vaccine outcomes for NHPI children in our clinics and the broader community in Utah.    We are in the planning stages of this work which will conclude in the Spring of 2024 with implementation beginning in June of 2024.  (For more information on the planning analyses, please see attachment #1.)  This grant is focused on implementation using Continuous Quality Improvement (CQI) methodology within clinical settings and the broader community.  Primary Settings, Number of Children Affected, and Proposed Interventions:   Clinical setting- Our data contains information about 1153 NHPI children receiving care at Intermountain Pediatric and Family Medicine clinics in Utah since 2018, before turning 2 years of age .  In addition to 33 hospitals across the intermountain west, Intermountain has 17 pediatric clinics and 53 Family Medicine clinics across Utah.  Our population health team also leads a pediatric population health network including large independent (not employed by Intermountain) pediatric and family medicine practices across the state of Utah who also care for NHPI children.  In June of 2024, we will start our CQI implementation within Intermountain Pediatric and Family Medicine clinics and refine our learning.  We will use input from our planning analyses and feedback from UPIHC to tailor processes for NHPI families.  We then will extend our CQI efforts across the population health network using our population health care coordination team by January of 2025.  Community setting- Based on early findings in our planning work, we will implement educational strategies in partnership with UPIHC to reach the broader NHPI community.  Examples include 1) pediatrician panels, in-person and virtual, for Questions and Answers on early childhood vaccines hosted by UPIHC and 2) Distributing vaccine educational materials created with UPIHC, tailored for our NHPI families and distributed at NHPI community events.  We will implement community efforts starting in the summer of 2024 and extending into 2025.  Project Goal and Anticipated Outcomes:  Our SMART goal is to reduce the disparity in early childhood vaccine outcomes for NHPI children attributed to both Intermountain clinics and to the pediatric population health network by 50% (i.e. improve current rate by 10 percentage points) by the end of 2025.  Our ultimate goal is to eliminate the disparity in Utah by 2030 as measured by the state vaccine registry.

Project Goal

Overall Goal/Aim: In partnership with the Utah Pacific Islander Health Coalition, eliminate the disparity  in early childhood vaccine outcomes (Combo 7) between Native Hawaiian/Pacific Islander children and the broader population of children in Utah by Jan2030 as measured by the state health department immunization registry.  (See shorter term goals below.)

Project Objective 1

Reduce the disparity in early childhood vaccine outcomes (Combo 7) between Native Hawaiian/Pacific Islander children and the broader population of children in Utah by 50% (10 percentage points) by the end of 2025 within employed Intermountain Pediatric and Family Medicine clinics. 

Project Objective 2

Reduce the disparity in early childhood vaccine outcomes (Combo 7) between Native Hawaiian/Pacific Islander children and the broader population of children in Utah by 25% (5 percentage points) by the end of 2025 the pediatric population health network.

Project Objective 3

Meet quarterly with the Utah Pacific Islander Health Coalition to track progress on activities and goals and to continue CQI work to define future activities and goals until we achieve our overall shared aim.

AAP District

District VIII

Institutional Name

Intermountain Health

Contact 1

Roy Davis, MD

Contact 2

Jake Fitisemanu, MPH