Our Duke Health Integrated Practice members and teammates are doing great work in the advancement of health equity. The impact of persistent health disparities affects all of us. In our respective clinical environment, there are numerous opportunities to contribute to the mission of delivering excellent care equitably to all patients while creating an environment of inclusion and belonging. We would like to highlight our DHIP teammates who have devoted their scholarly time and efforts to addressing health disparities, serving as an inspiration for all of us to get involved. This is our work to do.
Today, we highlight Simon Curtis & his team for their work toward Vaccination Equity.
Simon Curtis, Vice President, DHIP Ambulatory Services
Simon directs and integrates the various functions of DHIP ambulatory services into one organizational strategy and oversees the operations, finances, performance and quality outcomes of all DHIP and CPDC clinical sites, and Duke Health Access Services.
Experience with Advancing Health Equity
Simon was asked to participate in the Equitable Vaccine Distribution Committee established by the health system in January when vaccine eligibility began expanding: "Our role from the beginning has been to make the process, particularly around scheduling and operations, easier for any of the community groups that are trying to support and engage some of the underserved communities." Through his role within Duke Health Access Services (DHAS), Simon and the DHAS team have been working to ensure the number of appointment slots available are proportionate to the demographic breakdown of the population through targeted scheduling and template efforts. Efforts lead by various DUHS leaders have focused on creating "pop-up" vaccines sites in areas that are more accessible to historically marginalized community members in an effort to make people feel more comfortable in their given environment when agreeing to be vaccinated.
Improvements toward Equitable Vaccine Distribution
While there has been some improvement with vaccinating people at a rate that more closely reflects the demographics of the populations we serve, there is still a lot of work to be done, especially as it relates to the LatinX community. To help combat this issue, Duke Regional, DHAS and the LATIN-19 organization, led by DHIP member Vivianna Martinez-Bianchi have dedicated slots each week to vaccinate more members of the LatinX patient population in this group both in Durham and beyond. There have been similar efforts through churches and community health organizations to dedicate slots for African American patients within our facilities as well.
The data below provides an overview of how these targeted scheduling and vaccination efforts have improved over time.
| population estimates (Race) | Wake County | Durham County | NC | US |
| Caucasian | 67.9% | 49.2% | 70.6% | 76.3% |
| African American/Black | 21.0% | 38.7% | 22.2% | 13.4% |
| Asian | 7.7% | 5.4% | 3.2% | 5.9% |
| LatinX/Hispanic | 10.4% | 13.8% | 9.8% | 18.5% |
| 2 or more races | 2.6% | 3.2% | 2.3% | 2.8% |
| Not reported/Declined/Other | N/A | N/A | N/A | N/A |
Lessons Learned & the Road Forward
Reflecting on what this particular initiative has taught him, Simon states: Over the last year we've seen that equitable testing and distribution of vaccines doesn't just happen without focus and effort due to the structural issues that exist within our social systems. Duke would be in a different place had the health system leadership not taken that step to start by looking at the data through the lenses of race and ethnicity." Because this issue is going to continue unless we are deliberate, his hope is that we can start looking at more areas with a similar approach. As a second finding, he states, "In this work, where we're trying to engage communities in health and healthcare that haven’t been engaged in the past, there may be distrust in healthcare, healthcare systems, and big organizations. Our role is to support trusted organizations and the people who live and work in those communities in whatever way they need to be successful in improving health."
A Special Thank You
As this work requires the engagement of many Duke Health team members, we thank all who are working toward equitable vaccine distribution across Duke, the community, and beyond!
For DHIP members and staff interested in health equity projects, please visit: https://sites.duke.edu/reachequity/ or contact us directly.
Did You Know?
“Across these 40 states, the vaccination rate among White people was nearly twice as high as the rate for Hispanic people (25% vs. 13%), and 1.7 times as high as the rate for Black people (25% vs. 15%).”
“Only a subset (12 of 47, or 26%) of [state vaccination] plans specifically mention or consider efforts to include providers that will be needed to reach diverse populations. About half of plans (23 of 47, or 49%) mention targeted efforts to reach diverse communities or underserved populations as part of their communications plans.”
