HPV-Call-to-Action: Increasing HPV Vaccination Through Strengthening of Adolescent AFIX. 2PM ET June 28 th, 2017

Transcription

1 HPV-Call-to-Action: Increasing HPV Vaccination Through Strengthening of Adolescent AFIX. 2PM ET June 28 th, 2017

2 PPHF: Increasing HPV Vaccination Coverage $20.7 million 19 states 2 cities $20.7 million to 19 states and 7 cities to increase HPV vaccination coverage among adolescents through joint initiatives with immunization stakeholders, communication campaigns, IIS-based re-minder/recall, assessment and feedback (AFIX), and strategies targeted to improve immunization providers knowledge, skills, and adherence to current HPV vaccination recommendations. (AK, AZ, GA, IA, IL, KS, KY, MA, MI, MN, ND, NV, NY, OH, OR, RI, UT, WA, WI, Chicago, District of Columbia (DC), Houston, New York City, Philadelphia, San Antonio, and Puerto Rico)

3 Agenda owelcome & Housekeeping o Speaker Introductions o Presentations: Houston, Puerto Rico, Rhode Island o Discussion Reminder: Webinar is being recorded 3

4 Webinar Tech-Tips Choose EITHER your telephone or your computer s microphone and speakers. If you are dialing in on telephone, enter audio pin #yourpin#. Click either: USE Telephone for cell phone or land line OR USE Mic & Speakers for computer audio and voice 4

5 Discussion ALL Lines will be unmuted during the discussion portion of the call. PLEASE remember to mute your line if you are not speaking Type question in Question Box and AIM Staff will read your question to the panelist. Mute the line by muting your phone, or computer mic, or by clicking the green microphone button the Go To Webinar control panel 5

6 POLL QUESTION Please Participate! 6

7 The City of Houston LaTasha Hinckson Callis, MBA As the Administration Manager for the Houston Health Department s Immunization Bureau, Mrs. Callis provides leadership and oversight in the assessment of schools and child-care facilities to increase immunization rates and the overall health of children. In addition, she oversees Project Milestone a partnership between the Immunization Bureau and WIC to increase immunization rates of clients through service linkage, immunization education and record screening, while also managing all immunization community and provider education and new initiative implementation across the city of Houston and Harris County. Mrs. Callis earned her MBA in Healthcare Administration from The University of Texas at Tyler, as well as her BA in Spanish from The University of Texas at Austin. 7

8 Puerto Rico ANA LAURA VELÁZQUEZ-FERNÁNDEZ, MPH Ana Laura is the AFIX Adolescent Project Evaluator at the Puerto Rico Immunization Program. She has a Master s degree in Public Health from the Medical Sciences Campus of the University of Puerto Rico. She has worked in clinical trial research protocols for mental health patients, and has also participated in research projects related to social stigma for HIV patients and mental health patients. As a public health professional, she is committed to contribute to the accessibility and quality improvement of essential health services, including primary health, preventive care, and mental health. 8

9 Rhode Island Sue Duggan-Ball, MPA Sue has held the position of Quality Assurance Manager at RIDOH since December 2007, serving as both the AFIX and VFC Manager. Previously holding the position of Immunization Registry, KIDSNET, Provider Relations Manager for seven years. Before joining the Rhode Island Department of Health, Sue worked at Harvard Pilgrim Community Health of New England, at one of the health centers, where most of her time was dedicated to the Consumer Relations Department. 9

10 Increasing HPV Vaccine Coverage by Strengthening Adolescent AFIX Activities LaTasha Hinckson Callis, MBA Administration Manager Houston Health Department, Management Analyst IV Presentation Date: June 28 th 2017

11 Presentation Overview HPV Vaccination Rates in Houston Grant Overview: Strategies Outcomes Next Steps

12 HPV Rates in Houston ( and Doses Administered) TVFC Provider Rates Houston(2016): HPV 1: 69% HPV 3: 40% **Objective: 5% increase in 2017 NIS Rates years Houston (2015): HPV 1 (Female): 66.9% (National-62.8%) HPV 1 (Male): 58.6% (National-49.8%) HPV 3 (Female): 42.8% (National-41.9%) HPV 3 (Male): 22.7% (National-28.1%) 12

13 Strategy 1: Increase Adolescent AFIX Visits Increase the number and reporting of completed adolescent AFIX visits by 25% or at least 50 visits, whichever is greater, compared with Calendar Year Short Term: Conduct a needs assessment to identify providers who will be selected Mid Term: VFC providers will select and begin execution on 2-3 quality improvement (QI) strategies discussed during the initial assessment Long Term: VFC providers will maintain quality immunization services and increase HPV coverage rates among patients with increased involvement by physicians focused on AFIX 13

14 Strategy 1: Outcomes Factors in needs assessment: AFIX adolescent coverage rates (2016) Doses administered for HPV only (2016) Comparative data of doses administered for HPV, Tdap, and Meningococcal (2016) Of the 50 providers identified in Cohort 1, 11 received an adolescent AFIX in 2016 MCV 1 Coverage (96%) Tdap 1 Coverage (96%) HPV 3 Coverage (38%) Other updates: Adolescent AFIX: To date, 17 adolescent AFIX visits have been conducted in 2017 Staffing: Public Health Educator & LVN hired 14

15 Strategy 2: Improve Quality of Adolescent AFIX Visits Improve the quality of adolescent AFIX visits. Short Term: AFIX reviewers and the AFIX coordinator will participate in CDC led trainings. Mid Term: AFIX reviewers will receive training and shadowing from the AFIX coordinator to ensure quality AFIX visit. AFIX reviewers will assist providers with effectively communicating the importance of HPV vaccination to parents. Long Term: AFIX reviewers and the VFC provider will participate in continuous education and training to lead to improved HPV vaccination rates meeting the Healthy People (HP) 2020 coverage rate of 80%. 15

16 Strategy 2: Outcomes CDC led trainings: 2 staff attended AFIX training in March AFIX Reviewer Training: AFIX Coordinator trained reviewers based on CDC training HPV You Call the Shots modules Scheduled observations (6 yearly) check-ins (2 monthly) Continuous Education of VFC Providers: Adolescent/HPV Physician Toolkit Adolescent/HPV Parent Toolkit 16

17 Strategy 3: Implement Approaches for Adolescent AFIX Visits Implement one or more of the following approaches for adolescent AFIX visits. Short Term: Increase provider awareness of adolescent coverage rates within their practice and how their office compares to adolescent coverage rates into current National, State, HP 2020 rates. Mid Term: New QI strategies will foster more buy in from providers leading to more understanding of how improving HPV rates prevents HPV-related cancers. Long Term: Increase provider knowledge of adolescent coverage rates in VFC provider practices to encourage periodic self-assessment of coverage rates. 17

18 Strategy 3: Outcomes Activities: Disseminate Immunization Report Card during AFIX visit. Peer-peer webinars sessions (10) to providers. Quarterly educational webinars Newsletter spotlighting providers with high coverage rates Evaluation reports HPV Video 18

19 Next Steps Complete all initial and follow-up assessments in Cohort 1 (Cohort 2) Complete and distribute HPV Cohort 1 Newsletter Shoot and edit HPV Video Schedule peer-peer webinars Schedule educational webinars Distribute Report Cards & Toolkits 19

20 AIM HPV-Call-to-Action Webinar, Increasing HPV Vaccination Through Strengthening of Adolescent AFIX. June 28 th, 2017 PROJECT PROGRESS: PUERTO RICO Ana Laura Velázquez-Fernandez, M.P.H. AFIX-Adolescent Project Evaluator

21 WE ARE HERE!

22 Puerto Rico Unincorporated territory of the USA o Eligible for federal funding Population: 3.5 million 13 to 18 years old: 353,311 o 81% of this population (286,012 as of June/2016) is VFC eligible source: Puerto Rico Immunization Registry (IIS) VFC providers: 230 o 84% (193) of them are eligible for AFIX visits. Recent updates in public policy o Mandatory HPV vaccination for school year Health insurance companies cover HPV vaccine

23 Puerto Rico Cervical Cancer Incidence Data Period Age group Incidence rate x 100,000 Mortality rate x 100, * to 34 years old to 49 years old to 34 years old to 49 years old Sources: * Cancer in Puerto Rico, Puerto Rico Central Cancer Registry. San Juan, PR. Cancer in Puerto Rico, Puerto Rico Central Cancer Registry. San Juan, PR.

24 Percent of estimated coverage Vaccination Adolescent Coverage from 13 to 17 years old, Puerto Rico, Antigen and Dosis Source: National Immunization Survey

25 AFIX Implementation in Puerto Rico 8 regional coordinators o 22 AFIX reviewers that also conducts VFC visits Data gathered from PRIR (IIS) since 2015 AFIX only visits o Face to face only Calculation of both children and adolescent coverage and missed opportunities o o 2014: CoCASA 2015-Present: Puerto Rico Immunization Registry (IIS)

26 AFIX Puerto Rico Staff AFIX Lead Reviewer Health Education and Communication Specialist Project Evaluator Evaluation and Quality Assurance (EQAS) Team Lead AFIX Reviewers

27 IMPROVING THE QUALITY OF ADOLESCENT AFIX VISITS AFIX-Adolescent Project Activities

28 Policies and Procedures Guide First Official P&P Guide for Puerto Rico Contains every document necessary for AFIX implementation Culturally adapted guide Provides guidance with site visit implementation for reviewers Includes communication strategies

29 AFIX Online Tool User Guide CDC s AFIX Online Tool User Guide translation Added features More screenshots More specific instructions User friendly

30 AFIX Site Visit Form Spanish translation Improvements Developer functions allow the provider to answer questionnaire beforehand Format similar to the AFIX Online Tool Facilitates data entry process

31 Provider Report Card Updates and improvements to the PRC o HPV coverage by age cohort o User friendly format o Promotion of the AFIX Missed Opportunities o Advanced programming in Access-Excel databases

32 Vaccination Provider Coverage Report

33 Vaccination Provider Coverage Report

34 Missed Opportunities Provider Report

35 Trainings for Reviewers Development of a training module Divided into 2 sections (2 days of training) o AFIX training AFIX overview Role plays New documents and tools for AFIX visits o Visit documentation training AFIX Online Tool Provider coverage and missed opportunities Audience divided into 3 regions o 8-10 participants per group o Better attend the needs of participants

36 INCREASE KNOWLEDGE AND USE OF CDC RESOURCES AND AFIX STANDARDS Resources for providers, patients and parents

37 Educational Materials Data base of multiple resources Selection of culturally adapted materials Categorized for various population o o o Providers Patients Parents Accessibility through the PRDoH website o HPV section

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39 AFIX Booklet AFIX description and summary Easy to understand Culturally adapted Targeted for providers to promote participation in the AFIX program Promotion of AFIX

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42 AFIX Bulletin Informative sheet dedicated to clarify questions from providers and reviewers Published every 3 months 1 st edition: Coverage and missed opportunities

43 Vaccine Refusal Documentation Form Spanish version from the American Academy of Pediatrics Helps with accurate documentation Useful tool for providers in the implementation of QI strategies

44 Provider-Oriented Educational Material

45 Patient-Oriented Educational Materials

46 COLLABORATIONS WITH STAKEHOLDERS Increasing institutionalization of QI strategies and HPV strong vaccination recommendation in provider offices.

47 Collaboration With Stakeholders Centro Comprensivo del Cancer de Puerto Rico Puerto Rico Comprehensive Cancer Center o o Coalición para la Control del Cancer de Puerto Rico (Coalition for Cancer Control of Puerto Rico) Immunization Program Representation HPV Prevention Committee Voces - Coalición de Vacunación de Puerto Rico Voices - Vaccination Coalition of Puerto Rico o Immunization Conference (IMCO) Educational booth AFIX satisfaction survey for providers Presentation Quality Improvement in Provider Offices Communication Strategies for HPV

48 Collaboration with Stakeholders Ponce School of Medicine & Moffitt Cancer Center o ID HPV series completion barriers and facilitators among caregivers of Spanishspeaking /Spanish-preferring in Tampa FL, and Ponce, PR o Refine and assess acceptability of and HPV vaccine educational brochure content. o Data sharing o Instrument Feedback Provider oriented variables

49 Collaboration with Stakeholders Puerto Rico Health Department s Maternal, Child and Adolescent Health Program o Vacunarse es Vida campaign (2016) Target audience: Adolescents Multiple outlets Cinema commercials Social Media Billboards Printed and digital press Key chains

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51 AFIX HPV Project Evaluation 2 year evaluation plan Reviewers evaluation o Observational visits o Proficiency of the AFIX reviewers to conduct the AFIX visits o Reviewer s self-evaluation Provider s input o Perceptions, satisfaction and usefulness of the AFIX visits o Satisfaction and usefulness of the Provider Report Card o Assessment of technical assistance needs for providers Analysis of strengths and barriers for the AFIX visit implementation o Technical assistance for providers and reviewers

52 NEXT STEPS

53 Next Steps AFIX site visits (3 rd quarter 2017) Project evaluation process o o o Observational visits AFIX visit satisfaction survey for providers Process to identify technical assistance for AFIX reviewers and providers Development of the CME s system (1 st quarter 2018) Development of sustainable formal incentives structure and logistic Adaptation of Vacunarse es Vida campaign for providers Community outreach Collaboration with Merck & Co. o Train and encourage HPV vaccine promoters to adopt CDC language for quality improvement and communication strategies

54 Thank you! Ana Laura Velázquez-Fernández, MPH AFIX-Adolescent Project Immunization Program Puerto Rico Department of Health

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56 Increasing HPV Vaccine Coverage by Strengthening Adolescent AFIX Activities Presentation June 28, 2017 AIM Webinar

57 Grant Objectives Approaches to Increase Physician Engagement Improve the Quality of AFIX Visits Distribution of CDC Resources, Educate and Increase Awareness

58 Approaches to Increase Physician Engagement Peer to Peer visits conducted during non standard office hours: 7:30 AM, noon, 5 :00 PM Peer to Peer model requires 1 physician attend the visit, all other staff are welcome to join Initial exchange is conducted with practice staff, physician not required

59 Approaches to Increase Physician Engagement Rhode Island AFIX Webinar The webinar is available at a time convenient for the physician Receive CME incentive Follow up call to practice staff. Has physician shared AFIX QI activities agreed to with you? How is it going? Initial exchange conducted w/practice staff, physician encouraged, not required to attend

60 Improve the Quality of Visits Awardee Staff Training Physician consultant trains awardee staff on most current HPV data and clinical knowledge behind the data Consultant conducts follow up training and post test Provide ongoing training as needed Outcome: Awardee staff will conduct improved AFIX visits armed with most current data and knowledge

61 Distribution of CDC Resources Talking with Parents about HPV Vaccine HPV and Oropharyngeal Cancer Genital HPV Infection- CDC Fact Sheet Resources reviewed at awardee meetings Which resources are practices using the most? Awardee staff will be well versed on the most current CDC materials to share at visits

62 Additional Collaboration Joined Partnership to Reduce Cancer in Rhode Island, HPV subgroup Objective: Provide HPV and orpharyngeal cancer education & resources to dental community Working with the RIDOH Oral Health Program Manager and dentist to collaborate on these efforts Subgroup to develop education plan for Dental Hygienist Program students in Rhode Island colleges

63 Distribution of CDC Resources Talking with Parents about HPV Vaccine HPV and Oropharyngeal Cancer Genital HPV Infection- CDC Fact Sheet Resources reviewed at awardee meetings Which resources are practices using the most? Awardee staff will be well versed on the most current CDC materials to share at visits

64 Sample Material New Cancers Caused by HPV per Year United States Vagina n=600 3% Oropharynx n=2,000 10% Vulva n=2,400 13% Rectum n=500 3% Anus n=3,000 16% Cervix n=10,700 56% Penis n=700 6% Rectum n=200 2% Anus n=1,600 14% Oropharynx n=9,100 78% Women (n = 19,200) CDC, United States Cancer Statistics (USCS), Men (n = 11,600)

65 HPV Vaccination Coverage Rates

66 HPV Vaccination Coverage Rates

67 HPV Vaccination Coverage Rates

68 HPV Rate Increase Effective August 1, 2015 HPV required for school entry Vaccinate Before You Graduate expanded into middle school to vaccinate the second dose of HPV vaccine, most adolescents received the first dose at the provider office Peer to peer consultant began AFIX visits in RI, February 2015 Reminder/recall project 2016

69 Sue Duggan-Ball, MPA Quality Assurance Manager Office of Immunization Center for Preventive Services

70 Discussion--Please participate!! All lines are open! Please place your phone on MUTE when not speaking! 70

71 Reminders Take the event evaluation that appears at the end of the webinar. Your feedback will help us improve! Next HPV Call-to-Action: September 13th at 2 PM ET Featured topic: TBA 71