Improving Adult Immunization Rates: Ongoing Efforts in Four States

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1 Improving Adult Immunization Rates: Ongoing Efforts in Four States

2 What Works for Raising Adult Immunization Rates? Opportunity to Share State Experiences and To Generate Thinking About Your Own Successes

3 Today s Session What are states doing to improve adult immunization rates? Examples from Utah, Wisconsin, Missouri and Minnesota. Call on NAICP members to think about their own successes.

4 Considering Successes and Lessons Learned Do you know about a potential nomination for a National Adult and Influenza Summit award? Publication: Do you have data that can be published and added to the scientific literature? NAICP Executive Committee will send a poll to members about how to proceed with a grantee display of materials or posters at the May Summit Meeting in Atlanta. Today s session may generate suggestions or ideas for this. JH

5 Considering Successes and Lessons Learned Do you have an example to share that could be used in the 2015 What Works poster displays at the May Summit meeting in Atlanta? Partners.pdf Do you have successes due to use of your state IIS?

6 Adult Immunization Efforts in Utah Carlie Shurtliff Utah Immunization Program

7 LTC Site Visit Project: To Improve Vaccination Rates

8 Project Design Components Site visits using questionnaire & AFIX follow-up conducted Immunization education & record-keeping tools provided Flu Myth Buster and Storage & Handling presentations given USIIS enrollment encouraged & training provided Goal: visit 100+ LTCs across a 2 year period (those with lowest employee flu vaccination coverage rates and 50+ residents); to improve immunization knowledge, increase rates, and encourage USIIS participation

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10 Results: Coverage Rates for LTCs Visited Only Vaccine Coverage Employee Influenza Vaccination Rate 49.5% 54.5% Employee Hepatitis B Series Vaccination Rate 53.7% 54.2% Resident Influenza Vaccination Rate 72.1% 73.8% Resident PPSV Vaccination Rate 54.9% 53.5%

11 LTC Employee Vaccination Influenza Vaccine Coverage National LTC HCWs N/A N/A N/A N/A 64.4% 52.0% 58.9% 63.0% Utah LTC Employees 48.2% 47.8% 46.8% 48.6% 51.9% 55.6% 55.9% 61.4% Hepatitis B Vaccine Coverage ( 3 doses) NHIS HCWs 19 years % 64.7% 63.2% 63.8% 65.0% N/A Utah LTC Employees in direct patient care 55.2% 55.7% 53.1% 54.5% 54.5% 54.7%

12 LTC Resident Vaccination Influenza Vaccine Coverage Ntl. BRFSS adults 65 years 69.6% 72.0% 71.1% 70.1% 67.5% 61.3% 60.1% 62.8% Utah BRFSS adults 65 years 72.1% 76.2% 73.3% 68.8% 68.2% 56.9% 56.0% 57.4% Utah LTC Residents 72.0% 71.6% 74.2% 74.4% 78.8% 77.1% 75.3% 75.9% Pneumococcal Polysaccharide Vaccine Coverage (PPV) Ntl. BRFSS adults 65 years 2 Utah BRFSS adults 65 years % 67.3% 66.9% 68.5% 68.8% 70.0% 68.8% 69.5% 65.9% 68.8% 69.2% 69.0% 68.3% 70.0% 70.1% 69.4% Utah LTC Residents 44.1% 44.2% 46.6% 48.8% 60.5% 58.6% 57.2% 55.1%

13 Lessons Learned Employee turnover is biggest problem Record keeping practices in LTCs aren t good Sites aren t adhering to Immunization Licensing Rule (particularly PPSV tracking and vaccination) Drop-in visits may be better than scheduled visits Questionnaire needs amending (fewer direct questions, more observational check boxes) 1 to 2 month follow-up visit or call needed System changes needed with management buy-in in larger facilities

14 Future of Site Visit Project Continue site visits using 317 funding Revise questionnaire and follow-up timing Finish development of LTC Immunization Guidebook Develop LTC webpage Offer group training sessions for LTC HCWs Collaborate with Oregon State Health Department on lessons learned, guidebook and improvements to site visit protocols

15 Questions? Carlie Shurtliff M.A. Adult Immunization/Perinatal Hepatitis B Coordinator Utah Department of Health, Immunization Program cshurtli@utah.gov

16 Adult Immunization Efforts in Wisconsin Stephanie Borchardt Wisconsin Immunization Program

17 Adult Immunization Rates of Interest Tdap (19-64 years) HPV (19-26 years) Zoster ( 60 years) PPSV ( 65 years) Influenza ( 19 years) PCV ( 65 years)

18 Data Source Wisconsin Immunization Registry In use since May 2000 Lifespan immunization registry Use is not required, though is estimated to be used by about 95% of Wisconsin immunizing providers

19 Adult Immunization Efforts in Missouri Lana Hudanick Missouri Immunization Program

20 Efforts to Educate Patients and Providers Missouri s Poster for Pregnant Women

21 Adult Immunization Efforts in Minnesota Annie Federowicz Minnesota Immunization Program

22 Immunization & Pregnancy MIPAC Subgroup Presenter: Annie Fedorowicz, MPH NAICP Meeting January 6, 2015

23 The Minnesota Immunization Practices Advisory Committee (MIPAC) Background Purpose: - Advises MDH on reducing & eliminating VPDs across the lifespan through a statewide immunization program Member Representation: Professionals from a variety of health care organizations Professionals working in the metro & Greater MN For a more information on MIPAC, visit:

24 Immunization & Pregnancy Subgroup Goals: Advise MDH on developing strategies for: 1. Expanding the adoption of existing immunization recommendations for pregnant women 2. Utilizing prenatal care encounters to promote infant immunization Immunization Program has identified pregnant women as a priority population

25 Subgroup Summary Convened 7 meetings from Aug Jul members represented a variety of organizations that deliver prenatal care to pregnant women MDH staff & subgroup members developed a list of feasible & useful strategies Strategies will guide future Immunization Program activities

26 Recap of Meetings 1 3 Exploratory meetings Discussed: Health-systems & clinics methods of communicating immunization practice changes to their staff Methods for communicating immunization recommendations to prenatal care patients Common vaccine concerns prenatal care providers hear from their patients Methods for introducing the concept of infant immunization during prenatal care visits

27 Recap of Meeting 4 Strategies list developed: Member input Evidence-based strategies Strategies categorized for each goal: Provider Education & Resources Patient Education & Resources Partnership Building Outreach Systems Focus/QI Projects

28 Goal 1 (G1): Develop strategies for expanding the adoption of existing immunization recommendations for pregnant women

29 Goal 2 (G2): Develop strategies for utilizing prenatal care encounters to promote infant immunization Slide 29

30 Recap of Meetings 5 & 6 Prior to Meeting 5 & 6 MDH staff assessed the feasibility of the strategies Assigned strategies,, or feasibility ratings feasibility strategies would not be pursued Purpose Members prioritized the strategies Used webinar polling Discussed polling results Assessed the utility of these strategies Took feasibility ratings into account

31 High Priority Strategies Category Goal 1 (G1) Strategies Goal 2 (G2) Strategies Provider Education & Resources Patient Education & Resources Systems Focus/ QI Projects G1.4: MDH immunization & pregnancy webpage G1.5: MDH pregnancy & vaccination provider pocket-guide G1.8: Clinic-level provider training content G1.13: Provider online training G1.15: Clinic, health systems & health plans communications G1.19: Immunization & pregnancy factsheet or pamphlet G1.21: Waiting room & exam room messaging G1.26: Social media outreach G1.28: Messages for existing healthy pregnancy texting services G1.40: Rooming procedures G1.45: Standards & guidelines for clinical practice G2.1: Vaccine hesitancy communications G2.2: Articles for professional publications G2.6: Provider online training G2.10: Infant immunization resources sheet G2.11: Infant immunization factsheet or pamphlet G2.12: Stories of infants with VPDs G2.14: Waiting room & exam room msging G2.18: New-baby congratulations postcard or e-card G2.19: Social media outreach G2.30: Health systems & plans buy-in

32 Final Report Recommendations Short-term Continue to pursue National Infant Immunization Week (NIIW) activities Pursue activities beyond the NIIW campaign Cross-link all immunization & pregnancy related resources to one MDH Web page Easier to promote one Web page link

33 Final Report Recommendations Continue to pursue developing relationships with staff in clinics, health systems & health plans Focus on staff responsible for: Longer-term Internal provider communications Creating clinical practice guidelines & policies Pursue opportunities to partner with a variety of prenatal care settings to deliver trainings Available in person & online to maximize provider outreach Assess feasibility of an immunization educational texting pilot study with a MN prenatal care provider group

34 Comments or Questions? Subgroup facilitator contact information: Annie Fedorowicz Adult Immunization Outreach Specialist Office phone:

35 Time Permitting Other examples of successes or lessons learned about how to increase adult immunization rates?