Influenza Season

Transcription

1 11/2/ How to Improve Outcomes Related to Influenza & Pneumococcal Immunization Mary McGoldrick, MS, RN, CRNI Home Care and Hospice Consultant Saint Simons Island, GA Nothing to Disclose - Influenza Season Lessons learned: Vaccination rates Antiviral drugs Influenza vaccine 1

2 11/2/ Adjusted Influenza Vaccine Effectiveness Influenza Season Adjusted Overall Vaccine Effectiveness (%) Source: studies.htm Note: data not available. Influenza Positive Tests Reports to CDC 2

3 11/2/ Laboratory-Confirmed Influenza Hospitalizations Influenza Evidence-based Guidelines Recommendations of the Advisory Committee on Immunization Practices (ACIP) United States, 16 Influenza Season Population Vaccine type Source: Advisory Committee on Immunization Practices (ACIP). Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices. United States, 16 Influenza Season. August 7,. 64(30)

4 11/2/ Influenza Vaccination of Health-Care Personnel Educate healthcare personnel (HCP) re: Benefits of influenza vaccination Potential health consequences of influenza illness for themselves and their patients Epidemiology and modes of transmission, diagnosis, and treatment Nonvaccine infection control strategies (Category 1B) Influenza Vaccination of Health-Care Personnel Offer influenza vaccine annually (Category IA) Provide influenza vaccination to HCP at the work site and at no cost (Category IB) Obtain a signed declination (Category II) Monitor influenza vaccination coverage and declination at regular intervals (Category IB) Use influenza vaccination coverage as a measure of quality (Category II) 4

5 11/2/ Best Practices for Preventing and Controlling Influenza in Home Care Influenza vaccination Antiviral drugs Hand hygiene Standards precautions: Respiratory hygiene/cough etiquette Use of personal protective equipment Transmission based precautions Pneumococcal Disease Streptococcus pneumoniae Transmission Clinical features Risk factors Drug resistance Prevention 5

6 11/2/ Pneumococcal Evidence-based Guidelines Pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax 23 ) Pneumococcal conjugate vaccine (PCV13 or Prevnar 13 ) All adults 65 years of age or older Adult under 65 years with certain conditions ACIP Recommendations for PCV13 and PPSV23 Use Pneumococcal vaccine naïve persons Previous vaccination with PPSV23 Potential time limited utility of routine PCV13 use among adults 65 years Co administration with other vaccines Precautions and contraindications 6

7 11/2/ Questions? Mary McGoldrick, MS, RN, CRNI Home Care and Hospice Consultant Home Health Systems, Inc. Phone: (912) Fax: (800) E mail: mary@homecareandhospice.com Web: HomeCareandHospice.com 13 Improving Outcomes: Influenza & Pneumococcal Immunization HHQI RN Project Coordinators: Misty Kevech, BS Ed, MS, COS C, CCP Cindy Sun, BSN, MS, COS C 7

8 11/2/ Immunization & Quality Outcomes Hospitalizations Emergent Care Cardiovascular Health Chronic Disease Management Influenza & Pneumococcal Cross Setting Measures Home Health Hospitals LTACHs & IRUs Nursing Homes Physician Practices 8

9 11/2/ Underserved Populations Influenza: Race/Ethnicity Flu Vaccination Coverage by Race/Ethnicity, Adults 18 years and older, U.S., 2013 Season (CDC) White only Black only 25 Hispanic Asian AI/AK Other or multiple White only Black only Hispanic Asian AI/AK Other or multiple CDC, Underserved Populations Education Less than high school (66%) High school (73.6%) Some college/vocational (72.9%) College degree or more (78.2%) Socio economic Medicaid eligible dually eligible (63.9%) Not Medicaid eligible (73.7%) No Physician Visit (in year) Beneficiaries years (22%) Beneficiaries older than 74 (10%) (Lochner & Wynne, 2011, pp. E2 E3) 9

10 11/2/ Underserved Populations Pneumococcal: Race/Ethnicity Pneumococcal Vaccinations (PPSV23 & PCV13) Among Adults in US, % Adults % Adults 65 & older White Black Hispanic Asian CDC, Underserved Populations Pneumococcal: Poverty Pneumococcal Vaccination Among Adults age 18 and older by Poverty Level (%), U.S., Below 100% 100% 199% 200% 399% 400% or more CDC, 2013, Table 82 10

11 11/2/ Free Tools & Resources Immunization & Infection Prevention Best Practice Intervention Package (BPIP) Leadership Track Seasonal Influenza & Pneumococcal Immunization Infection Control Sample PDSA Worksheet & Checklist Clinician Tracks Nursing & Therapy Medical Social Worker Home Health Aide 11

12 11/2/ Sample Standing Orders for Influenza & Pneumococcal Proper Storage Storage & Handling Policies Processes for: New shipments Emergency plan (e.g., power outages) Proper storage equipment and correct temperatures 12

13 11/2/ Screening Checklist for Contraindications to Vaccines for Adults Vaccine Information Statements 13

14 11/2/ Strategies to Boost Patient Immunization Rates Tips to Boost Patient Immunization Rates Set and publicize your patient goals & progress Use your HHQI Data Reports Establish practice that every patient is to receive (or plan set in place to receive elsewhere) influenza vaccines unless: Contraindications Patient refusal Previous immunization Create process to track patients who have not received immunizations yet (and follow through) Assemble a list of local sites providing immunizations 14

15 11/2/ Immunization Reconciliation Process Immunization PDSA Worksheet 15

16 11/2/ Tips to Boost Patient Immunization Rates Survey staff to find out common themes of why patients are refusing Determine if there are racial/ethnical or other disparity issues effecting immunization Provide written information for patients, family members, and community organizations as needed Assess staff s buy in and understanding of evidence to support immunization 10 Common Flu Myths 16

17 11/2/ CDC Tools Multicultural/Multilingual Resources 17

18 11/2/ Multicultural/Multilingual Resources New Posters from CDC 18

19 11/2/ Strategies to Boost Staff Immunization Rates Tips to Boost Staff Immunization Rates Offer flexible and convenient staff influenza clinics Various times of day Locations Staff/team meetings Off site locations central to field staff Orientation for new employees September May Promote upcoming schedules Early sign up and add to clinician's schedule as reminder 19

20 11/2/ Tips to Boost Staff Immunization Rates Consider offering after hour clinics for both staff and their immediate families Benefit includes: Increased staff opportunity to get staff immunized Reduces influenza illness within immediate family call offs or spread of virus Portrays organization s caring about staff and their families Staff Promotional Posters 20

21 11/2/ CDC E-Postcards HHQI Customizable Posters 21

22 11/2/ Tips to Boost Staff Immunization Rates Offer rewards and recognition Post team or office staff immunization rates to promote competition Announce and recognize winning team(s) and runner up(s) Celebrate each team or office as they reach the agency s goal Promote rewards monthly through first few months of influenza season Tips to Boost Staff Immunization Rates Offer rewards and recognition (cont.) Offer team rewards (include office teams) Team lunch An extra hour of PTO Consider individual rewards Gift cards for free specialty coffee or drink or snack Healthy snacks/beverages or small gift with vaccination Raffle ticket for drawing for prize(s) Post and celebrate staff immunization goal & progress 22

23 11/2/ Penalties & Prevention of Harm Require staff to wear mask during flu season Institute policy with comprehensive refusal form (exception only related to contraindications or allergies) Include specific sections/documents to be read that provides education on benefits, risks of non immunization with patients and own families Additional ideas included in BPIP Success Stories Community Immunizations: Go Where They Are (BPIP p. 51) Successfully Implementing Employee Vaccines Policy (BPIP p. 55) 23

24 11/2/ HHQI s Immunization Data Reports HHQI s Immunization Data Reports Individualized reports: Influenza Pneumococcal Securely delivered online Updated monthly OASIS based Historical trends 24

25 11/2/ HHQI Data Access Welcome Screen 25

26 11/2/ Influenza Vaccine OASIS Items (M1041) Influenza Vaccine Data Collection Period: Does this episode of care (SOC/ROC to Transfer/Discharge) include and dates on or between October 1 and March 31? 0 No[Go to M1051] 1 Yes (M1046) Influenza Vaccine Received: Did the patient receive the influenza vaccine for this year s flu season? 1 Yes; received from your agency during this episode of care (SOC/ROC to Transfer/Discharge) 2 Yes; received from your agency during a prior episode of care (SOC/ROC to Transfer/Discharge) 3 Yes; Received from another healthcare provider (for example, physician, pharmacist) 4 No; patient offered and declined 5 No; patient assessed and determined to have medical contraindication(s) 6 No; not indicated patient does not meet age/condition guidelines for influenza vaccine 7 No; inability to obtain vaccine due to declared shortage 8 No; patient did not receive the vaccine due to reasons other than those listed in responses 4 7 Pneumococcal Polysaccharide Vaccine OASIS Items (M1051) Pneumococcal Vaccine: Has the patient ever received the pneumococcal vaccination (for example, pneumovax)? 0 No 1 Yes[Go to M1500 at TRN; Go to M1230 at DC] (M1056) Reason Pneumococcal Vaccine not received: If patient has never received the pneumococcal vaccination, state reason: 1 Offered and declined 2 Assessed and determined to have medical contraindication(s) 3 Not indicated; patient does not meet age/condition guidelines for pneumococcal vaccination 4 None of the above 26

27 11/2/ Influenza Vaccine Received, Contraindicated, Declined or Shortage Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Total Received Discharges Received Rate (%) State Rate (%) National Rate (%) Reasons For Not Receiving Influenza Vaccine Non Received Reasons 1. Offered & Declined 2. Medical Contraindication 3. Not indicated 4. Vaccine Shortage 5. None of the above Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Rate (%) Episodes Rate (%) Episodes Rate (%) Episodes Rate (%) Episodes Rate (%) Episodes Total 27

28 11/2/ Influenza Vaccine Received Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Total Received Discharges Received Rate (%) State Rate (%) National Rate (%) Influenza Vaccine Received Rate(%) by Age Groups AGE (Year) Jun Jul Aug Sep Oct <65 Rate (%) Discharges Rate (%) Discharges Rate (%) Discharges >84 Rate (%) Discharges Nov Dec Jan Feb Mar Apr May Total 28

29 11/2/ Influenza Vaccine Received Rate(%) by Race Groups Race Jun Jul Aug Sep Oct Asian Rate (%) Discharges Black Rate (%) Discharges Hawaiian Rate (%) Discharges Hispanic Rate (%) Discharges Indian Rate (%) Discharges White Rate (%) Discharges Nov Dec Jan Feb Mar Apr May Total Influenza Vaccine Not Received Rate(%) by Age Group AGE (Year) Jun Jul Aug Sep Oct <65 Rate (%) Discharges Rate (%) Discharges Rate (%) Discharges >84 Rate (%) Discharges Nov Dec Jan Feb Mar Apr May Total 29

30 11/2/ Influenza Vaccine Not Received Rate(%) by Race Groups Race Jun Jul Aug Sep Oct Asian Rate (%) Discharges Black Rate (%) Discharges Hawaiian Rate (%) Discharges Hispanic Rate (%) Discharges Indian Rate (%) Discharges White Rate (%) Discharges Nov Dec Jan Feb Mar Apr May Total Influenza Vaccine Received Rate(%) by Payment Source (M0150) Groups Current Payment Source Jun Jul Aug Sep Oct 01 Medicare FFS Rate (%) Episodes Medicare HMO Rate (%) Episodes Medicaid FFS Rate (%) Episodes Medicaid HMO Rate (%) Episodes Workers Comp Rate (%) Episodes Title programs Rate (%) Episodes Other government Rate (%) Episodes Private insurance Rate (%) Episodes Private HMO Rate (%) Episodes Self pay Rate (%) Episodes Other Rate (%) Episodes Nov Dec Jan Feb Mar Apr May Total 30

31 11/2/ Influenza Vaccine Not Received Rate(%) by Payment Source (M0150) Groups Current Payment Source Jun Jul Aug Sep Oct 01 Medicare FFS Rate (%) Episodes Medicare HMO Rate (%) Episodes Medicaid FFS Rate (%) Episodes Medicaid HMO Rate (%) Episodes Workers Comp Rate (%) Episodes Title programs Rate (%) Episodes Other government Rate (%) Episodes Private insurance Rate (%) Episodes Private HMO Rate (%) Episodes Self pay Rate (%) Episodes Other Rate (%) Episodes Nov Dec Jan Feb Mar Apr May Total QIN-QIO Immunization Project 31

32 11/2/ QIN-QIO Immunization Project Purpose Improve immunization rates and reduce immunization disparities among Medicare beneficiaries residing in 37 U.S. states and territories Includes Influenza, Pneumococcal, and Shingles immunizations States AK, AL, AR, AZ, CA, DC, FL, GA, HI, ID, IL, IN, KS, KY, LA, MD, MI, MO, MS, MT, ND, NE, NJ, NM, NV, NY, OR, PA, PR, RI, SC, SD, TX, UT, WA, WV, & WY Next Steps What did you hear that excites you? How will you assess your staff s understanding of evidence supporting immunization and their buy in? How will you evaluate your agency s immunization process and trends using HHQI Immunization Reports? How will you implement the tools and resources for home health or community clinicians? 32

33 11/2/ Resources HHQI Immunization and Infection Prevention BPIP HHQI Data Reports and Resources CDC New posters for seniors American Indians/Alaska Natives flu complication infographic Flu Prevention ecards Connect with HHQI Facebook Twitter Pinterest LinkedIn national campaign MyHHQI Blog LiveChats under Network tab on HHQI website 33

34 11/2/ Questions? THANK YOU! Contact Info: Cindy Sun Misty Kevech This material was prepared by Quality Insights, the Medicare Quality Innovation Network Quality Improvement Organization supporting the Home Health Quality Improvement National Campaign, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The views presented do not necessarily reflect CMS policy. Publication number 11SOW WV HH MMD