Immunize children and adults against vaccine-preventable disease in

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1 PERFORMANCE PLAN PHD/CHSB & SH CHSB: Yvette Griffin x1274, Teresa Moberly x1242 SHB: Helen Nace x1655, Jennifer Toma x8156 Program Purpose Program Information Immunize children and adults against vaccine-preventable disease in occurs three times a week on a walk-in basis. Immunizations are also provided in several Public Health programs; this plan focuses only on the. Vaccines required by the Code of Virginia for children to enter school are provided free. Vaccines offered include: hepatitis A and B, tetanus, diphtheria, pertussis, Haemophilus influenzae type B, measles, mumps, rubella, varicella (chickenpox), polio, pneumococcus, rotavirus, human papilloma virus, meningitis, and zoster (shingles). Required and recommended vaccines by age group: o More than 17 doses of vaccine required by Virginia Department of Health o (VDH) to enter kindergarten Additional 6 doses of vaccine recommended by CDC for children ages 7 to under 19 for adults are based on age, health conditions, job requirements, and other risk factors. provides influenza vaccine on a seasonal basis. Tuberculin Skin Tests (TST), which are used to identify the presence of the bacterium that causes Tuberculosis (TB) are offered in the Immunization Clinic. Co-managed by Community Health Services Bureau and School Health Bureau. Partners: Virginia Department of Health. PM1: How much did we do? Staff Customers and Service 4.45 FTEs including 2.25 Public Health Nurses 1.45 Clinic Aide/Administrative Team 0.6 Coordinator 0.15 Supervisor Clients under 7 years of age of Clients of Visits Clients ages 7 to less than 19 years of Clients of Visits Clients 19 years of age or older of Clients of Visits 740* 1,358 1,682* 3,184 1,666** 2,584 FY ,274 1,524 2,796 1,876 2,804 FY ,173 1,159 2,268 2,209 3,388 Average number of vaccines per visit, excluding flu, Average number of services per visit, including vaccines and TST,

2 PERFORMANCE PLAN *The increase in clients that are children may be due to a decrease in the number of private providers enrolled in the Vaccines for Children program that provides free vaccines to eligible children. **The decrease in the number of adult clients may be due to a change in the policies about collecting administration fees, the end of a grant that provided free Hepatitis B vaccine to eligible adults, more adults accessing care through private providers due to the Affordable Care Act, and clients moving from area due to cost of living. PM2: How well did we do it? 2.1 Children under seven years of age who were offered and received all ageappropriate 2.2 Children age seven to under 19 who were offered and received all age-appropriate 2.3 Customer feedback PM3: Is anyone better off? 3.1 Cases of reportable vaccine-preventable diseases among Arlington children and adults immunized at 2

3 Dtap Hep B Hib PCV Hep A Rotavirus Dtap Hep B Hib PCV Hep A Rotavirus PERFORMANCE PLAN Measure 2.1 Children under seven years of age who were offered and received all ageappropriate 2% Appropriate Vaccination at the Clinic Visit 2% 2% 3% 1% 28% 31% 7% 2% 2% 2% 1% Goal = 95% green 28% 31% 3% 7% 6 43% 49% 52% 42% 43% 49% 52% 42% 4 65% 33% 55% 48% 48% 56% 71% 68% 55% 93% 65% 33% 55% 48% 48% 56% 71% 68% 55% 93% N=165 Appropriately Not Offered Appropriately Offered and Refused Appropriately Offered and Given Missed Opportunities and Errors In, of all possible recommended and required vaccines, 97% were appropriately offered to clients. All 9 vaccines met the goal of being appropriately offered to clients 95% of the time. gathered through internal audit of randomly selected charts each quarter. The sample size is based on the number of visits in the quarter and is determined using standard statistical methods. In, the met goals for appropriately offering vaccines to children under 7 years old for all 9 vaccines. The refusal rate for Hepatitis A vaccine may be because of the following: it is not required for school entry; many clients are receiving a large number of other shots at that visit; and there may be a fee associated with the vaccine. Uninsured children who do not have Medicaid are eligible for free vaccine, but are still asked for a fee to cover vaccine administration. Although the fee can be waived, it may be a deterrent for some clients. Children with insurance are either referred to their primary care provider or charged the full price of the vaccine plus the administration fee and given a receipt that can submitted to their insurance. : Anticipate the rate will stay the same Stay the course. Continue to offer, recommend, and educate parents on the importance of Hepatitis A vaccine. 3

4 TDap TD HepB HPV MCV4 HepA TDap TD HepB HPV MCV4 HepA PERFORMANCE PLAN Measure Children age seven to under 19 who were offered and received all ageappropriate Appropriate Vaccination at the Clinic Visit 3% 3% 2% 12% 14% 12% 14% 26% 26% 3 27% 15% 3 27% Goal = 95% green 15% 41% 39% 41% 39% 46% 47% 36% 46% 47% 36% 26% 26% 69% 73% 58% 53% 59% 53% 49% 69% 46% 3% 3% 69% 73% 58% 53% 59% 53% 49% 69% 2% 46% N=194 Appropriately Not Offered Appropriately Offered and Refused Appropriately Offered and Given Missed Opportunities & Errors In, of all possible recommended and required vaccines, 97% were appropriately offered to clients All 9 vaccines met the goal of being appropriately offered to clients 95% of the time gathered through internal audit of randomly selected charts each quarter. The sample size is based on the number of visits in the quarter and is determined using standard statistical methods. In, the met goals for appropriately offering vaccines to children age 7 to under 19 for all 9 vaccines. The high refusal rates for HPV, MCV4, and Hepatitis A vaccines may be because of the following: they are not required for school entry; many clients are receiving a large number of other shots at that visit; and there may be a fee associated with the vaccine. Uninsured children who do not have Medicaid are eligible for free vaccine, but are still asked for a fee to cover vaccine administration. Although the fee can be waived, it may be a deterrent for some clients. Children with insurance are either referred to their primary care provider or charged the full price of the vaccine plus the administration fee and given a receipt that can be submitted to their insurance. : Anticipate the rate will stay the same Stay the course. Continue to offer, recommend, and educate parents on the importance of HPV, MCV4, and Hepatitis A vaccines. 4

5 Percent of Clients Percent of Clients PERFORMANCE PLAN Measure 2.3 Customer Satisfaction 6 4 Immunization Client Feedback Survey 1% 2% 2% 2% 2% 7% 4% 8% 8% Goal = 95% green 92% 95% 89% 89% FY Clients FY Clients 117 Clients Overall Satisfaction with Strongly Agree Agree Disagree Strongly Disagree Immunization Client Feedback Survey 1% 2% Goal = 95% Yes Goal = Yes % 98% 99% 99% FY Clients FY Clients 111 Clients FY Clients FY Clients 113 Clients Vaccine Information Was Clear Services Provided in an Easily Understood Language Yes No Survey conducted twice a year All clients served over a two-week period each time are offered the survey. Available in English and Spanish. Language Line used for those needing other languages. Response rate was 39%. 5

6 PERFORMANCE PLAN Client Satisfaction was high in all areas. Stay the course The survey included a comment area for suggestions. The one re-occurring theme in the comments was to improve clinic flow and reduce wait time. To address these concerns: o Training was conducted with front desk staff to improve registration. o During surge times, the clinic flow was reorganized to expedite clients there for immunization clinic and separate them from the clients for the regular evening clinics. Additionally, there was an increase in the number of staff registering clients during high volume times. An aide was at the elevator to greet clients and direct them to the appropriate clinic areas. o Signs were posted at the registration desk and waiting area alerting patients to expect an extended wait time to receive immunizations in lieu of handing individual fliers to every client. The response rate for the survey was 39%, a decrease from 5 FY Medical Reserve Corps volunteers had been used in the past to administer the survey, but it proved difficult to find enough volunteers with Spanish-language skills to ensure staffing for the entire clinic. : At least 95% of clients will be satisfied Information about extended wait time will be included on the immunization webpage in addition to continuing to display signs concerning longer wait times. To increase the survey response rate, the vaccinating nurses will be charged with giving the surveys to clients. An aide will be responsible for collecting the surveys and help clients who need assistance completing the survey. 6

7 PERFORMANCE PLAN Measure 3.1 Cases of reportable vaccine-preventable diseases among Arlington children and adults immunized at Cases of Vaccine Preventable Diseases Reported in Arlington Residents Immunized at FY 2015 FY There was one case of a vaccine-preventable disease in. A list of cases of vaccine-preventable disease among Arlington residents is obtained from the Disease Surveillance and Investigation program to see if they were immunization clinic clients. Probable and confirmed cases of vaccine-preventable disease are included. Immunizations are effective against vaccine-preventable diseases. The case of vaccine preventable disease identified was a confirmed case of pertussis (whooping cough). The client received the Tdap vaccine for tetanus, diphtheria, and pertussis appropriately at immunization clinic. Possible reasons for why this client got sick include vaccine failure or lessening immunity based on the time from the last vaccination. There was also a suspect case of mumps reported. The client did not have laboratory confirmation of mumps, but did present clinical symptoms of mumps, meeting the CDC case definition of a suspect case of mumps. Suspect cases are not counted by VDH when reporting surveillance data, although they are investigated by the Disease Surveillance and Investigation program and reported to VDH. The client received the vaccine for measles, mumps, and rubella appropriately at immunization clinic. Stay the course : We expect about the same number of cases of vaccine-preventable diseases 7