PHD/CHSB & SH CHSB: Yvette Wright 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. Fees for recommended adult and childhood vaccines are based on insurance status, following VDH guidelines. 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 (VDH) to enter kindergarten o Additional 6 doses of vaccine recommended by CDC for children ages 7 to under 19 Recommendations 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 668 1,172 1,349 2,338 1,504* 2,366 FY 2017 740 1,358 1,682 3,184 1,666 2,584 FY 2016 679 1,274 1,524 2,796 1,876 2,804 1
Average number of vaccines per visit, excluding flu, Average number of services per visit, including vaccines and TST, Clients under 7 years of age Clients ages 7 to less than 19 years Clients 19 years of age or older 1.6 1.5 0.4 2.7 2.7 2.0 *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 vaccines at the time of the visit 2.2 Children age seven to under 19 who were offered and received all age-appropriate vaccines at the time of the visit 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
Dtap MMR Polio Varicella Hep B Hib PCV Hep A Rotavirus Dtap MMR Polio Varicella Hep B Hib PCV Hep A Rotavirus Measure 2.1 100% 80% 20% 0% Children under seven years of age who were offered and received all ageappropriate vaccines at the time of the visit 1% 1% 1% 1% 3% 1% 1% 1% 1% 3% 7% 1% 1% 1% 37% 36% 28% 29% 1% 27% 37% 36% 28% 29% 27% 44% 49% 44% 24% 49% 24% Appropriate Vaccination at the Clinic Visit 62% 54% 50% 63% 71% 70% 46% 91% Goal = 95% green 62% 54% 50% 63% 71% 70% 46% 7% 91% N=169 Appropriately Not Offered Appropriately Offered and Refused (proj) Appropriately Offered and Given Missed Opportunities and Errors Summary In, of all possible recommended and required vaccines, 97% 100% 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. What is the story behind the data? In, the met goals for appropriately offering vaccines to children under 7 years old for all 9 vaccines. The 27% refusal rate for Hepatitis A vaccine may be because of the following: it is not required for school entry but recommended; 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 are eligible for free Hepatitis A vaccine, but are still asked for a fee to cover vaccine administration per Virginia Department of Health (VDH) policy. This fee may be a deterrent for some clients. If the client states they cannot pay it, the fee is waived. 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. Forecast : Anticipate the rate will stay the same Recommendations Continue to offer, recommend, and educate parents on the importance of Hepatitis A vaccine. 3
TDap TD MMR Polio Varicella HepB HPV MCV4 HepA TDap TD MMR Polio Varicella HepB HPV MCV4 HepA Measure 2.2 100% 80% 20% 1% 32% Children age seven to under 19 who were offered and received all ageappropriate vaccines at the time of the visit 24% 31% Appropriate Vaccination at the Clinic Visit 44% 39% 44% 37% 11% 67% 76% 69% 56% 61% 56% 49% 71% 1% 1% 1% 1% 1% 13% 17% 30% 1% 26% 43% 32% 24% 31% Goal = 95% green 44% 39% 44% 37% 13% 17% 11% 67% 76% 69% 56% 61% 56% 49% 71% 1% 30% 26% 43% 0% N=178 Appropriately Not Offered Appropriately Offered and Refused (proj) Appropriately Offered and Given Missed Opportunities & Errors Summary In, of all possible recommended and required vaccines, 99% 100% 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. What is the story behind the data? In, the met goals for appropriately offering vaccines to children age 7 to under 19 for all 9 vaccines. The refusal rates for HPV, MCV4, and Hepatitis A vaccines may be because of the following: they are not required for school entry but recommended; 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 are eligible for free recommended vaccines, but are still asked for a fee to cover vaccine administration per Virginia Department of Health (VDH) policy. This fee may be a deterrent for some clients. If the client states they cannot pay it, the fee is waived. Children with insurance are either referred to their primary care provider or charged the full price of the vaccine plus the Recommendations Continue to offer, recommend, and educate parents on the importance of HPV for males and females, MCV4, and Hepatitis A vaccines. 4
administration fee and given a receipt that can be submitted to their insurance. HPV vaccine is only required for school entry among females in Virginia. However, VDH has decided to reduce barriers for boys receiving the HPV vaccine by absorbing the cost of the vaccine and administration fees for males eligible under the Vaccine for Children program. The rate for HPV administration among males is expected to increase. Forecast : Anticipate the rate will stay the same 5
Percent of Clients Measure 2.3 Customer Satisfaction 100% Client Satisfaction Survey 7% 7% 5% 5% 7% 7% 80% 20% 38% 38% 38% 38% Goal = 95% 55% 55% 57% 57% 53% 53% 0% 123 Clients (projected) 123 Clients (projected) 123 Clients (projected) Overall Satisfaction How well did we explain things to you? How well did we use a language you easily understood and spoke? Wow Excellent Satisfactory Unsatisfactory Summary In, a new client survey was implemented as part of the Customer Experience Initiative in public health. Components of customer experience are rated as unsatisfactory, satisfactory, excellent, or wow to match division expectations of delivering an excellent or wow experience to all customers. Survey conducted twice a year, capturing all clients served over a four-week period, using a paper survey in English and Spanish. In, a new survey of customer experience replaced the previous satisfaction survey. Response rate was 50%, up from 39% in FY 2017. What is the story behind the data? In, 93% of clients rated their overall customer experience with services as excellent or wow ; 95% rated how we explained things as excellent or wow ; and 93% rated we used a language that they understood and spoke as excellent or wow. The response rate for the survey was 50%, an increase from 39% FY 2017. The vaccinating nurses provided the surveys to the clients for completion. An aide collected the surveys and assisted clients when needed to complete the survey. Recommendations 6
Although comments on the survey are overwhelmingly positive, the only consistent complaint is about wait times. Information about extended wait time during periods of high demand, such as back-to-school, was included on the immunization webpage. Signs concerning longer wait times are displayed. Patient Flow Analysis (PFA) are conducted to measure wait time. In April 2018, the average length of clinic visits was 1 hour and 20 minutes. Forecast : At least 95% of clients will be satisfied Conduct PFA during periods of high demand. Remind parents to come earlier in the summer to get school-required vaccinations. 7
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 2016 FY 2017 (proj) 0 1 0 0 Summary There were no cases 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. What is the story behind the data? Immunizations are effective against vaccinepreventable diseases. Forecast Recommendations : We expect about the same number of cases of vaccine-preventable diseases 8