Making Progress Towards Improving Adult Immunizations May 10, Carolyn B. Bridges, MD Immunization Services Division National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Outline Where are we now Vaccination coverage Implementation of the standards Use of immunization information systems Celebrating the work of the National Adult and Influenza Immunizations Summit Where do we go from here National Adult and Influenza Immunization Summit 5/10/ 1
Percent reporting vaccination Proportion of adults reporting vaccination for selected vaccines, by age group and high risk status, National Health Interview Survey (NHIS), United States, 2010-2014 100 90 80 70 60 50 40 30 20 10 0 70 60 50 40 30 20 10 0 Estimated proportion of adults aged 19 years who received selected vaccinations, by age group and high risk status, National Health Interview Survey (NHIS), United States, 2010-2014 National Health Interview Survey 2008- Influenza* - 19+ Pneumococcal - 19-64 HR Pneumococcal - 65+ Behavioral Tetanus - 19+ Risk Factor Tdap - 19-64 Surveillance Tdap - 65+ System Hepatitis A - 19+ Hepatitis B - 19+ Zoster - 60+ 2008-09 -14 2010 2011 2012 2014 2010 HPV females - 2011 19-26 HPV males- 2012 19-26 2014 Influenza* - 19+ Pneumococcal - 19-64 HR Pneumococcal - 65+ Tetanus - 19+ Tdap - 19-64 Tdap - 65+ Hepatitis A - 19+ Hepatitis B - 19+ Zoster - 60+ HPV females - 19-26 HPV males- 19-26 Adult Influenza Vaccination Coverage, by Age, United States, NHIS 2012-14 Influenza, 19 yrs -14 2012-13 2011-12 Influenza, 19 yrs, HCP -14 2012-13 2011-12 HP2020 Targets: 70% 19 years, 90% HCP 19 years Data Source: 2011, 2012, and 2014 NHIS 0 10 20 30 40 50 60 70 80 90 100 % Vaccinated National Adult and Influenza Immunization Summit 5/10/ 2
Adult Immunization Coverage, Selected Vaccines by Age and High-risk Status, United States Pneumococcal, HR 19-64yrs 2014 2012 Pneumococcal, 65 yrs 2014 2012 Zoster, 60 yrs 2014 2012 0 10 20 30 40 50 60 70 80 90 100 % Vaccinated HP2020 Targets: 90% PPV 65 yrs, 60% PPV HR 19-64 yrs, 30% zoster 60 yrs Data Source: 2012, and 2014 NHIS Adult Vaccination Coverage, Selected Vaccines, 2011 to 2014 HPV ( 1 dose), Women 19-26 yrs Tdap, 19-64 yrs 2014 2012 2011 2014 2012 2011 Tdap, HCP 19-64 yrs 0 10 20 30 40 50 60 70 80 90 100 Data Source: NHIS 2011-2014 National Adult and Influenza Immunization Summit 5/10/ 3
Hepatitis B Vaccination Coverage by Age and High-risk Status, United States, 2014 HepB ( 3 doses), Endemic Area Travel 31 (-2.6) HepB ( 3 doses), Chronic Liver Disease 30 HepB ( 3 doses), HCP 19 yrs 61 HepB ( 3 doses), Diabetes 19-59 yrs 24 HepB ( 3 doses), Diabetes 60 yrs 14 HP2020 Target: 90% HepB Healthcare Personnel (HCP) Data Source: 2014 NHIS 0 10 20 30 40 50 60 70 80 90 100 % Vaccinated Racial/Ethnic Vaccination Disparities in Adult Immunizations, NHIS 2014 Vaccination Group % Vaccinated Whites Disparity, Blacks Disparity, Hispanics Disparity, Asians Pneumo., HR 19-64 yrs 21-1 -5-7 Pneumo., 65 yrs 65-15 -20-17 Tetanus, 19-49 yrs 69-16 -17-17 Tetanus, 50-64 yrs 70-20 -15-20 Tetanus, 65 yrs 61-18 -12-14 Tdap, 19 yrs 24-12 -11-8 Tdap, 19-64 yrs 26-13 -13-11 Tdap, 65 yrs 16-11 -9-1 HepA, 19-49 yrs 13-2 -3 +3 HepB, 19-49 yrs 36-6 -16-1 Herpes Zoster, 60 yrs 32-20 -17-16 HPV, Females 19-26 yrs 46-9 -18-24 Tdap, HCP 19 yrs 46-22 -11-5 HepB, HCP 19 yrs 63-12 -12 +5 National Adult and Influenza Immunization Summit 5/10/ 4
Adult Immunization Practice Standards Assess immunization status of all patients in every clinical encounter. Strongly recommend vaccines that patients need. Administer needed vaccines or Refer to a provider who can immunize. Document vaccines received by patients, including entering immunizations into immunization registries where available. http://www.publichealthreports.org Percentage of most recent visit(s) to healthcare location or pharmacy* in past 12 months during which adults reported receiving vaccination assessment, Internet Panel Survey, February March 2015, United States (N=2,349) 100 90 80 70 60 50 40 30 31 32 31 20 10 14 8 5 0 Primary Care Internal Medicine (n=1859) (n=866) *Visited pharmacy to fill prescription for themselves. Family Medicine (n=907) Ob/Gyn (n=499) Other Specialties (n=142) Pharmacy (n=1604) CDC 2015 Preliminary Data unpublished National Adult and Influenza Immunization Summit 5/10/ 5
Percent Percent Percentage of most recent visit(s) to healthcare location or pharmacy* in past 12 months during which adults reported receiving vaccination assessment, Internet Panel Survey, February March 2015 and, United States (N=2,349 for 2015 data; N= 1,595 for data) 100 90 80 70 2015 60 50 40 30 20 10 38.1 34.5 31 32 31 31.4 14 8.5 8 17.5 5 8.5 0 Primary Care (n=1859; n=1307) Internal Medicine (n=866; n=706) Family Medicine (n=907; n=538) OB/GYN (n=499; n=319) Other Specialties (n=142; n=413) Pharmacy (n=1604; n=490) *Visited pharmacy to fill prescription for themselves. CDC 2015 Data unpublished, CDC Preliminary Data unpublished Percentage of adult patients who reported receiving a vaccination assessment during their most recent visit(s) to healthcare location or pharmacy* in past 12 months vs. percentage of healthcare providers who reported that they routinely assess vaccination status of their patients, Internet Panel Survey, February March, United States (N= 1,595 for patient data; N= 1,918 for healthcare provider data) 100 90 80 70 60 50 96 96.9 95.3 84.3 Patient perspective Healthcare provider perspective 67 68 40 30 35 38 31 20 10 9 18 9 0 Primary Care (n=1307; n=825) Internal Medicine (n=706; n=342) Family Medicine (n=538; n=483) OB/GYN (n=319; n=414) Other Specialties (n=413; n=392) Pharmacy (n=490; n=277) *Visited pharmacy to fill prescription for themselves. CDC Preliminary Data unpublished National Adult and Influenza Immunization Summit 5/10/ 6
Influenza Vaccination Coverage Use of Immunization Information Systems (IIS) for Adult Vaccination Use of IIS is an important component of the Adult Standards Six US sentinel IIS sites funded by CDC to improve enrollment of adult providers as part of pandemic influenza vaccine preparedness We juxtaposed National Immunization Survey (NIS) flu data and Behavioral Risk Factor Surveillance System data with IIS data from these six sites for influenza vaccinations No statistical comparisons made NIS influenza vaccination and BRFSS estimations based on patient recall only Over-estimate vaccination All 6 IIS sentinel sites are life-time registries with only NYS requiring adult patient consent for vaccines to be included in IIS. Michigan Coverage by Age Groups 100% 90% IIS, -2014 IIS, 2014-2015 NIS/BRFSS*, -2014 NIS/BRFSS*, 2014-2015 80% 70% 60% 50% 40% 30% 20% 10% 0% 6 23 months 2 4 years 5 12 years 13 17 years 18 49 years 50 64 years 65+ years Age Group *Child data source is NIS-flu; adult data source is BRFSS. National Adult and Influenza Immunization Summit 5/10/ 7
Influenza Vaccination Coverage Influenza Vaccination Coverage Minnesota Vaccination Coverage by Age Groups 100% 90% IIS, -2014 IIS, 2014-2015 NIS/BRFSS*, -2014 NIS/BRFSS*, 2014-2015 80% 70% 60% 50% 40% 30% 20% 10% 0% 6 23 months 2 4 years 5 12 years 13 17 years 18 49 years 50 64 years 65+ years Age Group *Child data source is NIS-flu; adult data source is BRFSS. New York City Vaccination Coverage by Age Groups 100% 90% IIS, -2014 IIS, 2014-2015 NIS/BRFSS*, -2014 NIS/BRFSS*, 2014-2015 80% 70% 60% 50% 40% 30% 20% 10% 0% 6 23 months 2 4 years 5 12 years 13 17 years 18 49 years 50 64 years 65+ years Age Group *Child data source is NIS-flu; adult data source is BRFSS. BRFSS data not available. National Adult and Influenza Immunization Summit 5/10/ 8
Influenza Vaccination Coverage Influenza Vaccination Coverage North Dakota Vaccination Coverage by Age Groups 100% 90% IIS, -2014 IIS, 2014-2015 NIS/BRFSS*, -2014 NIS/BRFSS*, 2014-2015 80% 70% 60% 50% 40% 30% 20% 10% 0% 6 23 months 2 4 years 5 12 years 13 17 years 18 49 years 50 64 years 65+ years Age Group *Child data source is NIS-flu; adult data source is BRFSS. Oregon Vaccination Coverage by Age Groups 100% 90% IIS, -2014 IIS, 2014-2015 NIS/BRFSS*, -2014 NIS/BRFSS*, 2014-2015 80% 70% 60% 50% 40% 30% 20% 10% 0% 6 23 months 2 4 years 5 12 years 13 17 years 18 49 years 50 64 years 65+ years Age Group *Child data source is NIS-flu; adult data source is BRFSS. National Adult and Influenza Immunization Summit 5/10/ 9
Influenza Vaccination Coverage Wisconsin Vaccination Coverage by Age Groups 100% 90% IIS, -2014 IIS, 2014-2015 NIS/BRFSS*, -2014 NIS/BRFSS*, 2014-2015 80% 70% 60% 50% 40% 30% 20% 10% 0% 6 23 months 2 4 years 5 12 years 13 17 years 18 49 years 50 64 years 65+ years Age Group *Child data source is NIS-flu; adult data source is BRFSS. Sentinel Site IIS Conclusions Variability among states in vaccination data capture Substantial number of pediatric and adult influenza vaccinations included in IIS In NYC where consent is required for adults (opt-in) but not for children (opt-out) High numbers of influenza vaccinations recorded for children relative to NIS flu data Substantially lower inclusion of adult influenza vaccinations relative to survey data and relative to other states National Adult and Influenza Immunization Summit 5/10/ 10
Family Physician Use of IIS vs. Influenza IIS is used to record vaccination(s) received in your practice : n=293; : n=226 32% 46% IIS is used to assess vaccination status 31% 44% Other Recommended Vaccines IIS is used to record vaccination(s) received in your practice 29% 40% IIS is used to assess vaccination status 32% 24% Survey data from Hurley, et al at University of Colorado Denver. Preliminary data not for distribution. General Internal Medicine Use of IIS vs. Influenza IIS is used to record vaccination(s) received in your practice (: n=324; : n=308) 16% 27% IIS is used to assess vaccination status 25% 17% Other Recommended Vaccines IIS is used to record vaccination(s) received in your practice 15% 25% IIS is used to assess vaccination status 20% 15% Survey data from Hurley, et al at University of Colorado Denver. Preliminary data not for distribution. National Adult and Influenza Immunization Summit 5/10/ 11
Accomplishments of NAIIS Actively engaged stakeholders across all sectors who Identified and communicated key issues among members Problem solved and took action Shared successes Disseminated key information and messages to constituents From www.capitaleventsmarketing.co.uk Developed new partnerships Provide energy and thoughtful input on policy Amazing dedicated leadership from all sectors! NAIIS Working Groups Patient education Co-leads: Jeff Goad (California Immunization Coalition), Alexandra Shevach (CDC), Najma Roberts (APCO) Provider education Co-leads: Susan Farrall (CDC), Laura Lee Hall (ACP), Debra Hawks (ACOG), and LJ Tan (IAC) Access and collaboration Co-leads: Carolyn Bridges (CDC), Kim Martin (ASTHO), Mitch Rothholz (APhA), and LJ Tan (IAC) Quality Measures Angela Shen (NVPO), Amy Groom (CDC and I.H.S.), and Sharon Sprenger (Joint Commission) Influenza Amy Behrman (U Penn) and Kelly McKenna (EverThrive Illinois) National Adult and Influenza Immunization Summit 5/10/ 12
Just SOME of the Accomplishments of NAIIS MADE PROGRESS ON IMPLEMENTATION OF STANDARDS FOR ADULT VACCINATION PRACTICE! Continue to provide forum for sharing influenza vaccine supply, distribution, and administration issues Improved communications with partners, providers and patients Catalogued library of website business and other tools Collected and published information on state-level projects to improve collaborations and awareness Developed primer on key messages Shared messages and plans for National Immunization Awareness Month Developed and updated slide sets on adult immunizations Standards Promoting adult and adolescent vaccination quiz www.izsummitpartners.org Just SOME of the Accomplishments of NAIIS Quality measures Conducted quality measures WG landscape analysis Development of quality measures in progress with Summit and in collaboration with PQA: Tdap and influenza vaccination of pregnant women Composite measure of immunizations for persons with ESRD Adult vaccine composite measure feasibility Proportion of vaccinations recorded in IIS Quality improvement resources page on CDC QI training website www.izsummitpartners.org National Adult and Influenza Immunization Summit 5/10/ 13
Just SOME of the Accomplishments of NAIIS Use of IIS Assessed and made available state level readiness for adult providers to use IIS Developed pamphlet to promote benefits of IIS for providers and patients IMPROVED USE OF IIS but also acknowledge where work needed Work with providers Increased awareness of adult immunization practice standards! Assessed, and articulated need for better economics data on adult vaccinations on costs and studies now underway Checklist to improve vaccination procedures in non-clinical care settings Developed fact sheet on disparities Promoted need and examples of improving provider education from trainees through MOC Identified many best practices at provider and health systems levels Celebrated successes through Summit Awards, What Works! posters www.izsummitpartners.org Where do we need to go? Identify specific actions needed in changing health care system / payment landscape to ensure vaccinations a priority Consider policies and practices that impede and also improve providers ability to implement the Standards, e.g. Fill data gaps to make the case for prioritizing vaccinations Continue progress on quality measures and use of IIS Assess policy barriers at all levels, including financial barriers Improve public s awareness Improve vaccine access and safe delivery Ensure providers receive training and education on immunizations National Adult and Influenza Immunization Summit 5/10/ 14
OUR CHARGE Determine: 1. What We Can Do as the NAIIS, and 2. What We Can Do as Individual Organizations to identify data gaps and fill them, and to identify barriers and address them, in order to reduce illness and suffering through improving vaccination. Thank you for all of your work and partnership throughout the year!! National Adult and Influenza Immunization Summit 5/10/ 15