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Disseminating Evidence-Based Strategies Associated With Improved Immunization Rates. Denise H. Benkel, MD, MPH Bureau of Immunization New York City Department of Health and Mental Hygiene. NICHQ. National Initiative for Children’s Healthcare Quality Not-for-Profit

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Disseminating evidence based strategies associated with improved immunization rates

Disseminating Evidence-Based Strategies Associated With Improved Immunization Rates

Denise H. Benkel, MD, MPH

Bureau of Immunization

New York City Department of Health and Mental Hygiene


Nichq
NICHQ Improved Immunization Rates

  • National Initiative for Children’s Healthcare Quality

  • Not-for-Profit

  • Partners with AAP, ABP, and IHI

  • Mission: To reduce the gap between what is and what could be in healthcare for all children.


NIS Results Improved Immunization Rates

Estimated vaccination coverage among NYC children 19 to 35 months of age


Evidence based strategies to improve immunization delivery
Evidence-based strategies to improve immunization delivery Improved Immunization Rates

  • Parent reminders for upcoming visits and recall notices

  • Nurse and/or physician reminders/prompts

  • Parent education and expanded access to services, such as after-hours/weekends

  • Quality improvement efforts, including repeated measurement of immunization levels of an office practice’s one and two-year-olds

  • Standing orders for RN’s, PA’s, and medical assistants

  • Multi-component interventions


Gap between evidence and practice
Gap between evidence and practice Improved Immunization Rates

Much is known about how immunization delivery should be conducted,

but…

Knowledge of what should be done does not always translate into practice,

and…

There are many reasons for this gap


Improving immunization delivery in new york city
Improving immunization delivery in New York City Improved Immunization Rates

  • Identify evidence-based best practices

  • Design a strategy for effective dissemination to all NYC childhood immunization providers

    • Dissemination Strategy Document

    • toolkit

    • facilitated “peer-to-peer” spread

  • Create a relatively easy way to assess change


Nichq practice assistance approach to improvement
NICHQ Practice Assistance Approach to improvement Improved Immunization Rates

  • Steps

    • Performance measurement and feedback

    • Creation of office team and selection of goals

    • Testing changes

    • Spread of effective changes to entire practice

  • Tools

    • Clinical guidelines, academic detailing sheets

    • Materials tailored to office routines

  • Training and support (clinical and QI)

    • Initially, on-site visits


Phases of the project
Phases of the project Improved Immunization Rates

  • Phase I EQuIP Collaborative:April 2002—April 2003

  • Phase II Dissemination Strategy:current

  • Phase III Development:

    next

  • Phase IV Implementation:

    future


Phase i equip collaborative
Phase I: EQuIP Collaborative Improved Immunization Rates

  • April 2002-April 2003

  • Nineteen pediatric healthcare providers

    • 6: preventive services

    • 13: asthma

  • Successful strategies

    • coordination of immunization reminders with WIC visits

    • use of preventive services prompting sheets

    • telephone reminder systems

    • use of Citywide Immunization Registry (CIR)

    • enthusiasm, will, and collaboration


Phase ii dissemination strategy
Phase II: Improved Immunization RatesDissemination Strategy

  • Interviews to generate ideas

    • EQuIP Collaborative teams

    • DOHMH staff

    • health policymakers

  • Design Team

    • DOHMH

    • NICHQ

    • local clinical consultants


Workgroup 1 practice outreach and assistance
Workgroup 1: Practice Outreach and Assistance Improved Immunization Rates

  • Lessons learned from current system: QI tools must be seamless and useful

  • Strategies for change

    • patient pre-set list online Registry

    • bring online CIR access to large facilities

    • access to physicians-in-training

    • recall features

    • contact/fine non-reporters


Workgroup 2 communication
Workgroup 2: Communication Improved Immunization Rates

  • Lessons learned from current system:

    There are many communication tools

  • Strategies for change

    • information and feedback should be better coordinated

    • key messages should be well-timed and regularly repeated

    • highlight common problems, while tailoring to individual provider’s needs


Workgroup 3 measurement
Workgroup 3: Measurement Improved Immunization Rates

  • Lessons learned from current system:

    Is difficult but extremely important

  • Strategies for change

    • special programming of Registry for regular monitoring of coverage

    • process and outcome measures

    • grouping of providers

    • customized reports for monitoring and feedback


Design meeting
Design Meeting Improved Immunization Rates

  • Public and private sectors

  • Managed care

  • Professional medical organizations

  • Advocacy


Phase iii development
Phase III: Development Improved Immunization Rates

  • Customize the NICHQ toolkit to NYC

  • Recruit leaders and champions

  • Develop communication and linkages to key organizations

  • Build technical infrastructure

    • refine CIR programming

    • refine staffing issues


Phase iv implementation
Phase IV: Implementation Improved Immunization Rates

  • DOHMH outreach staff

  • Site field staff

  • Incremental expansion

  • Continuous assessment of overall program performance


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