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MOC IV Learning Collaborative Session V September 12, 2012

MOC IV Learning Collaborative Session V September 12, 2012. IMPROVING IMMUNIZATION RATES. LEARNING OBJECTIVES. Enhance understanding of benefits of a recall system for adolescent immunizations and well checks.

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MOC IV Learning Collaborative Session V September 12, 2012

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  1. MOC IV Learning CollaborativeSession VSeptember 12, 2012 IMPROVING IMMUNIZATION RATES

  2. LEARNING OBJECTIVES • Enhance understanding of benefits of a recall system for adolescent immunizations and well checks. • Increase understanding of how many of your adolescent patients are administered needed vaccines. • Increase understanding of a multi-intervention strategy to increase vaccination rates.

  3. AUDIENCE SURVEY • Is your practice part of CCNC? • Does your practice use the NC Immunization Registry? • Do you have an Electronic Health Record? Can you actually get a report out of it without a PhD in Computer Science and purchasing more software? • Does your practice use a reminder/recall system for anything?

  4. 2012 ACIP Recommended Vaccines http://www.cdc.gov/vaccines/schedules/images/7-18yrs_chart_only.jpg

  5. North Carolina 2012

  6. How can we improve? • CDC Recommendations for Adolescent Immunizations, 2011. • National Foundation for Infectious Diseases. Call to action: Adolescent vaccination—Bridging from a strong childhood foundation to a healthy adulthood. Bethesda, MD, 2008. • Targeting Low Immunization Rates in Adolescents. Council of State Governments Report, Summer 2006 • AAFP, AAP • The Community Guide (The Community Services Task Force) • North Carolina Immunization Branch

  7. Community Services Preventive Task Force

  8. Community Services Preventive Task Force

  9. Client Reminder and Recall Systems • Recommended based on strong evidence of effectiveness in improving vaccination coverage • Initial review covering 42 studies (1980-1997) showed median absolute increase of 12% • Review covering 20 studies (1997-2007) less impressive at median absolute increase of 6.1% • In both reviews, combined interventions that included Client Reminder and Recall Systems consistently showed median absolute increases 1.5-2 times that of the isolated reminder and recall system

  10. Client Reminder and Recall Systems • Suh et al. Pediatrics 2012 129(6) p e1437 Effectiveness and Net Cost of Reminder/Recall for Adolescent Immunizations 4 private pediatric groups in Denver, each practice randomized 400 11-18 year olds who had not received 1 or more targeted vaccines (Tdap,MenACWY, 1st HPV for females) to intervention (2 letters, 2 phone calls) or control. Baseline rates ranged from 33% to 54% for having had all 3. “Post-intervention, the intervention group had significantly higher proportions of receipt of at least 1 targeted vaccine (47.1% vs. 34.6%, P<0.0001) and receipt of all targeted vaccines (36.2% vs 25.2%, P<0.0001) compared with the control group.”

  11. Immunization Information Systems • “…confidential, population-based, computerized databases that record all immunizations doses administered by participating providers to persons residing within a given geopolitical area.” • 194 papers • Client recall median absolute increase 5% • Provider assessment and feedback median absolute increase 9% • Provider reminder system (one study) 14% increase • Sometimes hard to distinguish change from growth in use and reporting; little cost data • CoCASA and NCIR are examples you can use

  12. Provider Assessment and Feedback • Assessment of providers coverage levels and immunization practices, then feedback to provider with recommended strategies to improve • 1980-1997 review (14 studies) showed median increase of 16% • 1997-2007 median increase 9.4% • When studied as part of a multi-intervention strategy this seems to account for less of the increase seen, but the overall increase in rates are higher in multi-intervention studies

  13. Provider Reminders • Inform providers that particular patients are due for specific vaccinations. • 1980-1997 median average increase of 16% • 1997-2007 median average increase of 10% (12% stand alone, 10% as part of multi-intervention strategy)

  14. Standing Orders • 1980-1997 review showed 27% median increase • This review showed a much higher increase when stand alone – small number of studies • Larger number of studies in the 1997-2007 review showed the opposite – 28% average median increase, 18% if stand alone, 32% as part of a multi-intervention strategy

  15. System-Based Combination Interventions • Recommend at least one intervention to increase demand (client reminder and recall) with one or more interventions aimed at providers/systems and one or more interventions to increase access (year round scheduling, expand hours, reduce copays, home visits, school clinics).

  16. What to do? Increase Demand Recall/Reminder • Use NCIR reporting system • Use CoCASA – CDC software program • Use your EHR if capable • Perhaps just a simple postcard you have patient fill out at visit, you mail when appropriate

  17. What to do? Provider Interventions “How Am I Doing?”

  18. What to Do – Provider Interventions • Provider Assessment and Feedback (you can use the data from recall and reminder) • Consider using AFIX – a quality improvement strategy, developed by CDC, to raise coverage levels and improve standards of practices at the provider level. • Assessment • Feedback • Incentives • eXchange Contact Amanda Dayton at NC Immunization Branch

  19. PDSA • Plan – Baseline rate, pick a strategy. • Do – Implement the strategy and observe. • Study – Are we improving? What worked? Why? • Act – Conclusions – continue or change and repeat cycle Consider using AFIX!!

  20. Resources & Links • CDChttp://www.cdc.gov/vaccines/pubs/pinkbook/downloads/strat.pdf http://www.cdc.gov/vaccines/who/teens/refs-pubs.html • NFIDNFID Call to action adolescentvacc.pdf • CSGhttp://www.healthystates.csg.org/NR/rdonlyres/49419EBC-E9E7-4A9B-8F61-CBD85DFE5018/0/TATargetingLowImmunizationRatesinAdol.pdf • Community Guide http://www.thecommunityguide.org/vaccines/index.html • AAFPhttp://www.aafp.org/online/en/home/clinical/immunizationres.html?navid=immunizations • AAP http://www2.aap.org/immunization/pediatricians/pdf/ReminderRecall.pdf

  21. http://www.immunize.nc.gov/providers/ncir.htm

  22. http://www.immunize.nc.gov/providers/providereducation.htm

  23. http://www.immunize.nc.gov/providers/afix.htm

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