Making Progress Towards Improving Adult Immunizations …...May 01, 2016 · National Adult and Influenza Immunization Summit –5/10/2016 1 Making Progress Towards Improving Adult

National Adult and Influenza Immunization Summit – 5/10/2016 1

Making Progress Towards Improving Adult Immunizations

May 10, 2016Carolyn 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


Proportion of adults reporting vaccination for selected vaccines, by age group and high risk status, National Health Interview Survey (NHIS),

United States, 2010-2014

National Health Interview Survey 2008-2013

Behavioral Risk Factor Surveillance System2008-09 – 2013-14

0

10

20

30

40

50

60

70

2010 2011 2012 2013 2014

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

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§

0

10

20

30

40

50

60

70

80

90

100

2010 2011 2012 2013 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§

Pe

rce

nt

rep

ort

ing

vacc

inat

ion

0 10 20 30 40 50 60 70 80 90 100

Influenza, ≥19 yrs, HCP

Influenza, ≥19 yrs

% Vaccinated

2013-14

2012-13

2013-14

2012-13

2011-12

Adult Influenza Vaccination Coverage, by Age, United States, NHIS 2012-14

HP2020 Targets: 70% ≥19 years, 90% HCP ≥19 years

Data Source: 2011, 2012, 2013 and 2014 NHIS

2011-12


0 10 20 30 40 50 60 70 80 90 100

Zoster, ≥60 yrs

Pneumococcal, ≥65 yrs

Pneumococcal, HR 19-64yrs

% Vaccinated

2014

2014

2014

20132012

20132012

2013

2012

Adult Immunization Coverage, Selected Vaccines by Age and High-risk Status, United States

HP2020 Targets: 90% PPV ≥65 yrs, 60% PPV HR 19-64 yrs, 30% zoster ≥60 yrs

Data Source: 2012, 2013 and 2014 NHIS

Adult Vaccination Coverage, Selected Vaccines, 2011 to 2014

0 10 20 30 40 50 60 70 80 90 100

Tdap, HCP 19-64 yrs

Tdap, 19-64 yrs

HPV (≥1 dose), Women 19-26 yrs

2014

2013

2012

20112014

Data Source: NHIS 2011-2014

20122011


Hepatitis B Vaccination Coverage by Age and High-risk Status, United States, 2014

14

24

61

30

31 (-2.6)

0 10 20 30 40 50 60 70 80 90 100

HepB (≥3 doses), Diabetes ≥60 yrs

HepB (≥3 doses), Diabetes 19-59 yrs

HepB (≥3 doses), HCP ≥19 yrs

HepB (≥3 doses), Chronic Liver Disease

HepB (≥3 doses), Endemic Area Travel

% Vaccinated

HP2020 Target: 90% HepB Healthcare Personnel (HCP)

Data Source: 2014 NHIS

Racial/Ethnic Vaccination Disparities in Adult Immunizations, NHIS 2014Vaccination Group % Vaccinated

WhitesDisparity,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


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)

31 32 31

148 5

0

10

20

30

40

50

60

70

80

90

100

Primary Care(n=1859)

Internal Medicine(n=866)

Family Medicine(n=907)

Ob/Gyn (n=499) Other Specialties(n=142)

Pharmacy (n=1604)

CDC 2015 Preliminary Data – unpublished

*Visited pharmacy to fill prescription for themselves.


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 2016, United States

(N=2,349 for 2015 data; N= 1,595 for 2016 data)

31 32 31

148

5

34.538.1

31.4

8.5

17.5

8.5

0

10

20

30

40

50

60

70

80

90

100

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)

2015 2016

CDC 2015 Data – unpublished, CDC 2016 Preliminary Data – unpublished


Pe

rce

nt

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 2016, United States

(N= 1,595 for patient data; N= 1,918 for healthcare provider data) 96 96.9 95.3

84.3

67 68

0

10

20

30

40

50

60

70

80

90

100

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)

Patient perspective

Healthcare provider perspective

35 3831

9

18

9

CDC 2016 Preliminary Data – unpublished


Pe

rce

nt


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

*Child data source is NIS-flu; adult data source is BRFSS.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

6–23 months 2–4 years 5–12 years 13–17 years 18–49 years 50–64 years 65+ years

Infl

ue

nza

Vac

cin

atio

n C

ove

rage

Age Group

IIS, 2013-2014 IIS, 2014-2015 NIS/BRFSS*, 2013-2014 NIS/BRFSS*, 2014-2015


Minnesota Vaccination Coverage by Age Groups


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Infl

ue

nza

Vac

cin

atio

n C

ove

rage

Age Group


New York City Vaccination Coverage by Age Groups

*Child data source is NIS-flu; adult data source is BRFSS.†BRFSS data not available.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Infl

ue

nza

Vac

cin

atio

n C

ove

rage

Age Group

IIS, 2013-2014 IIS, 2014-2015 NIS/BRFSS*, 2013-2014 NIS/BRFSS*, 2014-2015†


North Dakota Vaccination Coverage by Age Groups


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Infl

ue

nza

Vac

cin

atio

n C

ove

rage

Age Group


Oregon Vaccination Coverage by Age Groups


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Infl

ue

nza

Vac

cin

atio

n C

ove

rage

Age Group



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Infl

ue

nza

Vac

cin

atio

n C

ove

rage

Age Group


Wisconsin Vaccination Coverage by Age Groups


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


Family Physician Use of IIS 2013 vs. 2016

24%

32%

29%

40%

31%

44%

32%

46%

2013

2016

2013

2016

2013

2016

2013

2016IIS is used to record vaccination(s)

received in your practice

IIS is used to assess vaccination status


IIS is used to record vaccination(s)


Influenza

Other Recommended Vaccines

2016: n=293; 2013: n=226

Survey data from Hurley, et al at University of Colorado – Denver. Preliminary data not for distribution.

15%

20%

15%

25%

17%

25%

16%

27%

2013

2016

2013

2016

2013

2016

2013

2016IIS is used to record vaccination(s)




IIS is used to record vaccination(s)


General Internal Medicine Use of IIS 2013 vs. 2016

Influenza

Other Recommended Vaccines

(2016: n=324; 2013: n=308)

Survey data from Hurley, et al at University of Colorado – Denver. Preliminary data not for distribution.


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

Developed new partnerships

Provide energy and thoughtful input on policy

Amazing dedicated leadership from all

sectors!

From www.capitaleventsmarketing.co.uk

NAIIS Working GroupsPatient 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)

http://www.capitaleventsmarketing.co.uk/


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



Just SOME of the Accomplishments of NAIISUse 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


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


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, andto 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!!

Documents

Making Progress Towards Improving Adult Immunizations …...May 01, 2016 · National Adult and Influenza Immunization Summit –5/10/2016 1 Making Progress Towards Improving Adult