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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. - PowerPoint PPT Presentation
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MOC IV Learning CollaborativeSession V
September 12, 2012
IMPROVINGIMMUNIZATION
RATES
LEARNING OBJECTIVESEnhance 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.
AUDIENCE SURVEYIs 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?
2012 ACIP Recommended Vaccines
http://www.cdc.gov/vaccines/schedules/images/7-18yrs_chart_only.jpg
North Carolina 2012 VACCINE NORTH CAROLINA NATIONAL
≥ 2 MMR 89% 91%Female complete
HPV66% 71%
Female ≥1 HPV 54% 53%≥1 TdaP 78% 78%
≥1 MenACWY 66% 71%≥3 Hep B 89% 92%
≥2 Var 63% 68%≥1 Td/TdaP 84%
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, AAPThe Community Guide (The Community Services Task Force)
North Carolina Immunization Branch
Community Services Preventive Task Force
Community Services Preventive Task Force
Client Reminder and Recall SystemsRecommended 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
Client Reminder and Recall SystemsSuh 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.”
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% increaseSometimes hard to distinguish change from growth in
use and reporting; little cost dataCoCASA and NCIR are examples you can use
Provider Assessment and FeedbackAssessment 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
Provider RemindersInform 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)
Standing Orders1980-1997 review showed 27% median
increaseThis review showed a much higher increase
when stand alone – small number of studiesLarger 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
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).
What to do? Increase DemandRecall/Reminder
Use NCIR reporting systemUse CoCASA – CDC software programUse your EHR if capablePerhaps just a simple postcard you have patient fill
out at visit, you mail when appropriate
What to do? Provider
Interventions
“How AmI
Doing?”
What to Do – Provider InterventionsProvider 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
PDSA
Plan
Do
Study
Act
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!!
Resources & LinksCDC
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/strat.pdf http://www.cdc.gov/vaccines/who/teens/refs-pubs.html
NFID NFID Call to action adolescentvacc.pdfCSG
http://www.healthystates.csg.org/NR/rdonlyres/49419EBC-E9E7-4A9B-8F61-CBD85DFE5018/0/TATargetingLowImmunizationRatesinAdol.pdf
Community Guide http://www.thecommunityguide.org/vaccines/index.html
AAFP http://www.aafp.org/online/en/home/clinical/immunizationres.html?navid=immunizations
AAP http://www2.aap.org/immunization/pediatricians/pdf/ReminderRecall.pdf
http://www.immunize.nc.gov/providers/ncir.htm
http://www.immunize.nc.gov/providers/providereducation.htm
http://www.immunize.nc.gov/providers/afix.htm