Embed Size (px)
Citation preview
University of MichiganHealth System
Tracking and Evaluation of H1N1 Vaccine Implementation
by Immunization Grantees
Sarah ClarkChild Health Evaluation and Research Unit (CHEAR)
University of Michigan
Association of Immunization ManagersJanuary 22, 2010
University of MichiganHealth System
Background
• H1N1 vaccine implementation was characterized by:– Federal guidance and structure– Substantial flexibility for implementation at
the program level– Known unknowns and unknown unknowns
University of MichiganHealth System
Purpose
• To collect situational awareness data on H1N1 vaccine implementation– Collaborative approach– Useful in the short term
• To utilize situational awareness data in evaluating H1N1 vaccine implementation– Lessons learned based on experiences
University of MichiganHealth System
Methods – Phase 1
• Build consensus with partners– AIM, ASTHO, CDC
• Determine data sharing mechanisms– High priority for program officials to receive
data in a timely fashion– Concern about data becoming public
• Identify topics for data collection
University of MichiganHealth System
Data Collection – Phase 1
• Data collection from immunization program managers, their designee, and/or H1N1 vaccine implementation lead
• 50 state and 4 metropolitan areas
• Mix of telephone and email contacts:– Balancing concerns about time required for
participation with complexity of questions and responses
University of MichiganHealth System
Data Collection – Phase 1
• October 2, 2009 – ?– 16 weeks (and counting)
• Fantastic participation by program officials
• The “UM All-Stars”– CO, CT, FL, KS, LA, NC, ND, OH, RI
University of MichiganHealth System
Data Dissemination
• to AIM membership via email from AIM and members-only website
• to ASTHO membership via email from ASTHO
• to CDC officials responsible for vaccine implementation*
University of MichiganHealth System
Impressions #1
There was substantial variation across programs from the outset.
In other words, programs utilized the flexibility they were given.
University of MichiganHealth System
Results – Week of 10/2/09
• Target populations for initial LAIV doses– healthcare workers (42)– Children 24-48 months (32)– Children 5-9 years (26)– Children 10-18 years (22)– Caregivers of young infants (4)
University of MichiganHealth System
Results – Week of 10/2/09
• Target settings for initial LAIV doses– hospitals (29)– local public health (29)– private VFC providers (16)– private non-VFC (H1N1 only) providers (6)– community health centers (3)– Indian Health Service (3)
University of MichiganHealth System
Impressions #2
Program officials were asked to make complex decisions, often in a completely new context.
University of MichiganHealth System
Results – Week of 10/26/09
• Allocation Strategies– Focus on large sites with priority populations (3)– Every provider gets something (7)– Percentage of total based on estimated priority
patients (4)– Random selection of providers (1)– Match vaccine presentation with provider type (6)– Done by local public health partners (16)
University of MichiganHealth System
Impressions #3
The more things changed, the more things changed.
University of MichiganHealth System
ACIP Recommendation
Initial target groups:• Pregnant women• Caregivers of infants <6 months• Health care workers• Children 6 months - 24 years • Adults 25-64 years with high-risk conditions
University of MichiganHealth System
ACIP Recommendation
Subset of target groups (priority if vaccine supply is inadequate):
• Pregnant women• Caregivers of infants <6 months• Health care workers w/direct contact• Children 6 months - 4 years • Children 5-18 years with high-risk conditions
University of MichiganHealth System
• Unexpected decreases in vaccine projections prompted programs to consider moving to priority groups.
• Data on H1N1 disease impact cross different risk groups was just beginning to emerge.
University of MichiganHealth System
Impressions #4
Program officials balanced competing demands from multiple levels.
University of MichiganHealth System
We hear you!
“It would be nice if CDC would close down the rhetoric so we can get vaccine out and focus on what’s happening in our state. You can put that in BOLD print!”
University of MichiganHealth System
We hear you!
“That’s a really good idea…But it doesn’t really matter what I think. Nobody listens to me anyway. Even if we make a decision, they’re just going to change it at the last minute anyway.”
University of MichiganHealth System
We hear you!
“We’ve been doing this straightforwardly and transparently…The media have their own way of making it interesting.”
University of MichiganHealth System
We hear you!
“We strive for generalized consensus with all the counties; we agree on something. And then the next day, they just all do whatever they want anyway. It’s insane.”
University of MichiganHealth System
We hear you!
“65 and over is saying, Hey look at me! I have a condition!”
University of MichiganHealth System
We hear you!
“I’m deluged with call from providers, and strange requests on top of that—like the guy who was about to get a hernia operation but needed the vaccine first.”
University of MichiganHealth System
Evaluation
Goals of Phase 2:• Document objectives, decisions, considerations,
strategies across programs• Incorporate what was known at the time• Evaluate success in light of program-specific
objectives and strategies• Synthesize information to produce “lessons
learned” that will inform the future
University of MichiganHealth System
Potential Evaluation Topics
Decision-making • Core principles and objectives• Involvement of other agencies/entities• Challenges of local control• Information sources / adequacy • If I had it to do over…
University of MichiganHealth System
Potential Evaluation Topics
New relationships • Challenges/successes with new provider groups • School vaccination• Opportunity for ongoing collaborations
University of MichiganHealth System
Potential Evaluation Topics
Other areas • Obtaining and using data • Technical systems• Strategies/programs to maintain for future (and
how to fund them)
University of MichiganHealth System
Appreciation
• Anne Cowan, Brian Macilvain, Gary Freed• Claire Hannan, Kaitlyn Wells• Anna Buchanon, Kathy Talkington• Pascale Wortley & team
But most of all…• AIM members
University of MichiganHealth System
