NVPO Webinar Series: Project Successes and Challenges

July 18, 2013

Welcome and Overview• Bruce Gellin, M.D., M.P.H.

• Shary M. Jones, Pharm.D., M.P.H., BCPS CDR—U.S. Public Health Service National Vaccine Program Office

• Alaysia Phillips, M.P.H.—JBS International, Inc.

Presenters• Nichole Bobo, M.S.N., R.N.—National Association of School

Nurses

• David Kaelber, M.D., Ph.D., M.P.H., F.A.A.P., F.A.C.P.—MetroHealth System (Case Western Reserve University)

• Jacob Bueno de Mesquita, CDC P.H.A.P.—Union County Health Department

• Karen Hegranes—Langlade County Health Department

Bruce G. Gellin, M.D., M.P.H.Deputy Assistant Secretary for Health and Director

National Vaccine Program OfficeU.S. Department of Health and Human Services

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National Association of School NursesHPV - Enhancing School Nurse Knowledge to Support

Informed Adolescent Vaccine Decision-making

Nichole Bobo, M.S.N., R.N.Director of Nursing Education

National Association of School Nursesnbobo@nasn.org

Successes• Resources for school nurses

• Enthused content for review:

– NASN IZ Advisory Committee

– CDC Preteen/Teen

• NASN support builds our IZ platform

– Executive Director

– Director of Research (evaluation metrics)

– Director of Continuing Education (navigating new ANCC requirements)

• Launching Date

Challenges• Competing priorities

• Meeting task timeline

– New implementation of ANCC guidelines

– Unable to engage reviewer

– NASN Bi-Annual Board Meeting & Annual Conference (6/22-7/1)

– Learning management system

• School environment

Lessons Learned/Best Practices

• CNE development

• Challenges ≠ developing this resource

• Immunization partners = strength & quality

• Schools and school nurses are part of the medical

neighborhood

Evaluation/Measurable Outcomes• Process measures channel the work

• Outcome measures

• Current recommendations• Influencing factors• Recommended interventions

CNE Knowledge Outcomes

PretestPosttest30 day assessment

• Geographic location• Student population• Tracking• Interventions used

School Nurse Reach & Practice OutcomesPre-CNE30 day assessment

• Immunization website traffic (http://www.nasn.org/Tools/Resources/Immunizations )

Closing• Next Steps

‒ Launch & advertise CNE/revised website

‒ Collect evaluation metrics

‒ Efforts to sustain

MetroHealth System (Academically affiliated with Case Western Reserve University)

Using Electronic Health Record Technologies to Improve Vaccinations

David Kaelber, M.D., P.h.D., M.P.H., F.A.A.P., F.A.C.P.Associate Professor, Internal Medicine, Pediatrics,

Biostatistics, and Epidemiology dkaelber@metrohealth.org

Successes• Standing orders approved for diphtheria, HPV, influenza, pertussis,

pneumovax, and tetanus (not herpes zoster)

• Health Maintenance Reminders built for diphtheria, HPV, influenza, pertussis, pneumovax, and tetanus (not herpes zoster)

• Smart Sets built for diphtheria, HPV, influenza, pertussis, pneumovax, and tetanus (not herpes zoster)

• “Model” site for immunization decision support as designated by Epic corporation

Challenges• Vaccine administration and tracking for Herpes Zoster and Tdap are

VERY COMPLEX because of the reimbursement mechanism (Part D Medicare)

• Operationalizing vaccinations for people who are behind

Lessons Learned/Best Practices• Focus on immunizations that can be given (and reimbursed) in the clinic only

• Couple Health Maintenance Reminders with Best Practices Alerts (reminder that immunization (s)

needs to be given with “1-click” solution to order immunization (s))

• Develop complete work flow:

– Health Maintenance Reminders/Best Practice Alerts

– Standing Orders

– Patient Messaging

– In-Clinic Immunizations

– Evaluation and Monitoring

Evaluation/Measurable Outcomes• Still data gathering

• Process Measures

– Number of patients with adult immunization Health Maintenance Reminders

– Numbers of times adult immunization Best Practice Alerts fired

– Number of times adult immunization smart set used

– Number of adult immunization messages sent

• Outcome Measures

– Pre-Post improvement in adult immunization rates for diphtheria*, herpes zoster*, human papilloma virus, pertussis*, pneumovax, and tetanus*

• *Impossible to track immunizations given in pharmacies

Closing• Next Steps

‒ Messaging patients

‒ Continued evaluation

‒ Healthcare system-wide operationalization after the grant

Union County Health DepartmentHPV Immunization Campaign

Jacob Bueno de Mesquita, CDC P.H.A.P.Union County Health Department

Nursing Divisionalex.jones@uchd.net

Successes• Emphasized education on HPV and HPV

vaccine- Education to nursing staff and target

population

• Collected survey data on knowledge and attitudes toward HPV Vaccination

• Reduced economic barriers by enrolling eligible Medicaid Family Planning clients

• Targeted VFC eligible clients to provide free vaccine

Expand access through

community outreach and

reduce economic barriers

Educate on HPV disease,

risks, and vaccine

Improve vaccination

series completion

Project Goals:

Challenges• Lack of money to immunize privately insured youth

– In Union County, 38% of children are either uninsured or on Medicaid

• Only able to use VFC vaccine for this population

• Through outreach/education, our socially conservative county was more receptive than expected. However, igniting our BRAND is a process as well as trying to access schools

• Integrating routine HPV vaccination across all care

• providers

Lessons Learned/Best Practices• Branding!

• Incentives for survey completion

• Recruit more survey takers!

• Offer vaccine to all eligible clients, who come into the health department

Educational Materials:-Quick Facts-Merck Info-CDC Info

Evaluation/Measurable Outcomes• Called 750 uninsured (eligible)

boys & girls about starting or completing the HPV series

• Surveys (n=17)

– 41% agreed to take the vaccine

• Cited a desire to protect health against a preventable disease

– 59% declined the vaccine

• Cited lack of knowledge

Completed Doses:

1st Dose 2nd Dose 3rd Dose0

1

2

3

4

5

6

7

boysgirls

Number of boys receiving

vaccine is up by two-fold

compared to previous years!

Closing

Call all 11-24 year olds (not just the uninsured)

education

Postcard education

TV commercial education

Improve collaboration with schools, teams,

groupseducation

Further integrate survey/education with normal sexual health

clinic practice

Education of primary care physicians

Linking target population to primary care

Anticipate back to school increase in numbers.

Collect more data – assess barriersNext Steps:

Langlade County Health Department Langlade County Adult Immunization Health Project

Karen Hegranes, M.S.N., P.H.N.Clinical Supervisor of Public Health

Langlade County Health Departmentkhegranes@co.langlade.wi.us.

Successes• Designed an Adult Immunization brochure and distributed it to our

health care partners and community

• Increased awareness regarding adult vaccination opportunities using print and radio advertisements for adult clinics and reminder letters information individuals which vaccines they quality for due to age or uncompleted series. Alerting adults they may qualify for state provided vaccine which is administered without costs to adults uninsured and underinsured; this includes HPV and Pneumococcal Polysaccharide.

• Strengthened and improved relationships with local pharmacies and immunization providers for adults, through referrals and patient education

Challenges• Database for reminder letters is not up-to-date for current

addresses, so a % of letters to not make it to the clients. Benefits is that we can clean our resident database records of those moved out of the county.

• Cost of vaccine for Zoster is prohibitive for many seniors

• Many adults do not know they are eligible for vaccination

Lessons Learned/Best Practices

• Partnering with programs with matching demographics of target

populations increases success. Working with the WIC program has been

an excellent match.

• The Technical College clinics were held did not yield great vaccination

numbers; it turned out the days selected had a low number of students

and classes in the building.

Evaluation/Measurable Outcomes• Quality improvement survey has given us monthly data

regarding our adult immunization program

• Wisconsin Immunization Registry provides reports to quantify data

Closing• Next Steps

‒ Continue to incorporate adult vaccination in our clinics and look for new methods to communicate reminders to get immunized. Reminder calls, texting, and social media.

Question and Answer Session

Please send questions via WebEx chat box.

Please visit http://nvpo.jbsinternational.com to view Webinar recordings and presentations.

Next Webinar: July 18, 2013, 2:00 p.m. (ET)