Transcript NVPO March 2013 Project Successes and Challenges

NVPO Webinar Series:
Project Successes and Challenges
June 10, 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
• Luis Garza—Communidades Unidas
• Luana Scanlan, M.B.A.—American Samoa Cancer
Coalition
• Stefan Shearer—Oregon Health Science University
• Barbara Jorgensen, M.S.N.—Yavapai County
Community Health Services
Bruce G. Gellin, M.D., M.P.H.
Deputy Assistant Secretary for Health and Director
National Vaccine Program Office
U.S. Department of Health and Human Services
Insert video here
Comunidades Unidas/Communities
United Influenza Vaccine Project
Luis Garza
Executive Director
Comunidades Unidas
[email protected]
Successes
• Culturally & linguistically appropriate materials
• Distribution of information at strategic locations
• Text message reminder database
• Partnership with local businesses “Healthy Workplace Model”
• Focus not only on education but connecting community with
available resources
• Prepare community for influenza season and free clinics
Challenges
• Project is being implemented
outside influenza season:
- Issue is not in people’s minds
- Peer to peer outreach /
education not as successful as
planned
- Promotoras are focused on
other issues
Lessons Learned/Best Practices
• Build an understanding of the targeted community BEFORE
starting the intervention
• Empower the community to take care of their own health
• Build collaborative, community-based partnerships
• Don’t be afraid to think outside the box!
• Develop thoughtful relationships with community
members and organizations
Evaluation/Measurable Outcomes
• Outreach plan created to guide the
program
• Informational materials developed and
tested in the community
• Information displayed in 3 businesses
• 3 Promotoras (health outreach
workers) trained
• 556 individuals reached thus far
• 119 individuals added to our reminder
database
American Samoa Community Cancer Coalition
Development of an Evidence-Based HPV Immunization
Protocol for the American Samoa Immunization
Program, for Delivery into Local Elementary Schools
Luana Scanlan
Project Coordinator, ASCCC
[email protected]
Alignment with
Community Care
Coalition (CCC) Goals
The HPV Project
supports the Cancer
Prevention Goal by
increasing community
awareness of HPV
vaccination and HPV
related cancers using
culturally tailored
educational tools
Demographics
Population of 55,519 (2010)
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•
3.9% age 65+
92% are Pacific Islanders
Leading causes of death:
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•
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Heart disease
Diabetes
Cancer
Leading cancer types:
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Breast
Lung
Ovarian
Prostate
Healthcare:
Block grant Medicare
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One hospital, 4 clinics
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16 dialysis chairs running 24/7
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All vaccines at Dept. of Health
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HPV dosage 2009-2012 is less than 1,000
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90% of cancer patients have a less than 2-year survival rate
(2010) 33.4% of pop.
is age 0 – 14. As of
January 2013, there
are 3,062 children
enrolled in public
school grades 6th – 8th.
14% are targeted for
HPV vaccination
Successes
• HPV project team of relevant stakeholders
• Established baseline data and developed data collection tools
• Established first HPV protocol
• Obtained approval for outreach from the Department of
Education
• Obtained commitment from the Department of Health Nursing
Director
• Worked on recall system
• Established several partnerships
Challenges
• Low prioritization by Department of
Health
• Lack of data
• Lack of supporting infrastructure:
- No protocol
- No organized outreach
- No dedicated medical staff
• Under-utilized data management
system
• Poor leverage of partnerships and
resources
Result
Low HPV literacy
Low HPV
vaccination rate
Evaluation/Measurable Outcomes
HPV Vaccine Coverage Among
Adolescents Age 11–14 in Registry
2012-2013 (n=928)
0
1
2
3
459 Males
372
81%
44
9.6%
25
5.5%
18
4%
469 Females
226
48%
124
26%
74
16%
45
9.6%
928 Total
598
64%
168
18%
99
11%
63
6.8%
SOURCE: Immunization Registry, Feb. 2013
Baseline Data
Complete HPV vaccine coverage is
low: less than 4% in the Registry and
1% in the public school system
compared to 27% nationally and
approximately 25% in the target age
range (WHO, 2011).
Evidence to Support
Project Objectives
Community based interventions
implemented in combination to
increase vaccination rates produce
the highest impact when inclusive
of community-wide Education
Reminder and recall interventions
are effective in improving
vaccination coverage especially
with multiple dose vaccines like
the HPV vaccine
Project Objectives
Project Tasks
1. Expand access to HPV vaccine
amongst kids age 11-14
(grades 6–8)
1. Establish a systematic
immunization schedule in
DOE Schools
2. Ensure incoming freshman high
school students have
completed 3 doses of HPV
vaccine
2. Improve ASIP HPV client
reminder system
3. Increase community demand
for HPV vaccination using
parent/client education in DOE
settings
3. Develop parent-focused HPV
education that ASIP will
implement prior to
‘Immunization Day’ in each
elementary school
Closing
Next Steps:
Developing tools:
Our implementation plan:
• Department of Health nurses’
in-service
Piloting ‘Immunization Day’ in
two elementary schools which
have the most children
reportedly not immunized per
Registry
• Event planners
• Pre-Immunization Day
education (Continuing Medical
Educations)
• Parent-focused HPV education
Oregon Rural Practice-based Research
Network
Rural Adolescent Vaccinations in Enterprise Quality
Improvement (RAVE)
Stefan Shearer
Research Assistant
Oregon Health Science University
[email protected]
Challenges
• Technology
- Reporting and recall functionality of State database
has been malfunctioning for the past month
• IRB
- IRB approval was delayed which caused the start
date for outreach to be pushed back. In the end, the
IRB determined no oversight was needed.
Lessons Learned/Best Practices
• It takes coordination on behalf of the entire care team
(patient, front office, MA/RN, clinician) to begin
improving immunization rates and keeping patients up
to date
• Understanding each other’s role in the workflow and
increased and closed-loop communication allow the
care team to cross-monitor and prevent patients
from “falling through the cracks”
Evaluation/Measurable Outcomes
1
• Outreach began on
5/20
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0.9
0.8
0.7
From 5/20 - 5/31,
patients received:
68%
0.6
11%
1+ doses
1 dose (HPV)
0.5
23%
0.4

1st HPV – 1 female
0.3

2nd HPV – 2 males
0.2
– Lag time between
outreach and
immunization
– First monthly report on
outreach efforts due
on 6/20/13
80%
2 doses (HPV)
14%
33%
0.1
10%
11%
0
Tdap
Meningococcal
HPV (females)
HPV (males)
Up-to-date patients ages 11-18 n = 404
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206 females
198 males
Taken from baseline assessment on 3/1/13
3 doses (HPV)
Closing
• Next Steps
– Continue outreach efforts (first report due on 6/20)
– Continue to look for ways to improve upon workflow
• Questions?
Yavapai County Community
Health Services
Increasing routine HPV vaccination for
adolescents/young adults
Barbara Jorgensen, M.S.N.
Section Manager, Family Health & Wellness
Yavapai County Community Health Services
[email protected]
Successes
• Use of proven intervention strategies
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Computerized record reminders for physicians
Mailed reminder postcards
Telephone reminders
Patient education
• Collaboration between Federally Qualified Health Center
(FQHC) and Public Health Department
Post Cards/Movie Slides
Challenges
• Initial delay in getting contract signed/approved by
the County Authority
• Delays occurred with contractor for EMR in making
the changes/template enhancements
• Could not generate a list of patients/families for
phone call reminders until EMR upgrades
completed
Lessons Learned/Best Practices
• You cannot always be prepared for
changes/challenges
• Allow the people with the most experience in a
particular area to participate in decision making, etc.
• Using proven strategies should equate to
improved outcomes
Evaluation/Measurable Outcomes
• Able to report numbers of outreach contacts for phone
reminders and postcards
• Number of families reached by movie theater slides less
tangible
• Know baseline number of patients in clinic who have ever had
even one HPV vaccination prior to this project will compare
this to the number of clients (within designated age
group) who received HPV since project began
Closing
• Next Steps:
– EMR template changes will remain – will develop
physician/nurse training slides for new providers
– Phone reminder calls will also continue – at least annually
– Continue to monitor numbers – hope to see continued rise in
HPV vaccination rates
– AZ participation in 317 funding will make HPV vaccine available
to uninsured/underinsured (19-26 year olds)
• Questions?
Question and Answer Session
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Next Webinar: June 24, 2013, 2:00 p.m. (ET)