Transcript NVPO Webinar Series: Project Successes and Challenges July 18, 2013 Welcome and Overview • Bruce Gellin, M.D., M.P.H. • Shary M.

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 Office
U.S. Department of Health and Human Services
Insert video here
National Association of School Nurses
HPV - 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 Nurses
[email protected]
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
CNE Knowledge Outcomes
Pretest
Posttest
30 day assessment
School Nurse Reach &
Practice Outcomes
Pre-CNE
30 day assessment
•
•Current recommendations
•Influencing factors
•Recommended interventions
•Geographic location
•Student population
•Tracking
•Interventions used
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
[email protected]
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 Department
HPV Immunization Campaign
Jacob Bueno de Mesquita, CDC P.H.A.P.
Union County Health Department
Nursing Division
[email protected]
Successes
•
Project Goals:
Expand access
through
community
outreach and
reduce
economic
barriers
Educate on
HPV disease,
risks, and
vaccine
Emphasized education on HPV and HPV
vaccine
-
Improve
vaccination
series
completion
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
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
Completed Doses:
• Called 750 uninsured (eligible)
boys & girls about starting or 7
6
completing the HPV series
5
• Surveys (n=17)
4
boys
3
– 41% agreed to take the vaccine
girls
2
1
• Cited a desire to protect health
against a preventable disease
– 59% declined the vaccine
• Cited lack of knowledge
0
1st Dose
2nd Dose
Number of boys
receiving vaccine is
up by two-fold
compared to
previous years!
3rd Dose
Closing
Next Steps:
Collect more data – assess barriers
Anticipate back to school increase in numbers.
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 Department
[email protected].
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)