Increasing Adolescent Immunization Rates Through Office Champions Bellinda

Increasing Adolescent Immunization Rates Through Office Champions Bellinda K. Schoof, MHA, CPHQ Pamela Carter-Smith, MPA Conference on Practice Improvement December 6, 2014 L 41 - 1: 00 -2: 00 pm

Disclosures • Division Director, Health of the Public and Science • Clinical Policies Strategist, Health of the Public and Science • No Conflicts of Interest to Disclose

OBJECTIVES • Learn about the benefits of the Office Champions model for increasing adolescent immunization rates • Discuss best practices for increasing adolescent immunization rates • Understand a team-based performance improvement approach within a family medicine practice.

Family Medicine • AAFP Membership – 115, 900 family physician members • Family medicine is the most versatile of all physician specialties, providing comprehensive medical care to patients of all ages. • Approximately one in four of all office visits are made to family physicians. That is 214 million office visits each year — nearly 74 million more than the next largest medical specialty.

Family Medicine • Family physicians deliver care in a variety of settings, including: – Office practices – Hospitals – Nursing homes – Community health centers – Urgent care centers – Emergency rooms – University-based health centers • Family physicians deliver a range of acute, chronic, and preventive medical care services while providing patients with a patient-centered medical home.

Immunizations in the Family Medicine Practice Setting • Patient-centered Medical Home – Patient is an active participant in his/her own health and is cared for by a Family Physician who leads the practice team coordinating all aspects of the patient’s health – Ideally, all immunizations should be given in the PCMH and if not, they should be reported to the PCMH. (AAFP Policy)

Implementing the PCMH Transforming America’s Health Care System and Engaging Members Practice Organization Quality Care Health IT Patient. Centered Care Transforming Primary Care Practices

Practice Organization Quality Care 15 Health IT Patient. Centered Care

AAFP 2011 Immunization Data • • • 9 6 – 23 months 24 months – 3 years 4 years – 10 years 11 years – 18 years 19 years – 64 years 65 years + 73% 76% 81% 84% 91%

AAFP 2011 Immunization Data • Practices Routinely Providing Selected Vaccines for Adolescents Vaccine 10 2011 Meningococcal 76% HPV 88% Influenza 94% Tdap 95%

National Adolescent Immunization Rates • Need for Improvement! Vaccine 2012 2013 Tdap 85% 86% Men. ACWY 74% 78% HPV 3 dose completion (Female) 67% 70% HPV 3 dose completion (Male) 45% 48% Influenza (13 -17 years) 40% 46% NIS-Teen Data-Adolescent/Teens (13 -17) U. S. Vaccination Coverage Reported via NIS

AAFP Adolescent Immunization Office Champions Project • Performance improvement and education for family physicians and practice staff on effective strategies for increasing immunization rates. • Multi-faceted “office champions” model approach: – – Improving strong physician recommendations Reducing missed opportunities to immunize Increasing parental awareness and acceptance of vaccines Evidence-based practices to improve immunization rates • Office Champions for Children & Adolescents immunization projects funded by external partners. 12

AAFP Office Champions Model Methods: Twenty practices were recruited for each of the project grants for a total of 40 practices: Phase 1 • • AAFP Adolescent Immunization METRIC Performance Improvement Module Each practice determined baseline immunization rates Analysis of the immunization baseline chart review conducted Action plans developed and strategies implemented Phase 2 • • Implementing Action Plans Post intervention chart reviews were conducted Comparison analysis of baseline and post-intervention data Action plans and strategies evaluated and sustainability plans implemented Phase 3 • Implementation of sustainability plan • Final chart reviews and analysis will be conducted in January 2015 • Action plans routinized in practice systems

AAFP Office Champions Model Geographic Distribution of the Office Champion Practices 10 9 8 7 6 5 Merck Practices (n=19) 8 4 7 3 8 7 5 2 4 1 0 Urban Merck Practice Locations (n=19) CDC Practice Locations (n=20) Suburban Rural CDC Practices (n=20)

AAFP Office Champions Model % Increase Over Baseline Adolescent Project (CDC) Adolescent Project (Merck) Control Group MCV 1. 7%↑ 23. 73%↑ 6. 22%↓ Tdap 7. 5%↑ 12. 35%↑ 3. 3%↑ HPV 1+ (F) 20%↑ 25. 49%↑ 6. 5%↑ HPV 3 (F) 7. 41%↑ 15. 00%↑ 35%↑ HPV 1+ (M) 106%↑ 100%↑ 27. 5%↑ HPV 3(M) 71. 43%↑ 83. 33%↑ 126%↑ Influenza 2. 7%↑ 26. 67%↑ 29%↓

AAFP Office Champions Model Preliminary Practice Immunization Strategies - Survey Results (n=20) *prior to Phase 1 project initiation Do you currently us Standing Orders 95% 100% 90% 70% 65% 60% 80% 40% 70% 35% 45% 30% 60% 25% 50% Yes 5% 40% No 30% 20% 10% Don't have EHR 15% 10% Don't Know 5% 0% *CDC Funded Project* Immunization Schedules avilable in exam rooms Prior to visit do staff review patient immunization record Reminder & Recall system in practice Submit or retrieve immunization data in Electronic Health Record (EHR)

AAFP Office Champions Model Action Plan Strategies • Recordkeeping & Immunization Information Systems: Using immunization registries, creating Electronic Medical Records (EMR) alerts when vaccines are due, and utilizing state registries. • Recommendations & Reinforcement: Strong recommendations from healthcare providers for patients to receive the vaccine, and reinforcement of the need to return. • Reminder & Recall (Patients and Providers): Specific notification (telephone, email, etc. ) to inform why vaccines are due. Educational messages to providers regarding the importance of immunizations. • Reduction of Missed Opportunities & Reduction of Barriers to Immunizations: Standing orders, extended hours, educating healthcare providers on vaccines needs.

AAFP Office Champions Model – Phase 2 Missed Opportunities & Reduction of Barriers "I think I learned a lot about immunizations. I have always promoted them but participating in this project gave me more tools to use. " 8 19 Reminder and Recall (Patient & Provider) 15 15 Recommendation & Reinforcement 16 10 Recordkeeping/Immunization Information Systems 13 14 0 10 20 CDC: Number of Practices that Implemented Strategies (n=20) Merck: Number of Practices that Implemented Strategies (n=19)

Immunizations: A Winning Proposition • Deliver strong immunization recommendations • Address vaccine misinformation • Ensure adequate payment for vaccines and their administration • Ensure coverage for vaccines to lessen the burden of outof-pocket costs • Optimize EHR/IIS inter-operability

Team-based Approach! "Through the resources provided by the AAFP, we educated our staff that sick visits are an excellent time to catch up on missed vaccinations. "

AAFP Office Champions Model Phase 3 - Sustainability Plan • Important for team buy-in and participation • Evaluation of action plans and strategies • Practices demonstrating that they have sustained and/or improved their immunization rates. • Conduct chart reviews • Data collection tool used to ensure comparability. • Routinizing action plan and strategies into practice

AAFP Office Champions Model Phase 3 - Sustainability Action Plan Strategies evaluated and implemented to sustain and/or increase immunization rates: Missed Opportunities & Reduction of Barriers • Recordkeeping & Immunization Information Systems: Using immunization registries, creating Electronic Medical Records (EMR) alerts when vaccines are due, and utilizing state registries. 17 8 Reminder and Recall (Patient & Provider) 18 • Recommendations & Reinforcement: Strong recommendations from healthcare providers for patients to receive the vaccine, and reinforcement of the need to return. 15 Recommendation & Reinforcement 16 16 Recordkeeping/Immunization Information Systems 18 13 0 5 10 CDC: After Evalution of Action Plans and Strategies (n=19) CDC: Initial Action Plans and Strategies (n=20) • Reminder & Recall (Patients and Providers): Specific notification (telephone, email, etc. ) to inform why vaccines are due. Educational messages to providers regarding the importance of immunizations. 15 20 • Reduction of Missed Opportunities & Reduction of Barriers to Immunizations: Standing orders, extended hours, educating healthcare providers on vaccines needs.

AAFP Office Champions Model 1. Something the team learned by doing the Office Champions project? q Action plan & Strategies increase rates q Reminder & Recall systems to reinforce q Talking point on HPV q Educating Staff 2. What has your practice learned as a team about your immunization rates? q Surprised at the low HPV rates q Staff being more involved 1. What are some pearls that came out of the "Best Practices" that were implemented? q Talking about vaccines at every visit q Equalizing HPV vaccines

AAFP Office Champions Model Resources • Provider Resources for Vaccine Conversations with Parents • AAFP Immunization Resources • Centers for Disease Control and Prevention-Vaccines & Immunizations • Family. Doctor. org-Vaccines • Immunization Action Coalition • State Chapters for Immunization Information • Child and Adolescent Immunization Office Champions Project -Final Report

Discussion Please evaluate this session at: stfm. org/sessionevaluation Acknowledgments: The AAFP Adolescent Immunization Office Champions Projects are supported by a cooperative agreement from the Centers for Disease Control and Prevention (5 U 66 IP 000676 -02) and an educational grant from Merck & Co. , Inc. (The authors are solely responsible for the content and do not necessarily represent the official views of the CDC or Merck).