Utilizing CDCs AFIX Model in the Racial Ethnic

Utilizing CDC’s AFIX Model in the Racial & Ethnic Adult Disparities in Immunization Initiative (READII) Linda Brown, RN, MEd, CPHQ Mila Verdugo, MPH National Immunization Conference March 22, 2005

Overview • Racial and Ethnic Adult Disparities in Immunization Initiative (READII) • Chicago Plan − Partners − Provider Recruitment • Provider Quality Improvement Project − Process − Clinic Participation − Preliminary Results • Summary • Recommendations

READII • CDC funded demonstration project − September 2002 -December 2004 − Chicago, Milwaukee, San Antonio, Rochester, Mississippi Delta • Improve influenza and pneumococcal immunization coverage among African. American and Hispanic seniors over the age of 65

Chicago Plan • 14 communities identified • Community education − Public Awareness Campaign − Community Outreach • Improve access to immunizations • Encourage use of effective office-based strategies

Partners • African American Health Care Council & Chicago Hispanic Health Coalition − Identify and recruit providers • Chicago Department of Public Health (CDPH) − Identify and recruit providers • VFC provider listing − Conduct ACASAs and feedback sessions − Provide vaccine

Partners • Illinois Foundation for Quality Health Care (IFQHC) − Centers for Medicare and Medicaid Services’ Quality Improvement Organization − In-office and large group education • Utilize existing Quality Improvement Curriculum: Systems To Enhance Preventive Services • Review effective office strategies (standing orders, staff and/or patient reminders, or patient recalls) • Provide resources for implementing strategies

Recruitment Efforts • Initial efforts unsuccessful − Lack of access to free adult vaccine identified as primary barrier to immunization • CDPH intensified recruitment − Letters sent − Phone calls made − Free vaccine offered as incentive

READII Providers, Chicago

Quality Improvement Process • Office-based program modeled after CDC’s AFIX approach: Assessment Feedback Incentive e. Xchange

AFIX Model • Proven success in pediatric settings • Promoted by CDC & American Academy of Pediatrics to increase clinic level immunization coverage

AFIX Model (cont. ) • Recommended by National Vaccine Advisory Committee “Standards of Adult Immunization Practices” − Regular assessments of practice level vaccination rates − Reminder/recall systems for patients and health care professionals − Standing orders for vaccinations

Assessment: Pre-intervention Influenza and Pneumococcal Coverage Levels, ACASA, 2002 N=1342 Charts

Feedback • Office visits conducted with each clinic’s immunization leader − Coverage levels reviewed − Clinic-specific strategies recommended

Incentive • Providers were offered FREE resources for project participation − Influenza & pneumococcal vaccines − Continuing Education Credit − Attendance certificates − Resource Toolkit and Immunization materials (e. g reminder/recall postcards, chart stickers)

e. Xchange • In-office training sessions − Standing Orders − Provider/Patient Reminders • Group Learning Sessions (GLS) to share best practices • Teleconference on Medicare Billing and Reimbursement

Clinic Participation • Of the 31 participating clinics − 31 (100%) had pre-intervention assessments − 23 (74%) received in-office training − 8 (26%) attended 1 st GLS (basic) − 7 (23%) attended 2 nd GLS (advanced) − 8 (26%) attended billing teleconference

Evaluation • Telephone survey conducted to assess − Adoption of recommended strategies − Identify barriers to adoption • ACASA assessments repeated for a sample of provider clinics − Determine clinic-level post-intervention coverage levels

Provider Survey Results August 2004 • System Changes Adopted by Providers, N=29 − − − Standing Orders (11) Flow Sheets (9) Chart Stickers (5) Reminder Calls (2) Reminder Postcards (5) Other (17) i. e. walk-in clinic hours, new chart dividers, posters in patient & waiting rooms, pre-appt. chart review, TOTS registry

Provider Survey Results • CDC, CDPH or IFQHC resources used by providers − Vaccine Information Statements (20) − Flow Sheets (4) − Chart Stickers (8) − Posters, Brochures, IZ Cards (26)

Provider Survey Results • Did your clinic administer more vaccine this past flu season with the additional supply of free vaccine? − 26/29 (90%) responded “YES” • Were they patients who wouldn’t normally have received vaccine? − 25/26 (96%) responded “YES”

Post-intervention Influenza and Pneumococcal Coverage levels, ACASA, 2002 vs. 2003 % N=327 Charts

Summary • Providers who participated in the AFIX activities were likely to adopt recommended immunization strategies • Clinic-level immunization coverage rates increased from 2002 to 2003 • Combining CDC’s AFIX approach with the state QIO’s curriculum was an efficient and effective method for educating providers

Recommendations • Post-intervention (2004) coverage levels should be determined in READII clinics to determine the impact of the combined approach on immunization coverage levels • CDPH and the QIO should continue to support the clinics in order to encourage continued use of effective strategies

Contact Information For further questions, please contact: Linda Brown, RN, MEd, CPHQ Illinois Foundation for Quality Health Care Lbrown@ilqio. sdps. org 800 -386 -6431, #5815 Mila Verdugo, MPH Chicago Department of Public Health Verdugo_Mila@cdph. org 312 -746 -5381