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S afe & T imely I mmunizations C oalition

S afe & T imely I mmunizations C oalition. William McClellan, MD, MPH Jenna Krisher February 2007. Background. July 2005: CMS 6 awarded 2-year Special Project to Network 6 Goal: to increase Hepatitis, Influenza and Pneumococcal immunization rates in ESRD patients & staff in Network 6.

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S afe & T imely I mmunizations C oalition

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  1. Safe&TimelyImmunizationsCoalition William McClellan, MD, MPH Jenna Krisher February 2007

  2. Background • July 2005: CMS 6 awarded 2-year Special Project to Network 6 • Goal: to increase Hepatitis, Influenza and Pneumococcal immunization rates in ESRD patients & staff in Network 6

  3. Background • SOW Called for a Coalition to advise on • Implementation of evidence-based recommendations to increase patient and staff immunization rates • Incorporating CMS quality measures into current data systems • Specifications for a staff influenza immunization measure, as appropriate • Other topics related to increasing immunization rates in ESRD patients and staff

  4. Firm Deliverables What is “project” work Suspended existing flu project Independent Coalition What is “coalition” work Coalition enhanced existing project Integrating the Coalition into a Special Project

  5. SC SSA ESRD NW15 SC QIO NANT RCG DCI CMS GAKP FMC Safe & Timely Immunization Coalition Health Systems Mgmt. Gambro GA QIO ESRD NW 11 AAKP NC QIO CDC ESRD NW 6 NC SSA ANNA SC SSA

  6. Coalition GoalsAugust 2005  Today • Identify and leverage the Programs, Policies, Practices (P3) associated with higher immunization rates • Education Group  Education/Marketing • Educate patients and staff • Guidelines Group • Develop ESRD-specific immunization guidelines • Data & Surveillance Group • Establish/link electronic data collection system • Intervention and Evaluation • Evaluate STIC Resource materials • Design outcomes-based interventions

  7. Program Changes • Educational Resource materials sent to all facilities in STIC, all Networks and posted to web • ANNA CE on Wheels • STIC Speakers Packet • Numerous ESRD community presentations • Intervention plans in development • Networks 6,11,15 intensive immunization surveillance and QI • Building/strengthening of relationships • Spin offs – Leadership Coalition

  8. Policy Changes • CDC Guidelines • ANNA Position Statement • Conditions for Coverage???? • CDC funding

  9. Practice Changes • Tracking Mechanism at Facilities • Increased community interest in immunization • Feedback reports to generate facility QI • Facility practices / attitudes survey results to guide future activities

  10. Pre-Analysis STIC Expectations • Facility Variation in Immunization Rates would exist • Patient and Facility Characteristics would help explain variability • Facility practices would help explain variability • Standing Orders would directly correlate to immunization rates

  11. Baseline Data

  12. Patient Characteristics • Positive Association • Mean age • Negative Association • African American % • No significant association • Gender Ratio • Diabetes % • Age, sex, and race adjustment • Reduces overall variation and decreases the number with extreme rates • Accounts for only 7% of facility-to-facility variation

  13. Facility Characteristics • Marginally positive • Chain affiliation • Negative Association • Larger treatment centers • No significant association • Profit status • Free-standing

  14. Programs, Policies, Practices Examined • Administrative policies • Standing order policies • Immunization • Other Areas of Care • Likeliness to change and roles involved in decision • Staff vaccination policy • Immunization Systems in place • Tracking Systems • Reminder Systems • Performance assessment • Outcomes feedback

  15. Programs, Policies, Practices Examined • Education • Level of patient education and materials used • Amount and frequency of staff education • Attitudes, opinions, beliefs, and perceived barriers • Barriers to full implementation of standing order immunization programs • Attitudes, opinions and beliefs with regard to severity of infections and risk/benefit of immunization

  16. Practices in Place

  17. Perceived Standing Orders Barriers

  18. Influenza Vaccination Association with Standing Order Policy • No significant difference seen after multivariate adjustment for possible confounding factors (at facility level) • Analysis underway for patient level data

  19. Next Steps for STIC • Expand the toolkit/idea space: determine which programs, policies and practices are positively associated with immunization • Develop Network interventions based on these analyses • Conduct evaluation of educational resources & revise as needed

  20. Next Steps for STIC • Continue surveillance & feedback of immunization rates • Develop plan to assess staff immunizations • Extend to other Networks as feasible • Continue to pursue Conditions For Coverage

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