Adult Vaccines and Registries— Working With Long Term Care Facilities

1. Adult Vaccines and Registries—Working With Long Term Care Facilities Cheryl Stephens, Executive Director Liz Thom, RN, Regional Immunization Registry Coordinator Community Health Information Collaborative (North Central and Northeast Minnesota) 2003 Immunization Registry Conference

2. Workshop Objectives • Discuss issues in recruiting long term care (LTC) facilities as registry users. • Discuss how the needs of LTC can differ from primary care/pediatric practices. • Present the lessons learned and next steps.

3. A little about CHIC and Minnesota… • CHIC: Non-profit public-private organization created to improve the quality of health care through the use of information systems. • Immunization registry the most visible project. • Covers 18 counties and 29,000 sq. miles • Minnesota: Regional governance and provider recruitment/support; statewide web-based application and database.

4. Minnesota Immunization Information Connection A statewide network of regional immunization services Kittson Roseau Lakeof theWoods Marshall Koochiching Beltrami St.Louis Pennington Polk Cook Lake Red Lake ClearWater Itasca Norman Mahno- men Hubbard Cass Clay Becker Aitkin Crow OtterTail Wadena Carlton Wing Wilkin Pine Todd MilleLacs Grant Douglas Morrison Kanabec Benton Traverse Stevens Pope Stearns Isanti Big Stone Sherburne Chisago Swift Anoka Kandiyohi Wright Wash-ing-ton Lac Qui Parle Chippewa Meeker Ram- sey Hennepin Pending 1 McLeod Carver Renville YellowMedicine Dakota Scott Sibley Le Sueur Goodhue Lincoln Redwood Lyon Rice Nicollet Wabasha Brown Blue Earth Murray Dodge Waseca Cottonwood Pipestone Central Minnesota Immunization Connection (CMIC) Winona Olmsted Watonwan Steele Houston Rock Nobles Jackson Martin Faribault Freeborn Fillmore Mower Communities Caring for Children (CCC) ImmuLink Immtrack Community Health Information Collaborative (CHIC) Southeast Minnesota Immunization Connection (SEMIC) Southwest Minnesota Immunization Information Connection (SW-MIIC) June 2003

5. Why include adults in registries? • VPD morbidity and mortality are generally higher in adults than children. • High pneumococcal vaccine coverage rates in particular have proven elusive. • Immunization histories are as scattered as pediatric histories. • Medicare requirements for influenza and pneumococcal vaccinations.

6. Methods • Selected 5 LTC facilities of different sizes and types. • Visited each to interview about: • Immunization screening at admission • Sharing immunization data • Protocols for vaccine administration • Current methods of tracking vaccines • Perceived benefits and barriers to routinely using a registry

7. Findings – Current Procedures • All sites screen for flu and pneumococcal. • A Medicare requirement • Two screen for Td history; One screens for BCG. • Screen for Hepatitis B disease only. • The family is not usually involved in vaccination decisions.

8. Findings – Perceived Benefits • Reduced ward clerk and nurse time • Accurate information • Reduced vaccine costs to the facility (avoiding unnecessary shots) • Ease of reporting • More accurate forecasting of next shot due • More accurate histories than if from the mildly cognitive-deficient resident.

9. Findings – Perceived Barriers • Need to allocate staff time for record queries. • Internet access not always at nursing/admission station. • New information system for staff to learn • Not a significant factor

10. Employee Health – The Other Payoff • Most desired benefit cited by the LTC sites: Tracking Mantoux’s, • A Medicare requirement • Tracking influenza is also important. • As well as Hepatitis B, Varicella, MMR, Td for staff; • Occupational health contractors need registries for tracking vaccines required by different employers. • Many also serve correctional facilities, which have both resident and staff vaccination requirements.

11. Lessons Learned To Date • There is little sharing of immunization data among LTC and providers that treat seniors. • May need to recruit internists and other groups to the registry. • The benefits and barriers of registry participation are largely the same as for pediatric providers. • Occupational vaccine tracking is a big issue. • Registry screens and reports may need to be modified to better reflect adult vaccines.

12. Next Steps • Find the “CHAMPIONS” for adult immunizations. • Assess computer accessibility/internet access at the line-staff level of LTC facilities • Partners needed for • Education - public and professional groups • Funding – to prevent barriers to Registry participation • Support – to promote adult wellness • To prevent vaccine –preventable diseases