Using the Community Guide to Examine Worksite Influenza Vaccination Program Effectiveness

1. Using the Community Guide to Examine Worksite Influenza Vaccination Program Effectiveness matt griffith, MPH Robin Soler, PhD David Hopkins, MD Qiana Baker, MPH

2. Disclaimer The findings and conclusions in this presentation have not been formally determined by the Task Force on Community Preventive Services or disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any Task Force or agency determination or policy.

3. Overview • Systematic reviews • The Community Guide • A systematic review of worksite influenza vaccination efforts • Teams and concepts • Decisions • Initial findings • Closing observations

4. Evidence-Based Public Health • “EBPH is the development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems and appropriate use of program planning models.” Brownson (1999)

5. Systematic Reviews • Systematic process to specify research questions, find relevant literature, assess quality of studies, and synthesize results • Method to distill and summarize large and diverse bodies of evidence Strengths -Transparent process -Standardized methods that reduce potential for bias -Consolidated body of evidence Limitations -Slow process -Categorized continuous evidence -Inability to “fix” gaps or limitations in the evidence

6. The Community Guide • An independent US Task Force • A method for conducting systematic reviews • A focus on population-based interventions • Communities • Health care systems • Evidence-based conclusions and recommendations regarding use

7. The Community Guide: Methods • Assemble a team • Develop conceptual framework • Search for and retrieve evidence • Abstract data • Summarize evidence (quality, findings) • Task Force translates strength of evidence into findings • Recommended • Insufficient evidence • Recommended Against

8. Rationale • Influenza burden on public health • Potential pandemic influenza • HP 2010 and ACIP recommendations • Vaccination effectiveness for improving • Public health threats • Worker outcomes (e.g., morbidity, medical costs) • Employer outcomes (e.g., productivity)

9. Worksite Coordination Team • Task Force Members • Nico Pronk, Vice-President, HealthPartners • Ron Goetzel, Director, Institute for Health and Productivity Studies • CDC • Lisa Koonin, Branch Chief, Office of Public and Private Partnerships • Leigh Ramsey Buchanan, Coordinating Scientist, Division of Nutrition and Physical Activity and Obesity • Abby Rosenthal, Health Education Specialist, Office on Smoking and Health • Deborah Bauer, Partnership and Dissemination Coordinator, Community Guide • Academic and Private Sectors • Dee Edington, Professor, University of Michigan • Curtis Florence, Assistant Professor, Emory University • Deborah MacLean, Operations Manager, Coca-Cola • Dennis Richling, VP and Medical Director, CorSolutions • Andrew Walker, Private Consultant 9

10. Influenza Consultation Team • Public Sector • Faruque Ahmed, Medical Epidemiologist, CDC Immunization Services • Deborah Banton, Public Health Nursing Director, San Juan Basin Health Department (CO) • Pamela Butler, Health Commissioner, Wood County Health District (OH) • Renee Funk, Medical Epidemiologist, NIOSH • Gina Mootrey, Medical Officer, CDC Immunization Services • Kristin Nichol, Chief of Medicine, Minneapolis VA Medical Center/Professor of Medicine, U of Minnesota • Private Sector • Theresa Frost, Health Education Specialist, Pitney Bowes, Inc. • Sara Kashima, Health Information Coordinator, Chevron Corporation • Advocacy • Charlie Key, Treasurer-Secretary, Georgia AFL-CIO • Diane Peterson, Associate Director, Immunization Action Coalition 10

11. Decisions Along the Way • Begin with on-site (at the workplace) programs • Conduct separate reviews for healthcare and non-healthcare settings • Different contexts • Different motivations • Different implications • Compare all potential intervention methods

12. Access to Vaccine Knowledge of Vaccine/ Disease Beliefs and Attitudes Influenza Vaccination at Work to Increase Coverage among Workers Interventions Exposure to Influenza Effectiveness of Vaccine Morbidity and Mortality Working population Social determinants Vaccination Coverage Susceptibility Norms and Perceived Norms Healthcare System Use Worker Productivity 12

13. Potential Worksite Approaches

14. Search and Evaluation Results 4,088 References 4,014 from systematic literature search 64 from reference lists 10 from other sources 2,081 Excluded 84 Not English 1,910 Not Worksite 87 Not Influenza 1,280 Duplicates removed 676 Papers “Healthcare Workers” setting 728 Full papers screened 51 Papers “Non-Healthcare Worksite” 6 Papers do not evaluate an intervention 45 Non-HCW Intervention Papers 28 Efficacy papers in worksites 3 Efficacy studies with coverage data abstracted 17 Intervention Papers 11 Interventions 7 Papers abstracted Potential Body of Evidence: 6 papers 4 Papers excluded for design 4 Papers not located

15. Evidence: Another look Note: all of the interventions had on-site vaccination programs with reduced-out-of-pocket costs (i.e., free vaccination).

16. On-site Vaccination Coverage Change M=37.55 pct pts Dille 99 Higgins 91 Strunk 05 Ausseil 99 Percentage Point Difference Janes 08 (Arm 1: Free on-site vaccination versus no program): 19.6 pct pts Janes 08 (Arm 2: $5 copay on-site program versus no program): 8.1 pct pts

17. Other Results Ahmed 04 evaluated the effectiveness of using 2 postcard reminders against one postcard reminder in high risk workers. Percentage point difference= 0.8 pct pts Ausseil 99 evaluated the change in the average number of sick leave days claimed before implementing an on-site, ROPC vaccination program against the number claimed after the program. Difference= -0.01 days per person

18. Observations and Next Steps • Appears to be a positive effect from implementing on-site, ROPC influenza vaccination programs • Smaller body of evidence than expected (80-90% of large employers offer worksite-based vaccination programs) • Conduct similar review of healthcare worksites • Present findings to Task Force • Interpretability for implementers (e.g., worksites, employers, benefits providers, health departments) • Weak participation from individuals/organizations with workforce perspective

19. Closing • Thank you • Abstraction training • Contact • ftq6@cdc.gov • 404-498-0955 • www.thecommunityguide.org