AIM Annual Survey Review 2015

Katelyn Wells Ph.D.

AIM Research and Development Director

1

AIM Annual Survey 2014 n = 60 & 2015 n = 63

Purpose: assess and characterize immunization program policy, infrastructure, program activities and priorities and the impact of funding changes (both federal and state) on immunization programs (IP)

• Survey designed by AIM committees CDC and partner feedback

• Administered online January-March 2014 & April – June 2015

2013 and 2014 Grant Year Funds

2013 and 2014 Calendar Year Activities

Current Policies

• Survey responses sent to each IP for verification

3

IP Structure: Number of IP with Staff Currently in Position to Support Function- 2015

(located in the immunization program, w/ designated funding, includes contract staff, does not include LHD staff )

13

13

6

10

1

8

26

25

18

14

23

11

22

23

38

38

38

43

0 10 20 30 40 50 60 70

Adult immunization programming

Adolescent immunization programming

School assessments (assures compliancewith school law)

VPD surveillance & reporting

Managing perinatal hepatitis B

Research (program evaluation and/orassessing coverage rates)

No FTEs

.50 FTE

>1 FTE>1 FTE

4

IP Structure: No Staff Person in Position to Support Function 2015 vs. 2014

(located in the immunization program, at least .50 FTE, w/ designated funding, includes contract staff, does not include LHD staff )

3

5

6

13

14

15

18

20

24

1

10

6

13

13

8

0 10 20 30

Vaccine manager/coordinator

Registry manager/coordinator

Managing Perinatal hepatitis B staff (Identification of HBsAg-positive pregnant women; Newborn prophylaxis; Post-…

VPD surveillance & reporting staff

School Assessments coordinator (assures compliance withschool law)

Health educator

Adult coordinator

Adolescent coordinator

Research staff (Program Evaluation and/or Assessing CoverageRates)

2015

20142014

2015

*Question was not asked for 2015

* *

*

*

*

IP Staff Environment: Number of IPs with Change in Leadership in CY2013 vs. CY2014

5

50.0%

30.0%

52.5%

17.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

ImmunizationProgram Manager

Epidemiology andSurveillance

Manager/Director

State Health Official Governor

12

20

21

5

11

11

12

15

16

17

18

20

0 5 10 15 20 25

Local Commissioner

Adult manager/coordinator

Epidemiology and surveillance manager

Adolescent manager/coordinator

VFC manager/coordinator

AFIX manager/coordinator

IIS manager/coordinator

Immunization program manager/director

State Health Official

2014

2013

*

*Question was not asked for CY2013

*

IP Staff Environment: Number of IPs with Change in Leadership Positions CY2014 (out of 9 positions)

6

50.0%

30.0%

52.5%

17.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

ImmunizationProgram Manager

Epidemiology andSurveillance

Manager/Director

State Health Official Governor

49 of 63 17

11

9 8

3

1

0

2

4

6

8

10

12

14

16

18

1 leadershipchange

2 leadershipchanges

3 leadershipchanges

4 leadershipchanges

5 leadershipchanges

6 leadershipchanges

78% or (49 or 63) IPs had at least one leadership change in CY2014

IP Staff Environment: Impact of state/local policies

CY2014

37 IPs (59%) with hiring delays

28 IPs (44%) with travel restrictions

7 IPs with hiring freezes

9 IPs with pay freezes or reductions

8 IPs with reductions in force Other state policies impacting IPs: - Contract and grant process are cumbersome and lengthy - Centralized IT - Change in Indirect Rate - Cap on FTEs - State budget deficits

8

IP Staff Environment: Number of Staff in Leadership Positions Within IPs

Includes those individuals whom immunization in program manager feel have a social influence or are in a position to enlist the aid and support of others in the accomplishment of a common task. These individuals would benefit

from leadership training e.g., change management, communication skills, etc.) and could include supervisors, managers and coordinators.

4

20

16

22 1 to 2 leaders

3 to 4 leaders

5 leaders

more than 5 leaders

Approximately 400+ leaders

2015

Yes 57%

No 43%

Advisory Committee

No 27%

Yes 73%

Immunization Coalition

IP Structure: Percentage of IPs with a Coalition or Advisory Board

Fiscal Environment: GY2014

0

31

23

4

3

3

0

2

13

8

9

9

6

16

30

44

25

3

5

27

26

19

12

4

25

20

25

22

27

24

20

9

0 20 40 60

PanFlu

State/Local Operations Funding

State/Local Vaccine Funding

VFC AFIX Funding

VFC Ordering Funding

VFC Operations Funding

Section 317 Operations/InfrastructureFunding

Section 317 Vaccine Funding

N/A-We donot have thisfunding type

Funding wascut orreduced

Funding wasincreased orrestored

Funding waslevel, nochange from2013

0%

10%

20%

30%

40%

50%

60%

70%

80%

2013 2014

State/Local VaccineFunding

State/Local OperationsFunding

Section 317 VaccineFunding

Section 317Operations/InfrastructureFundingVFC AFIX Funding

VFC Operations Funding

VFC Ordering Funding

Fiscal Environment: Percentage of IPs with Cuts GY2013 vs.GY2014

2

2

2

3

3

5

5

5

5

6

6

6

7

7

8

8 8 8

9 9

13 14

22

0 5 10 15 20 25

VFC provider recruitment/training for IIS

Implementing Meaningful Use

Daycare/school assessments

Pharmacy recruitment/training for IIS

Provider VFC site visits

Childhood vaccine purchase

School located vaccination clinics

Enhancement of IIS

Adult provider recruitment/training for IIS

Adolescent vaccine purchase

Provider education

Provider AFIX site visits

Funding for local health departments

Staffing/administrative support

Adolescent programming

Provider VFC/AFIX combined visits

Purchase of vaccine storage and handling equipment for providers

Pan Flu exercises

Public education

Purchase of provider incentives

Supply of provider education materials

Adult programming

Adult vaccine purchase

Fiscal Environment: Number of IPs with Reduction/Cut in Specific Activities - GY2014 (All Funding Sources)

Fiscal Environment: Number of IPs Use of 317 Vaccine Funds

GY2014

53

28 14

32 28

6

27

43

25 29

0

10

20

30

40

50

60

70

No, Section 317vaccine fundingwas not used

Yes, Section 317vaccine fundingwas used

13

49

27

15 17

28

8

2 2 0 1

8 10

0 0 0 0

10

20

30

40

50

60

317 purchase for ongoingactivity (over multipleyears)

317 purchase for planneddemo or pilot project

Ad hoc or end-of-year 317purchase

Fiscal Environment: Percent of IPs using 317 Vaccine Funds

(GY2013 vs. GY2014)

53

28 14

32 28

6

27

43

25 29

0

10

20

30

40

50

60

70

No, Section 317vaccine fundingwas not used

Yes, Section 317vaccine fundingwas used

14

90%

52%

26%

50%

89%

64%

31%

47%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Adults Outbreaks School-locatedvaccination clinics

Hepatitis B birthdose

2013

2014

IP Effort: Percent of IPs Reporting Current Activity 2014 vs. 2015

15

42%

58%

63%

47%

53%

65%

60%

84%

82%

23%

44%

51%

57%

61%

64%

64%

66%

66%

66%

72%

75%

84%

89%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Check for provider invoices to private insurance

Complete separate VFC site visit and AFIX > 25% of providers

Requiring VFC providers to use digital data loggers

Require providers to use IIS

Require providers to submit templogs with orders

Require providers to track doses administered by funding source

Host regional provider trainings

Require providers to reimburse the program for wasted vaccine

Conduct provider training online

Assess provider education needs and identify resources to meetneeds

Conduct adolescent AFIX visits (stand alone or routine childhoodvisit)

Visit new providers more than once in the first year

Require providers to submit doses administered

Conduct compliance site visits to > CDC-required 50% of VFCproviders

2015

2014

IP Effort: Percentage of IPs with Non-traditional Providers Enrolled in VFC

CY2013 vs. CY2014

16

28% 27% 27%

63%

25%

35% 36%

62%

44%

54%

0%

10%

20%

30%

40%

50%

60%

70%

Pharmacists CommunityVaccinators

OB/GYNs STD/FamilyPlanning Clinics

Internists College/schoolbased health

service

2014 20152014 2013

IPs Current Activities for NON-VFC Enrolled - 2015

26

21

32

28

26

32

34

26

32

30

25

31

13

11

14

11

12

13

7

6

11

9

7

5

0 20 40 60 80 100

Pharmacists

Community Vaccinators

OB-GYNs

STD and/or Family PlanningClinics

Internists

College/school based healthservice

Distribution ofinformation/educationalmaterials aboutimmunizations

IIS enrollment/training

Virtual training forimmunizations

On-site training forimmunizations

8

11

11

14

14

15

18

23

20

26

25

29

30

33

33

33

13

18

18

16

20

28

30

26

31

28

35

32

40

39

42

45

0 10 20 30 40 50 60 70 80 90

Racial and ethnic specific

Adult-Pneumococcal specific

Healthcare worker vaccination specific

Chronic medical condition specific, e.g.diabetes.

Adult-MMR specific

Adult-Tdap specific

Child-Pertussis specific

Pregnant women specific

General Adult Vaccines

HPV with cancer prevention focus

Child-Measles specific

Adolescent-HPV specific

General Adolescent Vaccines

Child-Influenza specific

Adult-Influenza specific

General Childhood Vaccines

Social Media(e.g.,Facebook, Twitter,Youtube, Texting)

General Media (e.g.,Website, Radio, TV,Newsletters,Newspapers, etc.)

IP Effort: Number of IPs with Targeted Communication Campaigns CY2014

IP Effort: Percent of IP Addressing Vaccine Confidence/Hesitancy CY2014

19 19%

26%

42%

46%

47%

47%

53%

56%

60%

60%

63%

63%

67%

81%

83%

83%

84%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Check for provider invoices to private insurance

Require providers to use VTrckS

Complete separate VFC site visit and AFIX visits >25% of…

Conduct validation audits of provider profile information

Require providers - track doses administered by funding source

Evaluate the effectiveness of VSH provided to provider staff

Host regional provider trainings

Evaluate the effectiveness of VSH education/training provided…

Visit new providers more than once in the first year

Require providers to use IIS

Require providers to submit templogs with orders

Conduct adolescent AFIX

Require reimbursement for wasted vaccine

provider training online or in-person class room style…

Conduct compliance site visits for more 50% of VFC-enrolled…

Check provider profile info against provider orders

Require providers to submit doses administered

5%

5%

10%

11%

14%

21%

24%

25%

37%

41%

46%

46%

47%

47%

48%

53% 61%

76% 79%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Passed laws or regulations to strengthen exemption laws

Conducted focus groups/surveys of schools

Used IIS to determine vaccine refusal and target intervention by…

Conducted focus groups/surveys of Parents

Conducted focus groups/surveys of Providers

Identified schools with high exemption rates and targeted…

Disseminated coverage and exemption rate “report cards” to …

Disseminated toolkit/resources to schools

Encouraged providers to document in IIS vaccine refusals and/or…

Sponsored or promoted web based Provider training

Sent messages to Providers via website and/or social media

Disseminated Provider toolkit/resources

Provided school coverage and exemption rate reports for public…

Sent messages to Parents via mass media (website, print, TV,…

Sent messages to Parents via social media (Facebook, Twitter, etc.)

Collaborated with AAP

Collaborated with immunization coalition

Addressed at in person Provider training (meetings, conferences,…

Addressed during AFIX or VFC site visit

11% of IPs did not conduct any of the provided activities to address vaccine confidence/ hesitancy

IP Effort: Percent of IPs use of Funding to Address Vaccine Confidence/ Hesitancy CY2014

20 19%

26%

42%

46%

47%

47%

53%

56%

60%

60%

63%

63%

67%

81%

83%

83%

84%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Check for provider invoices to private insurance

Require providers to use VTrckS

Complete separate VFC site visit and AFIX visits >25% of…

Conduct validation audits of provider profile information

Require providers - track doses administered by funding source

Evaluate the effectiveness of VSH provided to provider staff

Host regional provider trainings

Evaluate the effectiveness of VSH education/training provided…

Visit new providers more than once in the first year

Require providers to use IIS

Require providers to submit templogs with orders

Conduct adolescent AFIX

Require reimbursement for wasted vaccine

provider training online or in-person class room style…

Conduct compliance site visits for more 50% of VFC-enrolled…

Check provider profile info against provider orders

Require providers to submit doses administered65%

38%

33%

29%

21%

0%

10%

20%

30%

40%

50%

60%

70%

Section 317 VFC AFIX VFC Operations State/local Categorical PPHF

IP Effort: Priority Level CY2015 vs. CY2014

21

1.8

1.9

3.3

2.5

3

3.8

4.1

4.2

4.2

4.3

4.3

4.4

1.0 2.0 3.0 4.0 5.0

Change vaccine financing policy

Enroll pharmacists as VFC providers

Increase the number of school located vaccination clinics

Work with payers to expand reimbursement for…

Partner with community vaccinators

Increase the number of pharmacists using IIS

Address vaccine safety/hesitancy

Implement/enhance billing at local health departments

Improve pandemic preparedness

Increase implementation of the adult immunization standards

Increase adult rates

Increase the number of adult providers using IIS

Support upcoming legislative activities

Work with coalitions

Implement PPHF grants

Increase the number of VFC providers using IIS

Implement Meaningful Use/Interoperability

Increase HPV rates

Identify and address low coverage rates

Improve vaccine storage and handling

Improve VFC accountability

2015 2014

1= Not a Priority 2= Low Priority 3= Mod. Priority 4= High Priority 5= High Priority

AIM Next Steps Send aggregate results to AIM Members (10/23 Weekly Update)

Publish Policy Maps (October 2015)

- Available on AIM and vaccinefactsandpolicy.org websites

Present AIM 2015 Data Review to Partners at 2016 Partner Meeting (AIM Leadership in Action Conference)

Present HPV Related Data on HPV Call to Action

Present Vaccine Confidence/Hesitancy Data at Texas Immunization Conference

Conduct a research project further analyzing Vaccine Confidence/ Hesitancy Data (Partners Dr. Saad Omer and Dr. Dan Salmon, Ed Marcuse)

Decide/Prioritize how to further analyze and publish results Student Practicums Insight/Direction from Research Committee Decision from Executive Committee

Add select data to www. vaccinefactsandpolicy.org 22

“A Comprehensive Database of U.S. Immunization Information”

www.vaccinefactsandpolicy.org

Key Features: Printable Profile Reports

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Key Features: Printable Reports by Topic

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