Embed Size (px)
Citation preview
NVPO Webinar Series: Project Successes and Challenges
June 10, 2013
Welcome and Overview
• Bruce Gellin, M.D., M.P.H.
• Shary M. Jones, Pharm.D., M.P.H., BCPS CDR—U.S. Public Health Service National Vaccine Program Office
• Alaysia Phillips, M.P.H.—JBS International, Inc.
Presenters
• Luis Garza—Communidades Unidas
• Luana Scanlan, M.B.A.—American Samoa Cancer Coalition
• Stefan Shearer—Oregon Health Science University
• Barbara Jorgensen, M.S.N.—Yavapai County Community Health Services
Bruce G. Gellin, M.D., M.P.H.Deputy Assistant Secretary for Health and Director
National Vaccine Program OfficeU.S. Department of Health and Human Services
Insert video here
Comunidades Unidas/Communities United Influenza Vaccine Project
Luis GarzaExecutive Director
Comunidades Unidas [email protected]
Successes• Culturally & linguistically appropriate materials
• Distribution of information at strategic locations
• Text message reminder database
• Partnership with local businesses “Healthy Workplace Model”
• Focus not only on education but connecting community with available resources
• Prepare community for influenza season and free clinics
Challenges• Project is being implemented
outside influenza season:
- Issue is not in people’s minds
- Peer to peer outreach / education not as successful as planned
- Promotoras are focused on other issues
Lessons Learned/Best Practices• Build an understanding of the targeted community BEFORE
starting the intervention
• Empower the community to take care of their own health
• Build collaborative, community-based partnerships
• Don’t be afraid to think outside the box!
• Develop thoughtful relationships with community members and organizations
Evaluation/Measurable Outcomes• Outreach plan created to guide the
program
• Informational materials developed and tested in the community
• Information displayed in 3 businesses
• 3 Promotoras (health outreach workers) trained
• 556 individuals reached thus far
• 119 individuals added to our reminder database
American Samoa Community Cancer CoalitionDevelopment of an Evidence-Based HPV Immunization
Protocol for the American Samoa Immunization Program, for Delivery into Local Elementary Schools
Luana ScanlanProject Coordinator, [email protected]
Alignment with Community Care
Coalition (CCC) Goals
The HPV Project supports the Cancer Prevention Goal by
increasing community awareness of HPV
vaccination and HPV related cancers using
culturally tailored educational tools
DemographicsPopulation of 55,519 (2010)• 3.9% age 65+ • 92% are Pacific Islanders
Leading causes of death:• Heart disease• Diabetes• Cancer
Leading cancer types:• Breast• Lung• Ovarian• Prostate
Healthcare:Block grant Medicare• One hospital, 4 clinics• 16 dialysis chairs running 24/7• All vaccines at Dept. of Health• HPV dosage 2009-2012 is less than 1,000• 90% of cancer patients have a less than 2-year survival rate
(2010) 33.4% of pop. is age 0 – 14. As of January 2013, there are 3,062 children enrolled in public
school grades 6th – 8th. 14% are targeted for
HPV vaccination
Successes• HPV project team of relevant stakeholders
• Established baseline data and developed data collection tools
• Established first HPV protocol
• Obtained approval for outreach from the Department of Education
• Obtained commitment from the Department of Health Nursing Director
• Worked on recall system
• Established several partnerships
Challenges• Low prioritization by Department of
Health• Lack of data
• Lack of supporting infrastructure:- No protocol- No organized outreach- No dedicated medical staff
• Under-utilized data management system
• Poor leverage of partnerships and resources
Result
Low HPV literacy
Low HPV vaccination rate
Evaluation/Measurable OutcomesHPV Vaccine Coverage Among
Adolescents Age 11–14 in Registry 2012-2013 (n=928)
0 1 2 3459 Males 372
81%44
9.6%25
5.5%184%
469 Females 22648%
12426%
7416%
459.6%
928 Total 59864%
16818%
9911%
636.8%
SOURCE: Immunization Registry, Feb. 2013
Baseline Data
Complete HPV vaccine coverage is low: less than 4% in the Registry and 1% in the public school system compared to 27% nationally and approximately 25% in the target age range (WHO, 2011).
Evidence to Support Project Objectives
Community based interventions implemented in combination to increase vaccination rates produce the highest impact when inclusive of community-wide Education
Reminder and recall interventionsare effective in improvingvaccination coverage especiallywith multiple dose vaccines likethe HPV vaccine
Project Objectives
1. Expand access to HPV vaccine amongst kids age 11-14 (grades 6–8)
2. Ensure incoming freshman high school students have completed 3 doses of HPV vaccine
3. Increase community demand for HPV vaccination using parent/client education in DOE settings
Project Tasks
1. Establish a systematic immunization schedule in DOE Schools
2. Improve ASIP HPV client reminder system
3. Develop parent-focused HPV education that ASIP will implement prior to ‘Immunization Day’ in each elementary school
ClosingNext Steps:Developing tools:• Department of Health nurses’
in-service• Event planners• Pre-Immunization Day
education (Continuing Medical Educations)
• Parent-focused HPV education
Our implementation plan:Piloting ‘Immunization Day’ in two elementary schools which have the most children reportedly not immunized per Registry
Oregon Rural Practice-based Research Network
Rural Adolescent Vaccinations in Enterprise Quality Improvement (RAVE)
Stefan ShearerResearch Assistant
Oregon Health Science [email protected]
Challenges• Technology
- Reporting and recall functionality of State database has been malfunctioning for the past month
• IRB- IRB approval was delayed which caused the start
date for outreach to be pushed back. In the end, the IRB determined no oversight was needed.
Lessons Learned/Best Practices
• It takes coordination on behalf of the entire care team (patient, front office, MA/RN, clinician) to begin improving immunization rates and keeping patients up to date
• Understanding each other’s role in the workflow and increased and closed-loop communication allow the care team to cross-monitor and prevent patients from “falling through the cracks”
Evaluation/Measurable Outcomes• Outreach began on
5/20– From 5/20 - 5/31,
patients received: 1st HPV – 1 female 2nd HPV – 2 males
– Lag time between outreach and immunization
– First monthly report on outreach efforts due on 6/20/13
Tdap Meningococcal HPV (females) HPV (males)0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
80%
68%
0.33
0.11
0.23
0.1
0.11
0.14
1+ doses1 dose (HPV)2 doses (HPV)3 doses (HPV)
Up-to-date patients ages 11-18 n = 404• 206 females• 198 males• Taken from baseline assessment on 3/1/13
Closing• Next Steps
– Continue outreach efforts (first report due on 6/20)– Continue to look for ways to improve upon workflow
• Questions?
Yavapai County Community Health Services
Increasing routine HPV vaccination for adolescents/young adults
Barbara Jorgensen, M.S.N.Section Manager, Family Health & WellnessYavapai County Community Health Services
Successes• Use of proven intervention strategies
– Computerized record reminders for physicians– Mailed reminder postcards– Telephone reminders– Patient education
• Collaboration between Federally Qualified Health Center (FQHC) and Public Health Department
Post Cards/Movie Slides
Challenges• Initial delay in getting contract signed/approved by
the County Authority
• Delays occurred with contractor for EMR in making the changes/template enhancements
• Could not generate a list of patients/families for phone call reminders until EMR upgrades completed
Lessons Learned/Best Practices
• You cannot always be prepared for changes/challenges
• Allow the people with the most experience in a particular area to participate in decision making, etc.
• Using proven strategies should equate to improved outcomes
Evaluation/Measurable Outcomes
• Able to report numbers of outreach contacts for phone reminders and postcards
• Number of families reached by movie theater slides less tangible
• Know baseline number of patients in clinic who have ever had even one HPV vaccination prior to this project will compare this to the number of clients (within designated age group) who received HPV since project began
Closing• Next Steps:
– EMR template changes will remain – will develop physician/nurse training slides for new providers
– Phone reminder calls will also continue – at least annually– Continue to monitor numbers – hope to see continued rise in
HPV vaccination rates– AZ participation in 317 funding will make HPV vaccine available
to uninsured/underinsured (19-26 year olds)
• Questions?
Question and Answer Session
Please send questions via WebEx chat box.
Please visit http://nvpo.jbsinternational.com to view Webinar recordings and presentations.
Next Webinar: June 24, 2013, 2:00 p.m. (ET)
