Six Years Later: Tiffany A. Tate, MHS Maryland Partnership for Prevention, Inc. National Immunization Conference March 30, 2011 Lessons Learned from a Healthcare Personnel Immunization Effort

Acknowledgments Robin Decker & Elease Booker Elease Booker Maryland Center for Immunization

Maryland Healthcare Personnel Immunization Initiative (MHCPII) Partnership between coalition and state health department Center for Immunization Partnership between coalition and state health department Center for Immunization Began in 2005 as HCW “Influenza” Initiative Began in 2005 as HCW “Influenza” Initiative Officially changed to “Immunization” initiative in 2009 Officially changed to “Immunization” initiative in 2009

What is the Maryland HCP Immunization Initiative? A year-round effort to increase HCP vaccination rates for recommended vaccines A year-round effort to increase HCP vaccination rates for recommended vaccines Provides grants, technical assistance, and resources to support campaigns Provides grants, technical assistance, and resources to support campaigns Collects data on facility-specific vaccination rates Collects data on facility-specific vaccination rates

MHCPII Participants Local health departments Local health departments Acute care hospitals Acute care hospitals Private medical providers Private medical providers Long term care facilities Long term care facilities Colleges and universities Colleges and universities Outpatient centers Outpatient centers Home health agencies Home health agencies Assisted living centers Assisted living centers

MHCPII Flu Phase Late summer launch Late summer launch Toolkit Toolkit $1,000 grants to support campaigns $1,000 grants to support campaigns Technical assistance and information Technical assistance and information All participants report immunization rates All participants report immunization rates

HCW Toolkit Contents Resources & Strategies Resources & Strategies ACIP Recommendations ACIP Recommendations Maryland Regulations Maryland Regulations Standing Orders Standing Orders Vaccine Information Statements Vaccine Information Statements VARs and Consent Forms VARs and Consent Forms Document Templates Document Templates Articles and Policy Statements Articles and Policy Statements

How It Works… Flu Phase Partner with professional associations to promote and recruit Partner with professional associations to promote and recruit Registered Partners (RP) complete baseline survey: Registered Partners (RP) complete baseline survey: –RPs eligible for $1,000 grant –RPs receive toolkit, resources, and incentives –RPs regular updates –RPs report results at end of season Wrap-Up Meeting and Awards Ceremony Wrap-Up Meeting and Awards Ceremony

Funded Grant Projects Staffing Staffing Financial incentives Financial incentives Vaccine purchase Vaccine purchase Educational materials Educational materials Parties, contests, etc. Parties, contests, etc.

MHCPII “Non-Flu” Phase Spring launch Spring launch Toolkit supplement Toolkit supplement Grants to support campaigns Grants to support campaigns –2-for-1 Vaccine Matching Grant Program –Best Practices Challenge

MHCPII 2-for-1 Grant All Registered Partners eligible All Registered Partners eligible Grant matches X2 vaccine purchased by applicant Grant matches X2 vaccine purchased by applicant (Eg. They buy 2 doses, we give them 4; results in a total of 6 doses) (Eg. They buy 2 doses, we give them 4; results in a total of 6 doses) For all HCP recommended vaccines, except flu For all HCP recommended vaccines, except flu

for-1 Grant Program Funded 10 projects Funded 10 projects –2 LHDs –4 Acute Care Hospitals –2 LTC –2 Outpatient Awarded 1,367 doses of non-flu vaccine Awarded 1,367 doses of non-flu vaccine

for-1 Grant Program Total doses awarded: Tdap – 520 Tdap – 520 MMR – 270 MMR – 270 Varicella – 225 Varicella – 225 Zoster – 122* Zoster – 122* Hep B Hep B - 230

Best Practices Challenge (BPC) Yearlong effort to identify Best Practices in HCP vaccinations Yearlong effort to identify Best Practices in HCP vaccinations Offers up to $15,000 in grants to programs deemed Best Practices Offers up to $15,000 in grants to programs deemed Best Practices Three Best Practice Categories: Three Best Practice Categories: –Promising – earn up to $5,000 for start-up –Existing – earn up to $5,000 for continuation –Enduring – earn up to $10,000 for continuation NEW!

How It Works… Best Practices Challenge Facilities apply for consideration in one or more categories Facilities apply for consideration in one or more categories Promising and Existing Best Practices awarded at outset Promising and Existing Best Practices awarded at outset “Enduring” projects register at beginning “Enduring” projects register at beginning

How It Works (cont.)… Best Practices Challenge Promising and Enduring report periodically and accept technical assistance Promising and Enduring report periodically and accept technical assistance Enduring Best Practices evaluated and awarded at end Enduring Best Practices evaluated and awarded at end Best “Enduring” projects awarded $10,000 Best “Enduring” projects awarded $10,000

BPC Interest Stats 77 registered for Introductory Webinar 77 registered for Introductory Webinar 27 participants in Application Guidance Webinar 27 participants in Application Guidance Webinar

Six Year Overview

Maryland HCP Immunization Initiative Registered Partners,

Registered Partner Survey Completion Baseline v. Wrap-Up

If flu vaccination is refused, will you ask employee to sign a declination?

Describe your practice or policy on HCP influenza vaccination ( ) Mandatory for all HCPs 7% Strongly encouraged; declination forms required 60% Strongly encouraged; declination form requested 15% Suggested; declination form not requested 18%

How will you promote flu vaccinations to employees and volunteers? ‘05 – ‘06 ‘06 – ‘07 ‘07 – ‘08 Posters68%78%90% Flyers81%67%90% Paycheck Stuffers 22%26%25% Announcements81%85%75% Incentives22%30%50% Other54%44%45%

How will you promote flu vaccinations to your employees and volunteers?

Flu vaccinations will be offered to employees and volunteers… ‘05 – ‘06 ‘06 – ‘07 ‘07 – ‘08 ‘08 – ‘09 ‘09-’10‘10-’11 Free95%96%95%90%94%91% At Cost/ Discount 4%0%5%2%4%4% Will not be provided 0%4%0%1% Other0%0%0%7%2%4%

Barriers to vaccinating staff and volunteers against influenza… ‘05 – ‘06 ‘06 – ‘07 ‘07 – ‘08 ’08 – ‘09 ’09 – ‘10 ’10 – ‘11 Lack of funding 9%7%10%16%18%18% Staffing18%15%20%16%24%20% Time18%19%10%16%19%14% Employee knowledge 50%67%75%64%62%56% Support from Admin. 0%11%10%5%6%5% No standing order 9%7%10%7%2%1%

Describe your practice or policy on HCP non-flu vaccinations ( ) Some IZs required as condition of employment 30% Offer for free 84% Offer at discounted rate 1% Refer HCP to own healthcare provider 23% Request declination form 55% Do not promote non-flu vaccinations to HCPs 6%

Which vaccines are mandatory for staff and volunteers with direct patient contact? ’05 - ’10 ’10 – ’11 Hep A 3% Hep B 30% HPV1% Flu18% MMR34% Meningococcal1% Pneumococcal2% Tdap11% Varicella27% Zoster1%

For which vaccines does your facility have standing orders? ’09 - ’10 ’10 – ’11 Hep A 11%16% Hep B 84%76% HPV7%4% Flu88%75% MMR42%38% Meningococcal15%8% Pneumococcal14%21% Tdap36%35% Varicella38%35% Zoster7%6%

Which vaccines do you routinely promote to your employees and volunteers? ’08 – ‘09 ’09 - ’10 ’10 – ’11 Hep A 11%14%14% Hep B 94%91%91% HPV1%3% Flu94%95%98% MMR48%54%46% Mening.11%8%8% Pneumo.27%19%30% Tdap46%45%46% Varicella15%51%45% Zoster14%6%5%

What inspires your facility’s participation in MHCPII? ’09 - ’10 ’10 – ’11 Resources85%89% Grants74%75% Recognition41%37% Partnerships59%60% Technical Asst. 45%38% Other13%14%

Observations, Challenges & Lessons Learned

Observations Steady increase in interest in HCP vaccination Steady increase in interest in HCP vaccination Most HCP employers offer vaccine free Most HCP employers offer vaccine free HCP knowledge remains barrier to vaccination HCP knowledge remains barrier to vaccination Difficult to measure HCP vaccination rates Difficult to measure HCP vaccination rates

Persistent Challenges Lack of knowledge/acceptance from some HCPs Lack of knowledge/acceptance from some HCPs Absence of standard definitions for “Healthcare Personnel” and “Patient Contact” Absence of standard definitions for “Healthcare Personnel” and “Patient Contact” Low response rate to wrap-up survey Low response rate to wrap-up survey

Persistent Challenges Reporting errors (appx. vs. exact, percentages vs. actual number) Reporting errors (appx. vs. exact, percentages vs. actual number) Changes in denominator from year to year Changes in denominator from year to year Changes in facility representation from survey to survey Changes in facility representation from survey to survey

Lessons Learned: Profile of a Winning Facility Offers free vaccinations onsite Offers free vaccinations onsite Has standing orders Has standing orders Asks “refusers” to sign declination Asks “refusers” to sign declination >3 methods for promoting vaccinations >3 methods for promoting vaccinations >2 methods for administering vaccinations >2 methods for administering vaccinations Applies for an initiative grant Applies for an initiative grant Offers incentives Offers incentives

Lessons Learned Most HCPs know vaccination is the right thing Most HCPs know vaccination is the right thing Support and promotion should come from the top Support and promotion should come from the top Large and small incentives work Large and small incentives work

Lessons Learned HCP immunization campaigns should be: HCP immunization campaigns should be: –Year-round –Include ALL recommended vaccines Grants and technical assistance are valued Grants and technical assistance are valued Find a champion within participant categories Find a champion within participant categories

Lessons Learned When measuring rates: When measuring rates: –Try to anticipate trends for consistency in measuring –Frequently remind and support data collectors

Thank You! Maryland DHMH Center for Immunization Maryland HCW Planning Committee Registered Partners Supporting Partners

Tiffany Tate Maryland Partnership for Prevention