Impact of a Telephone Intervention to Increase Pneumococcal Vaccination Rate in a Managed Care Population

Acknowledgments Carla A Winston, PhD - CDC Kecia Leatherwood, MSPH Pascale Wortley, MD, MPH - CDC Michael Blue, MSHA Latoya Cochran, BS This study was funded by the CDC and took place at Kaiser Permanente, Georgia. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agency.

Overview Pneumococcal vaccine is recommended for: Persons age >65, Younger persons with chronic medical conditions.

Background Pneumococcal immunization is safe, Effective at preventing hospitalizations from pneumococcal disease, But underutilized, even in managed care systems

Prior Initiatives to Increase Pneumococcal Immunization Rates Patient Centered: Outreach letters during fall influenza campaign Newsletter articles Prevention guideline posters in exam rooms Pneumococcal posters in clinic triage station

Prior Initiatives to Increase Pneumococcal Immunization Rates Clinician Centered: Published Guidelines on website, pocket guide and email Mandatory CME tests Lime green chart flags in targeted member’s medical record Departmental & individual quality measure

Research Question Does telephone outreach improve Pneumococcal vaccination rates in a managed care environment?

Methods Target Population 3,711 patients > age18 with diabetes, congestive heart failure or coronary artery disease (Chronic) 2,395 patients > age 65 (Elderly) Randomized to intervention and control

Intervention Advance letter mailed to intervention patients Up to 4 telephone calls made by managed care nurses Nurses confirmed patient vaccination status Nurses provided tailored advice in response to reasons for non-vaccination

Intervention Continued Nurses informed patients that vaccination: was free, available at a nurse visit, an appointment could be scheduled during the call

Analysis All eligible patients were followed for six month to determine the vaccination status outcome. Comparison of vaccination rate in intervention versus control group.

Prior Vaccinations determined by Outreach Calls Chronic Group n=1043 Previously vaccinated 234 (22.44%) Never vaccinated 809 Elderly Group n=850 Previously vaccinated 375 (44.12%) Never vaccinated 475

Immunization Response Rates at 6 Months *Chronic # N 288 111 % 16 6 P<0.0001 2.66x *Elderly # N 201 100 % 17 8 P<0.0001 2.1x * Intervention group # Control group Patients who received the intervention were on average 2.3x more likely to be vaccinated than control group

Cost of Nursing Intervention Nursing Cost $41,520.50 Additional patients vaccinated 278 Average nurse cost per additional member vaccinated $147.35 Nursing cost for additional vaccinations was low No formal cost effectiveness analysis was performed

Results Patients who received the vaccine did so within 1-3 months after the intervention The majority of the unvaccinated members at the start of the study, remained so after the study ended

Conclusions Telephone outreach calls are relatively inexpensive and successful at raising vaccination rates. The elderly group had larger numbers that were previously immunized that was not known to the administrative data

Recommendations Immunization programs in Managed Care environments can enhance their vaccination rates by employing a variety of low cost and higher cost intervention strategies Improved data capture on prior immunizations can improve the targeting and thus lower the cost of outreach programs