Improving Adult Immunization Rates Influenza Pneumococcal Pneumonia Herpes Zoster

Atlantic Quality Innovation Network (AQIN) One of 14 QIN-QIOs across the country working to provide quality improvement learning opportunities, technical assistance and free resources in support of CMS healthcare quality goals. Led by IPRO in New York State. Partners include Delmarva Foundation in the District of Columbia and the Carolinas Center for Medical Excellence in South Carolina.

Project Goals To Be Achieved by 2019 ■ National immunization rates of 70% for influenza, 90% for pneumonia and 30% for herpes zoster ■ Reduction of disparities among racial and ethnic minorities and rural populations ■ One million people who were not previously vaccinated will receive pneumonia immunizations ■ A rate of 90% for adult immunization status assessment, appropriate immunization or referral ■ Documentation of patient ‘s immunization status to include reporting immunizations to the NYS DOH Immunization Information System (IIS) or NY CIR via CEHRT and other electronic methods

The Advisory Committee on Immunization Practices Recommendations: Most persons > 65 years of age receive the following immunizations; ▪ Annual influenza vaccination ▪ Tdap vaccination, if not vaccinated with this vaccine previously, followed by tetanus and diphtheria (Td vaccine) booster every 10 years ▪ Two pneumococcal vaccines in series (pneumococcal conjugate 13 valent (PCV13) followed 12 months later by pneumococcal polysaccharide 23 valent (PPSV23) vaccine) ▪ One herpes zoster at age 60 years or older 4

Disparities and Adult Vaccination Rates-2013 Immunization Type Total White Black Hispanic Asian Other Seasonal influenza 46.3% 48.5% 40.2% 41.5% 52.6% 43.2% Pneumococcal 59.7% 63.6% 48.7% 39.2% 45.3% 54.6% Herpes Zoster 24% 27.4% 10.7% 9.5% 22.6% 24.5% Table 7 Supplement. Influenza Vaccination Coverage* by Race/Ethnicity, Adults 18 years and older–United States,† 2013-14 Season available at www.cdc.gov/flu/excel/fluvaxview/sep-2014/2013-14_coverage_supplemental-2.xlsx - 38k - 2015-06-10 - Text Version http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6404a6.htm#Tab1

The National Vaccine Advisory Committee Recommends that All Practitioners and Providers: ▪ Incorporate immunization needs assessment into every clinical encounter. ▪ Strongly recommend needed vaccine(s) and either administer vaccine(s) or refer patient to a provider who can immunize. ▪ Stay up-to-date on, and educate patients about vaccine recommendations. ▪ Implement systems to incorporate vaccine assessment into routine clinical care. ▪ Understand how to access immunization information systems (IIS) (i.e., immunization registries) and document vaccines in the IIS where available 6

Strategies to Increase Adult Immunizations: ▪ Clinician Recommendation & Patient Communication ▪ Patient Reminders – Recall ▪ Chart/Provider Reminders ▪ Standing Orders ▪ Immunization Information Systems ▪ Home Visits ▪ Patient Education ▪ Personal Health Records ▪ Expanding Access in Healthcare Settings ▪ Performance Feedback

Examples of Identified Barriers to Adult Immunization ▪ Lack of practitioner, provider, and patient knowledge about the recommendations and necessity for immunizations of healthy and at-risk adults. ▪ Acute care and chronic care have had priority over preventive services. ▪ Some providers not offering vaccines or offering only a subset of vaccines recommended for beneficiaries. ▪ Limited use of electronic tools to ensure routine assessment of vaccination status of patients. ▪ Third-party payers do not pay all practitioners or providers that administer immunizations. ▪ Patients may see several practitioners or providers, which may complicate coordination of care. 8

Vaccination Process ▪ Assess vaccination status ▪ Recommend vaccination ▪ Screen for contraindications and precautions ▪ Provide appropriate Vaccine Information Statement (VIS) ▪ Administer vaccine ▪ Document vaccine administration 9

Collaboration on Project: QIO Will Provide ▪ How to incorporate immunization assessment into your work flow process and track patients’ immunization status in EMR ▪ How to use your EMR to identify patients who are in need of immunizations and target higher risk patients ▪ Review of reports and identify opportunities for improvement ▪ Identify benefits of reporting and querying Immunization Information Systems (IIS) ▪ Access to online learning via Learning Action Network ▪ Resources for patient education 10

Collaboration: Expectations of Participation ▪ Assess patients immunization status ▪ Provide immunizations or refer patients for immunizations ▪ Document patients’ immunization status in EMR ▪ Agree to run reports on immunization status and share with QIO ▪ Commitment to improve immunization rates ▪ Identify benefits of reporting/querying immunization registry 11

For more information Veronica Pryor, RN, MPA Immunization Task Leader / Project Manager Health Care Quality Improvement Program Tel: direct: (516) 209-5631 or 516 326-7767, ext 631 Main: (516) 326-7767 E-mail: vpryor@ipro.org Fax: (516) 304-3795 IPRO CORPORATE HEADQUARTERS 1979 Marcus Avenue Lake Success, NY 11042-1002 IPRO REGIONAL OFFICE 20 Corporate Woods Boulevard Albany, NY 12211-2370 www.atlanticquality.org This material was prepared by the Atlantic Quality Innovation Network (AQIN), the Medicare Quality Innovation Network - Quality Improvement Organization for New York State, South Carolina, and the District of Columbia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 11SOW-AQINNY-Tsk F11604