Continuous Quality Improvement: Making follow-up work Lynn Bahta Minnesota Department of Health lynn.bahta@health.state.mn.us

Acknowledgements Abstract submitted by Emily Litt, R.N., MSN, PHN emily.litt@health.state.mn.us

Background On average, 800 active providers in Minnesota MDH contracted with local public health to conduct site visits The program combined VFC site visits and assessment components and called the program Immunization Practices Improvement

Immunization Practices Improvement VFC requirements Vaccine management Program compliance Assessment of immunization practices Vaccine administration Provision of resources Assessment of practices to improve immunization rates Reducing missed opportunities Tracking, reminder/recall activities Use of registry Assessment of immunization rates ( CASA/ CoCASA)

IPI Program background continued Two tools were developed for data collection for reports and evaluation Questionnaire: filled out ahead of visit by provider Checklist: filled out by IPI Advisor during site visit Letter templates for feedback were created for local public health IPI Advisors Training to Advisors is conducted annually, either via interactive videoconference or regional sessions Program resources put on the web

IPI Program Quality Assurance Two levels Local public health Provider Evolving Focus shifted based on findings Coordinator position unstable CDC guidance becoming more specific

Findings, 2001-2005 Local public health issues Provider issues Inconsistent documentation: findings vs feedback, using templates as “one size fits all” Lack of follow-up Lack of documentation of action taken Provider issues Storage and handling Exceeding vaccine administration fee cap Lack of reminder/recall Recommendations were not being implemented consistently

Vaccine Management Indicators, 2003 and 2004 Percent of Clinics

If an administration fee is charged, what is the fee per immunization? Number of Clinics

Clinical Immunization Practices Indicators, 2004 Percent of Clinics

Recall Activities, 2004 Percent of Clinics Among 212 clinics who are able to identify patients who are due/overdue for shots.

Needs Identified: Improve Accountability Assure that LPH advisor was providing feedback consistent with their findings LPH needed more authority to elicit changes from the clinic A venue was needed to make documentation of actions and plans easier and more efficient

Solution Create a process that enhances the public/private collaboration into workable plans Create a tool that categorizes observation and assessment data into standards Utilize terminology familiar to the healthcare provider/field that would facilitate action Enhance the reward/recognition for those who demonstrate immunization excellence

Continuous Quality Improvement Plan Five standards identified Includes an area to document action taken, as well as specific plans agreed upon between advisor and provider Prompts for specific action timelines if necessary: Storage and handling mishaps VFC non-compliance Vaccine administration fee cap Eligibility screening NCVIA requirements

CQI Launched in June via regional trainings Solicited feedback after IPI Advisors used the tool Consolidated feedback and other issues identified and revised tool to current form

CQI Issues Identified Issues Response Local public health IPI Advisors were concerned about perception of regulatory role Discussed provider familiarity of CQI terminology Softened heading terminology Encouraged them to continue to be consultative Pushback about one more form to use Eliminated feedback letter requirement Confusion about follow-up expectations Offered one-on-one consultation Developing SOG that include MDH/LPH responsibilities

Evaluation of CQI Plan tool Currently ongoing, qualitative evaluation in 2008 Anecdotal: Storage and handling mishaps are no longer discovered after paperwork comes in, being addressed on the spot More consistent reporting and documentation of interventions Providers are following up on identified issues LPH are identifying and working with MDH on issues regarding: Vaccine administration fees VFC eligibility screening

Evaluation of CQI tool cont. MDH’s IPI Program database Similar to VFC/AFIX evaluation in CoCASA Web-based application Rolling out to LPH this year To feature feedback prompts depending on response entered Ability to provide qualitative data for further evaluation

Contact and resources IPI forms and tools: http://www.health.state.mn.us/divs/idepc/immunize/ipi/formtool.html IPI Coordinator: Sue Turner, CPNP susan.turner@health.state.mn.us