Collaboration Project Between 3 Provider Sites and:

NameJobProject Role Kristina Crane CHILD Profile Consultant, KL Crane AssociatesSpokane registry expert Chris HalsellVaccine Management Consultant, DOH Immunization Program CHILD Profile Technical Assistance Pamela Johnson Special Projects Coordinator, DOH Immunization Program CHILD Profile Technical Assistance Cindy JobbPublic Health Clinic Manager, Spokane Regional Health District Spokane project coordination Rita MellPublic Health Clinic Manager, Snohomish Health District Snohomish project coordination Elizabeth Nucci Health Marketing Specialist, CHILD Profile Immunization Registry Snohomish registry expert Michele Roberts Health Promotion & Communication Manager, DOH Immunization Program CHILD Profile Technical assistance Lin WatsonCDC Sr. Public Health Advisor, DOH Immunization Program CHILD Profile TA & overall project coordination Karen Wormell Immunization Program Community Worker, Spokane Regional Health District Spokane project coordination

1. Szilagyi, P.G., Bordley, Clayton, Vann, J.C., Chelminski, Ann, Kraus, R.M., Macrgolis, P.A., & Rodewald, L.E. Effect of Patient Reminder/Recall Interventions on Immunization Rates. Journal of American Medical Associates, Vol. 284 No. 14, October 11, ² National, state and local area vaccination coverage among children aged months—United States, MMWR Morbidity Mortality Weekly Report 2007;56:880-5.

I mmunization Schedule Complex Changing & confusing School requirements vs. recommended Many new vaccines Providers Missed opportunities Financial cost Lower priority Nurse’s job IT tools Personal belief & resistance Time Vaccine Storage/ handling Staff turnover Parents # of Injections Personal Beliefs Busy/ overwhelmed Misinformation Cost School schedule Provider driven Work schedule Cultural impact Access to care D ocumentation Missed opportunities Various charting methods Multiple provider sites/counties Complex Assessment tool Records from other places CHILD Profile Participation Laws/reg's. Data use

Provider Site Criteria  Currently using CHILD Profile Immunization Registry  Does not have a current reminder/recall process in place  Is or willing to enter historical data into the registry  Is or willing to inactivate patients, in the registry, that are no longer their patient

Pediatric Office Snohomish Co. Large Pediatric practice birth – age 19 6 MD’s Admin. 1,929 immunizations during Nov Manual entry into CHILD Profile Immunization Registry Pediatric Office Spokane County Mostly young children 1 MD, 2 ARNP’s, 2 PA’s Admin. 733 immunizations during Oct Manual entry into CHILD Profile Immunization Registry Family Medicine Spokane County All ages 2 MD’s, 1 DO, 1 ARNP Administered 56 immunizations during Nov Manual entry into CHILD Profile Immunization Registry

Data Sources  CHILD Profile Immunization Data  CDC’s CoCASA Program that allows a provider office to assess their clinic immunization rate  Tracking Sheet for clinic use Use collected data to answer:  Did the project increase the number of children months old who are fully immunized?  Did the project improve current data in the registry?  Did the project improve use of the Immunization Registry?  Will the provider continue with reminder/recall system?  What frequency should reminder/recall occur?

Week 1 Using CoCASA, run baseline immunization rate using CHILD Profile data Project orientation and training Print reminder-recall mailing labels from the Immunization Registry Mail first set of postcards to the patient cohort Week 1-4 Update patient’s historical records in CHILD Profile Enter patient’s immunization information in CHILD Profile at each visit Inactivate patients in CHILD Profile that are no longer associated with your practice based on the directions indicated on the postcard Update patient address information for returned postcards Complete the supplied tracking form Track patients that call in to make an appointment to get an immunization (with family practice provider only)

Week 5 Complete 2 nd CoCASA report for the patient cohort (using registry data) Conduct check in meeting with the provider’s staff Print 2 nd set of CHILD Profile Reminder-Recall mailing labels for the patient cohort Mail second set of postcards Week 5-11 Monitor activity the same as week 1-4 Week 12 Complete final CoCASA reports for the patient cohort (using registry data) Week Collect tracking forms and conduct check-in meeting with the provider

865 in Cohort 843 in Cohort 942 in Cohort

843 in Cohort Postcard Cohort (60) 26.7% patients responded to first mailing  6 records were updated with historic data for dose 1 of HepA  8 doses were administered out of the 16 postcard respondents

388 in Cohort 362 in Cohort 353 in Cohort

9 weeks as of 12/31/2007–Preliminary Data 41 in Cohort 39 in Cohort 41 in Cohort 39 in Cohort

Use collected data to answer the following Results Did the project increase the number of children months old who are fully immunized?  Yes  This can be a challenge to determine Did the project improve current data in the registry?  Yes, yes, and yes! Did the project improve use of the Immunization Registry?  Yes!  Both the LHJs and providers increased knowledge and use Will the provider continue with reminder/recall system?  Maybe  Depends on provider’s time and resources What frequency should reminder/recall occur?  Data inconclusive

Lessons Learned Reminder/recall depends on updated records in the immunization registry Need flexibility – every practice is different Consider reminder-recall with other age groups, such as adolescents Staff expertise – having both local immunization staff and registry expert working with provider offices is important Need provider office champion and support from their executive leadership Staff time needed from provider office to update and maintain records Need to demonstrate benefits to the practice (i.e. money savings with future patient management capabilities)

 Check back with pilot sites to determine if they will continue to send reminders based on CHILD Profile Immunization Registry data  Share project with other LHJs – good basis for local health indicator work and performance measures  Continue to conduct project with other provider offices  Depends on resources – incorporate lessons learned to make the project manageable within available resources