1. New Jersey’s Improving Preventive Services Project (NJIPSP) 40 th National Immunization Conference March 6 – 9, 2006 Atlanta, GA Ruth Gubernick, Adrienne Millican, Arlene Patrick, Dorothy Williams “Achieving, Sustaining and Spreading Improvements in Immunization Delivery”

2. Project AIM A collaborative project which supports use of the statewide immunization registry (NJIIS) to improve immunization service delivery at primary care practices.

3. Objective To present results from the pilot and initial “spread” phase of NJIPSP, a collaborative network of primary care practices, the NJ Dept. of Health and Senior Services, the American Academy of Pediatrics/New Jersey Chapter’s Pediatric Council on Research and Education (PCORE) and the National Initiative for Children’s Healthcare Quality (NICHQ)

4. Methods The NJIPSP uses an “enhanced” Learning Collaborative model, with practice teams working with expert faculty during three learning sessions, utilizing a Model for Improvement, sharing innovative solutions, participating in monthly conference calls, a listserv and receiving on-site support. The NJIIS data is used to assess monthly improvement.

5. NJIIS New Jersey Immunization Information System operating since 1997, is the established statewide immunization information system serving as the official repository of immunizations administered to children in New Jersey.  921,181 Children  6,294,931 Doses  1114 Active Users  400 Active Providers Zina Kleyman @ NJDHSS, Jan ‘06

6. Site selection Criteria  Recruited from referrals by regional NJIIS Coordinators and pilot site participants  Contract initiated – 1 yr commitment  Pre-work gathered before LS 1: * Formation of Practice team * VFC Quality Assurance Review (QAR) *Random (30) chart review *Self-assessment (Walk-through)

7. Monthly Improvement Measurement Categories  Percentage UTD 24 Months  Percentage UTD 19-23 months  Percentage UTD 7-11 Months  Percentage of children under 24 months with 2+ shots in registry  Percentage of doses reported to registry within 7 days of vaccine administration

8. Sites Specifics – Pilot (Jul 2004 – Jun 2005) Site # 1Private Practice Essex County Problem: Obtaining up to date addresses and phone numbers Problem: Timely data entry into NJIIS Problem: Missed immunizations Site # 2Hospital-based Family Health Center Monmouth County Problem: Physician prompting Problem: Follow-up on screening appointments Problem: On-time lead screening Site # 3Private Practice Essex County Problem: Vaccine prep time Problem: Using separate practice management software Problem: Need transfer of data from PM application to NJIIS Site # 4Private Practice Essex County Problem: Physician prompting Problem: Timely data entry into NJIIS Problem: Vaccine storage and monitoring Site # 5Family Health Center Middlesex County Problem: Improving no-show rate Problem: Missed appointment follow-up Problem: Obtaining up to date patient information Site # 6Hospital-affiliated Private Practice Burlington County Problem: Transitioning to EMR (hospital based application) Problem: Need transfer of data from EMR to NJIIS Problem: Outreach system is paper based

9. Results – Pilot Sites (does not include Disp measurement – VFC vs Non-VFC) (monthly averages)

10. NJIIS Data Entry - Pilot sites

11. Overall Results – Pilot sites As a result of the pilot project: 100% are now using the NJIIS to: · Identify patients’ needs at every visit · Remind and recall patients 67-83% reported use of the NJIIS highly effective and 83-100% found it easily adoptable · 50% increase (to 100%) checking immunizations at sick visits. · 33% increase (to 100%) using chart prompts · 33% decrease (to 0%) pre-filling syringes · 16% increase (to 100%) conducting in-service trainings Mentoring opportunities in “spread” phase keep pilot practices engaged

12. Initial Spread Phase Dec 2005 - present  8 additional sites: Cumberland, Camden, Essex, Hudson, Middlesex (2), Morris, Union  Private practices, Family Health Centers, Community Health Centers (FQHCs), Hospital- based Pediatric Clinic  Same methodology and “change package” : * Focus on missed opportunities, physician prompts, timely assessments, reminder recall activities and data entry

13. Results – Spread sites (monthly averages)

14. NJIIS Data Entry - Spread sites

15. Practice Participant Testimonial

16. Trinity Health & Family Service Center Perth Amboy, NJ St. John’s Health & Family Service Center New Brunswick, NJ

17. Oh No……Children!!!

18. My Broken Heart

19. SPREAD “Achieving, Sustaining and Spreading Improvements in Immunization Delivery”

20. SPREAD

21. S- Sharing Information

22. SPREAD IDENTIFY PATIENT NEEDS FRONT OFFICE STAFF WAS TRAINED TO USE THE SCHEDULER DETAIL TO ACCESS THE CHILD’S IMMUNIZATION NEEDS PROMPT CLINICIAN THE SCHEDULER DETAIL IS PLACED IN THE CHART PRIOR TO THE VISIT AND REVIEWED BY BOTH THE NURSES AND PHYSICIAN CHART COMPLETION FLOW SHEET

23. Help interpret the complex immunization schedule

24. CHART COMPLETION FLOW SHEET TRINITY HEALTH CENTER CHART COMPLETION FLOW SHEET DATE:____________  DR. ACEVEDO/ K. LABOSCO APN  NURSE  FRONT DESK  Change of Address/Phone  Change of Insurance  No Show  Completed Revised

25. SPREAD P-Passion

26. Trinity Health Center Statistics

27. SPREAD R-Research  Plan Do Study Act (PDSA)

28. SPREAD E-Encourage

29. SPREAD A-Achieving

30. Trinity Health Center Statistics

31. SPREAD D-Deliver

32. Improvement Project Surprises From small acorns, big trees grow. (The small task of printing the scheduler detail has increased our immunization rates and decreased missed opportunities)

33. WHY?

34. SPREAD

35. Contact Information Arlene Patrick, RN Trinity Health Center 271 Smith Street Perth Amboy, NJ 08861 (732) 826-9160 Office (732) 826-8342 Fax

36. Conclusion Improvement of immunization delivery is possible with innovative technology and a commitment and plan for continuous quality improvement. Utilizing a registry supports easy improvement measurement. NJIPSP is a model to be spread to other practices seeking to improve immunization delivery.

37. This collaborative project to improve immunization and other preventive service delivery has been developed and is being facilitated by in Collaboration with the National Initiative for Children’s Healthcare Quality We would like to thank the above groups for their support of this initiative Funded by the NJDHSS, Vaccine Preventable Disease Program