1. Racial and Ethnic Adult Disparities in Immunization Initiative (READII) Tamara J. Kicera National Immunization Program Centers for Disease Control and Prevention

2. Project Genesis DHHS initiative to reduce racial- ethnicity-related health disparities –Emphasis on prevention CDC asked for proposed program possibilities

3. The Problem … –Approximately 36,000 adults die/200,000 hospitalized from influenza and pneumococcal disease each year in the U.S. –Adults 65 years and older have immunization coverage rates that are significantly lower than the Healthy People 2010 Goals of 90% –Significant racial and ethnic disparities in adult immunization coverage exist, and persist despite controlling for SES, access to care and insurance coverage

4. Figure 1: Receipt of influenza vaccination during the previous 12 months by race/ethnicity among persons >65, 1989-2003, National Health Interview Survey Healthy People 2010 Goal *2003: early release data

5. Pneumococcal Vaccine Coverage by Race/Ethnicity (2002 NHIS data)

6. READII Project Multi-year Demonstration Project begun 2002, ends December 31, 2004 Five sites: –Chicago, IL –Milwaukee, WI –Mississippi (19 county) Delta region –Rochester, NY –San Antonio, TX CDC lead with collaboration of CMS, HRSA, AoA, and AHRQ

7. Underlying Principles Local buy-in Communities need to engage critical partners/stakeholders Evidence-based interventions –Providers –Community 3 (flu) season approach

8. READII Activities Develop Community Plans Communications Research Local Community Roll-outs Implement interventions Evaluation

9. Programmatic Strategies General strategies: –Improve provider vaccination practices –Increase access –Increase demand Target multiple provider groups Tailor specific interventions based on local needs and capacity Key factors for choosing interventions: –Feasibility –Expected impact on target population

10. Potential Interventions Standing orders Patient reminder/recall Provider reminders Expanded access at provider site; collaboration with non-traditional providers Assessment and feedback Effective patient-provider interaction

11. Challenges Identification and engagement of key (adult) stakeholders Effective Communications for Providers and Consumers Evaluation (process & outcome) Feasibility/Sustainability

12. Desired Outcomes Short term –Feasibility demonstration –Learning opportunity Long term –Exportable, successful models –Capacity building/Sustainability –Reduce/eliminate disparities

13. Early Findings/Feedback –Significant differences between Pediatric & Adult providers in terms of buy-in/engagement –Attitudes of office nursing, support staff; vaccination rates among providers –Disorganization/Confusion re: ACIP recs –Target populations’ communities often lack mass immunization sites –Tap into existing partner activities, rather than starting new initiatives/efforts

14. Early Findings/Feedback (continued) –Childhood program success may never be replicable with adults –Capacity building: May need to consider other models (e.g., collaboration between providers and mass immunizers) –More research needed (i.e., universal flu recommendations? attitudes of support staff? provision of vaccines up-front? effects of increased reimbursement rates?) –Effects of HIPPA on activities/efforts

15. Questions?