1. Southeast Michigan PARTNERS PROJECT
Evaluation of Inpatient Immunization in Michigan Hospitals
Carla A. Winston, PhD, MA
Megan C. Lindley, MPH
Pascale M. Wortley, MD, MPH

2. Background Partners Project started in 2000 Overall Goals:
Build collaborative relationships
Enhance delivery of evidence-based preventive health care services
Establish lasting public/private partnerships at the local level

3. SE MI Partners Project Alliance of Community Health Plans (ACHP)
Blue Care Network
Blue Cross Blue Shield
Care Choices
CDC
DaimlerChrysler
Detroit Regional Chamber
Ford Motor Company
General Motors Corporation
Greater Oakland Visiting Nurses Association
Health Alliance Plan
HealthPlus of Michigan
M-CARE
Michigan Department of Community Health
Michigan Health and Hospital Association
MPRO (Michigan’s Quality Improvement Organization)
Michigan Medical Society
PPOM (physician network)
Southeast Michigan Visiting Nurses Association
United Auto Workers

4. 2003-2004 Inpatient Pilot Project
Standing orders effective
Hospital vaccination coverage low (Bratzler et. al. 2002)
1.9% influenza vaccination
1% pneumococcal vaccination
Change in Federal Register, 2002
Accrediting organizations use immunization rates as quality measures

5. Pilot Implementation Facilitate web training
Secure volunteer hospitals
Kick-off meeting June 2003
Provide ongoing technical assistance
Process, structure, components
Policy guidance and templates
CD-Rom available

6. Participating Hospitals
Hospital A: Nurse standing order
Hospital B: Assessment and order by MDs
Hospital C: Nurse standing order
Hospital D: Nurse standing order
Hospital E: No standing orders implemented
Hospital F: Flagship hospital, standing orders since 2001

8. Initial Successes
Five of six participating hospitals have active programs
Positive hospital feedback
Qualitative interviews
Independent evaluation through MPRO
Compare 2002 vs vaccination coverage

9. Chart Abstraction Date of birth Date of discharge ICD-9 Codes Gender
Payment Source
Vaccine Assessment Form
Influenza and Pneumococcal Vaccination

10. Inpatient Evaluation Hospitals pulled random samples of
100 charts age discharged Nov 2002
100 charts age 65+ discharged Nov 2002
100 charts age discharged Nov 2003
100 charts age 65+ discharged Nov 2003
Exclusion criteria
Pneumonia diagnoses
Died in hospital or received only hospice
Transferred to another short-term facility
Discharged against medical advice (AMA)

11. Use of Vaccine Assessment Forms, 2003
Hospital A
Hospital B
Hospital C
Hospital D
n=90
n=87
n=49
n=114
n=95
n=96
n=91
n =98

12. Vaccination Rates Among Eligible Patients
Eligible patients were those without a history of allergy to vaccine or components, and those not vaccinated prior to admission
Numerator: Eligible patients vaccinated in hospital
Denominator: (influenza) All eligible patients

13. Influenza Inpatient Vaccination among Eligible Patients 50-64
Hospital A
Hospital B
Hospital C
Hospital D 6 3 8 5 7 1 1
n=93
n=84
n=36
n=32
n=92
n=69
n=94
n=66

14. Influenza Inpatient Vaccination Rate among Eligible Patients 65+
Hospital A
Hospital B
Hospital C
Hospital D 10 9 6 7 5 4 1
n=93
n=68
n=71
n=60
n=78
n=44
n=69
n=60

15. Using CMS Measures
Numerator: Patients vaccinated in hospital + patients refused + patients with allergies + patients vaccinated prior to admission
Denominator: (influenza) All patients

16. Influenza CMS Measures among Patients 50-64
Hospital A
Hospital B
Hospital C
Hospital D 68 54 25 42 16 18 3 1
2002n=93
2003n=90
2002n=39
2003n=49
2002 n=109
2003n=95
2002 n=112
2003n=91

17. Influenza CMS Measures among Patients 65+
Hospital A
Hospital B
Hospital C
Hospital D 74 70 59 34 50 37 30
2002n=93
2003n=87
2002n=98
2003 n=114
2002 n=110
2003n=96
2002 n=102
2003n=98

18. Challenges for Inpatient Immunization
Physician/nursing support
Champion critical
Training and education
ACIP recommendations
Contraindications
Reimbursement
Public payer: process too cumbersome
Private payer: hospitals not reimbursed
Tracking assessments and immunizations

19. Conclusions Continue to promote vaccination Focus on reimbursement and
Assessment rates increased dramatically
Vaccination rates increased modestly
Focus on reimbursement and
electronic systems
Evaluate program changes over time
Share lessons with other hospitals

20. Thank you Terrisca Des Jardins, Project Manager John Spiegel, ACHP MPRO HOSPITALS AND PARTNERS