1. How to Develop an Evaluation for the Perinatal Hepatitis B Program: The Massachusetts Experience
Good morning to all. I am…………..This morning I would like to review with you the September 2001 school entry requirements and also give you some information on what we consider to be “best practices” in immunizing your patients. We will discuss documentation, missed opportunities, how to get your patients in the door and much more. Please feel free to ask questions during the presentation.
Let’s start with the September 2001 school entry requirements.
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2. Presenter Martha Badger, RN, BSN Nursing Supervisor
Massachusetts Immunization Program
Massachusetts Department of Public Health
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3. Massachusetts Statistics
Population (pop.) ~ 6 million
Birth cohort of ~ 80,000
HBsAg-positive pregnant women identified per year (285 target)
~ 34% of pop. living in pocket of need
~ 12% of pop. foreign-born
~ 19% of pop. PLINE
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4. Evaluation Benchmarks
Staff
Resources
Referral Sources
Case Management
Birth Hospital Record Reviews
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5. “Ancient” History
( )
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6. Hepatitis B Coordinator Perinatal Hepatitis B Nurse
Staff
Medical Director
Hepatitis B Coordinator
Perinatal Hepatitis B Nurse
6 Regional Immunization Nurses
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7. - Clinical consultation Hepatitis B Coordinator
Staff Roles
Medical Director
- Clinical consultation
Hepatitis B Coordinator
- Education, outreach, training
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8. Perinatal Hepatitis B Nurse - Case management, database management
Staff Roles (cont’d)
Perinatal Hepatitis B Nurse
- Case management, database management
6 Regional Immunization Nurses
- Case follow-up
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9. Hepatitis B Coordinator position funding lost 4 years ago (1999)
Staff Challenges
Hepatitis B Coordinator position funding lost 4 years ago (1999)
Nursing Supervisor assumed oversight of Perinatal Hepatitis B Prevention Program
Perinatal Hepatitis B Nurse limited by case management, data entry
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10. - One child per mother, only
Resources
FoxPro Database (DOS!)
- Designed in 1991
- Missing data fields
- One child per mother, only
Perinatal Hepatitis B Prevention Project Protocol
- 2 pages long, written in 1996
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11. Referral Sources BOHs 27% 15% 15% Labs 9% 22% 10%
Prenatal
BOHs % % %
Labs % % %
Providers % % %
56% 58% %
Postnatal
NSP % % %
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12. Case Management HBIG + 90% 96% 99% Birth Dose Hep B 3 63% 78% 79%
HBIG % % %
Birth Dose
Hep B % % %
by age 8 mos
Post-vax % % %
screening
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13. Birth Hospital Record Reviews
Documentation of Maternal Screening for HBsAg
2000:
100% of maternal records
96% of newborn records
1996:
98% of maternal records
92% of newborn records
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14. Birth Hospital Record Reviews (cont’d)
Hep B-1 Administration
2000: 91% of infants, regardless of mother’s HBsAg status, received hep B-1 in the hospital
1996: 89% of infants, regardless of mother’s HBsAg status, received hep B-1 in the hospital
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15. Recent History
( )
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16. Staff Medical Director Nursing Supervisor
Perinatal Hepatitis B Nurse (resigned September 2002)
6 Regional Immunization Nurses
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17. Perinatal Hepatitis B Prevention Project Protocol
Resources
Unchanged since 1996:
FoxPro Database (DOS!)
Perinatal Hepatitis B Prevention Project Protocol
- 2 pages long, written in 1996
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18. Referral Sources 2001: Prenatal referrals: 49%
- BOHs, dagnostic labs, providers, viral case reports
Postnatal referrals: 49%
- Newborn Screening Program (NSP), birth hospitals
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19. Referral Source Challenges
2001:
Continuing low HBsAg+ reporting levels for women of childbearing age ( yrs) from diagnostic labs (10%) and providers (18%), despite mandatory reporting laws since 1994 (105 CMR )
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20. Referral Source Challenges (cont’d)
Increasing number of false positive reports from NSP
HBs-Ag-negative confirmatory lab results
- 2001: 4 / 143 (0.3%)
: 31 / 140 (22%)
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21. 2001: 98% receive hep B-1 and HBIG at birth
Case Management
2001: 98% receive hep B-1 and HBIG at birth
2001: 73% receive hep-3 by age 8 months
2001: 50% receive post-vaccination serologic screening
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22. Effects of Joint Statement on Thimerosal: July 1999 - present
10-month effort to ensure all birth hospitals had resumed policy of vaccinating all newborns at birth, regardless of mother’s HBsAg status (July June 2000)
Affected Massachusetts 2001 NIS immunization levels and ranking
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23. Estimated Vaccination Coverage with Hepatitis B by Age in Massachusetts, 1998-2001
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24. Massachusetts NIS Data
% UTD
US Rank
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25. Future Plans
(2003 and beyond)
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26. New Perinatal Hepatitis B Nurse
Staff
New Perinatal Hepatitis B Nurse
- Case management, education, outreach, training
Research Analyst (RA)
- Database management, etc.
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27. 6 Regional Immunization Nurses
Staff (cont’d)
Medical Director
Nursing Supervisor
6 Regional Immunization Nurses
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28. Eventual Web-Based Database - Interactive case management tool
Resources
Access Database
- Interim
Eventual Web-Based Database
- Interactive case management tool
Perinatal Hepatitis B Prevention Project Protocol
- Updated to 12 pages, so far
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29. Increase percentage (%) of cases identified prenatally
Referral Sources
Goals:
Increase percentage (%) of cases identified prenatally
Reduce number of false HBsAg-positive reports from NSP
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30. Increasing Prenatal Referrals
Perinatal Hepatitis B Nurse will:
Conduct inservices for OB providers to improve reporting
Work with MDPH Surveillance Program to promote electronic diagnostic lab reporting
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31. Increasing Prenatal Referrals (cont’d)
Community Health Center Quarterly Reports
- Number of pregnant women screened for HBsAg
- Number and names/DOB of HBsAg+ pregnant women
- Include HBsAg-positive lab results with quarterly report
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32. Reducing NSP False Positive Reports
Perinatal Hepatitis B Nurse will:
Conduct trainings for birth hospital maternity unit nursing staff to improve NSP reporting
- Suspect staff are checking “positive” for anti-HBs+, instead of HBsAg+
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33. Case Management Recent initiative:
Provide birth hospital maternity unit nurse managers with Infant Case Management Forms to complete and return to MDPH when infant born to HBsAg+ mother
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34. Birth Hospital Record Review
Scheduled for 2003
- Further study of the impact of joint statement on thimerosal of July 1999
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35. Birth Hospital Record Review (cont’d)
Provides feedback to OB providers and birth hospitals
Directs changes in Perinatal Hepatitis B Prevention Project protocol
Ultimate evaluation tool
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