1. Impact of a Telephone Intervention to Increase Pneumococcal Vaccination Rate in a Managed Care Population

2. Acknowledgments Carla A Winston, PhD - CDC Kecia Leatherwood, MSPH
Pascale Wortley, MD, MPH - CDC
Michael Blue, MSHA
Latoya Cochran, BS
This study was funded by the CDC and took place at Kaiser Permanente, Georgia. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agency.

3. Overview
Pneumococcal vaccine is recommended for:
Persons age >65,
Younger persons with chronic medical conditions.

4. Background
Pneumococcal immunization is safe,
Effective at preventing hospitalizations from pneumococcal disease,
But underutilized, even in managed care systems

5. Prior Initiatives to Increase Pneumococcal Immunization Rates
Patient Centered:
Outreach letters during fall influenza campaign
Newsletter articles
Prevention guideline posters in exam rooms
Pneumococcal posters in clinic triage station

6. Prior Initiatives to Increase Pneumococcal Immunization Rates
Clinician Centered:
Published Guidelines on website, pocket guide and
Mandatory CME tests
Lime green chart flags in targeted member’s medical record
Departmental & individual quality measure

7. Research Question
Does telephone outreach improve Pneumococcal vaccination rates in a managed care environment?

8. Methods Target Population
3,711 patients > age18 with diabetes, congestive heart failure or coronary artery disease (Chronic)
2,395 patients > age 65 (Elderly)
Randomized to intervention and control

9. Intervention Advance letter mailed to intervention patients
Up to 4 telephone calls made by managed care nurses
Nurses confirmed patient vaccination status
Nurses provided tailored advice in response to reasons for non-vaccination

10. Intervention Continued
Nurses informed patients that vaccination:
was free,
available at a nurse visit,
an appointment could be scheduled during the call

11. Analysis
All eligible patients were followed for six month to determine the vaccination status outcome.
Comparison of vaccination rate in intervention versus control group.

12. Prior Vaccinations determined by Outreach Calls
Chronic Group
n=1043
Previously vaccinated
234 (22.44%)
Never vaccinated
809
Elderly Group
n=850
Previously vaccinated
375 (44.12%)
Never vaccinated
475

13. Immunization Response Rates at 6 Months
*Chronic # N
288
111 % 16 6
P<0.0001
2.66x
*Elderly # N
201
100 % 17 8
P<0.0001
2.1x
* Intervention group # Control group
Patients who received the intervention were on average 2.3x more likely to be vaccinated than control group

14. Cost of Nursing Intervention
Nursing Cost
$41,520.50
Additional patients vaccinated
278
Average nurse cost per additional member vaccinated
$147.35
Nursing cost for additional vaccinations was low
No formal cost effectiveness analysis was performed

15. Results
Patients who received the vaccine did so within 1-3 months after the intervention
The majority of the unvaccinated members at the start of the study, remained so after the study ended

16. Conclusions
Telephone outreach calls are relatively inexpensive and successful at raising vaccination rates.
The elderly group had larger numbers that were previously immunized that was not known to the administrative data

17. Recommendations
Immunization programs in Managed Care environments can enhance their vaccination rates by employing a variety of low cost and higher cost intervention strategies
Improved data capture on prior immunizations can improve the targeting and thus lower the cost of outreach programs