1. Evaluation Plan to Determine Effectiveness of Promoting Timely Infant Immunizations, Philadelphia, PA
Philadelphia Department of Public Health
Andrew Chilkatowsky, Abbey Mahady, Lisa Morgan, Michael Eberhart
National Immunization Program
Maureen Kolasa, John Stevenson

2. Objectives of Presentation
Background: Need to increase timeliness of immunizations
Program description
Evaluation Plan

3. Background
Late receipt of infant immunizations contributes to lower immunization coverage rates and increases susceptibility to disease.
Children late for immunizations at age 2, 4, and 6 months more often not up-to-date at 19 months.
~37% of children during their first 24 months of life are severely under-vaccinated (Barker, JAMA; March 9, ‘05)

4. Philadelphia: NIS 2004
98%
82%

5. Research from Children’s Hospital of Philadelphia
- Reinforces the importance of giving DTaP4 at earliest possible opportunity, starting at 12 months. - Immunizing at both sick and well visits significantly decreases immunization delay Adopting a schedule geared toward immunizing at the earliest possibility opportunity improved rates. - Technology can be useful in improving immunization delivery.
(CHOP; Fiks, Grundmeier, Biggs, Alessandrini)

6. Timeliness of Immunization Initiative
Philadelphia providers have expressed interest in a less complex immunization schedule.
PDPH developed Timeliness of Immunization Initiative

7. Setting
Approximately 250 providers in Philadelphia vaccinate children < 35 months.
99% of providers vaccinating children in Philadelphia are enrolled in VFC.
~80 providers serve >40 children 0-12 months of age.

8. Resources Timeliness program implemented through AFIX staff (5).
PDPH hiring one part-time nurse.
Focus on AFIX and timely immunization.
All immunization program areas will reinforce timely immunization messages.
Support from the Philadelphia Immunization Coalition (PIC).

9. Information Packet Timely Immunization Schedule Letter to providers
Highlights the benefits of the timely immunization schedule and addresses frequently asked questions.
KIDS Registry brochure
Educates providers about new web-based registry and the ability to forecast immunizations due

10. Program Implementation
- Informational packet on timely immunizations sent to all 250 providers.
- Nurse calls all provider offices who see more than 40 children under 12 months (n=80).
Strongly encourages timely immunizations
Addresses questions
Offers further assistance
Nurse will conduct training of interested
providers

11. Program Implementation: In-service training
Nurse delivers in-service training to sites expressing interest during phone call.
- VFC-AFIX feedback session emphasizing timely
immunization
- Describes timely immunization schedule
- How adoption will address practice-specific issues (late starters, missed opportunities, drop-off)
- Staff training on new web based KIDS Registry and how it will benefit providers

12. Follow-up Activities
Monthly follow up (phone and on-site) to support implementation
Monthly registry assessment to
Track timeliness of immunizations given
Track invalid doses

13. Informational Packets (250)
Targeted by nurse (80)
Not targeted (170)
Provider interested
Provider not interested
Provider interested
Provider not interested
AFIX + nurse in-service with ongoing
follow up
AFIX; assess whether provider is interested in new schedule
Nurse in-service phone call
AFIX
Yes, provider interested
Provider not interested

14. Timeline July 2005-present: Program planning March 2006: Nurse hired
April 2006: Program Implemented
November 2006: Initial coverage assessments on children at age 6 mo
2008 NIC: Presentation of findings
Expect to carry on program indefinitely

15. Evaluation Objectives
Determine impact of initiative promoting on-time administration of infant immunizations.
2, 4, 6, 12 month immunizations
Administer DTaP4 six months after DTaP3
Default to the catch-up schedule for children who have delayed immunizations

16. Analysis Survey all 250 sites targeted for adoption
Willingness to incorporate timeliness schedule (Why/why not)
Database tracking activities
Registry data combined with chart assessment to determine coverage
All children in practice assessed
All children not up-to-date in registry receive chart audit

17. Process Evaluation
Characterize practice response to nursing intervention and mailed information packet
Policy changes
In-services held
Provider satisfaction and comments on initiative
Reasons for not adopting

18. Analysis of immunization coverage
Compare coverage and invalid doses among children age 13, 15, 19 months before and after intervention
Within practices
Between practices receiving nursing intervention

19. Revision of Program Revise program based on findings
Expect revisions in:
Information packet
Topics covered or methods of covering topics in nurse visits
Telephone support characteristics

20. Limitations Generalizability Limited to City of Philadelphia
Sample not random
To best use resources to raise coverage, focusing intervention on large providers.
Provider decides if program will be implemented.

21. Potential Benefits
Increase awareness of importance of timely infant immunization among providers.
Increase in timeliness of infant immunizations.
Increase in coverage at months.