1. Impact of Provider-Based Interventions on Influenza and Pneumococal Coverage Levels among African American and Hispanic Seniors Chicago READII
Dianne Rucinski, PhD
University of Illinois
Julie Morita, MD
Mila Verdugo, MPH
Chicago Department of Public Health

2. Racial and Ethnic Adult Disparities in Immunization Initiative (READII)
CDC funded demonstration project
September 2002-December 2004
Chicago, Milwaukee, Mississippi Delta, Rochester, San Antonio
Improve influenza and pneumococcal immunization coverage among African-American and Hispanic seniors  65 years

3. Chicago Population Total > 65 years NH White 31% 50%
NH African American
36%
Hispanic
26% 9%

4. Chicago Neighborhoods76 51 25 28 55 61 70 49 30 24 10 56 15 19 71 17 53 23 54 22 69 66 02 46 09 01 12 13 77 11 04 14 03 16 05 06 21 18 20 07 08 26 27 32 29 33 31 34 60 35 59 36 58 38 57 37 39 62 63 40 41 64 68 42 67 65
READII Neighborhoods 43 45
African-American 44 48 47
Hispanic 73 72 50 52 74 75

5. Immunization Coverage Among Persons > 65 yrs, Chicago
Medicare Beneficiary Survey, February-April, 2003

6. Chicago READII Goals
Increase adult health care providers’ use of effective immunization strategies
Assessment, Feedback, Incentives, eXchange (AFIX)
Improve access to immunizations in READII neighborhoods
Increase minority seniors’ knowledge about influenza and pneumococcal diseases and immunizations

7. Provider Intervention
Assessment
Coverage determined by ACASA*
Feedback
Coverage levels
Clinic-specific strategies
Incentives
Vaccine
Certificates
In-office education
CEU/CME
Resource materials
eXchange
Newsletters
Group learning sessions
Tele-conferences
Chicago Dept. Public Health (CDPH)
Illinois Foundation for Quality Health Care
(IFQHC)
*ACASA = Adult Clinic Assessment Software Application

8. Vaccine as an Incentive
Initial recruitment efforts unsuccessful
Lack of vaccine identified as a barrier
CDPH offered free influenza and pneumococcal vaccine for use among patients > 65 years of age
Participating clinics submitted orders
CDPH filled most orders in their entirety

9. Evaluation Methods
Pre and post-intervention assessments of clinic-level influenza and pneumococcal immunization coverage
50 randomly selected charts per clinic
ACASA
Clinic survey
Structured telephone interviews

10. Clinic Survey Organizational strategies used Vaccine supply
Implementation challenges
Vaccine supply
Awareness of reimbursement and purchasing processes
CDC, CDPH, and IFQHC resources used

11. Results

12. Clinic Participation Intervention: 31 Evaluation
Clinics serving African American seniors: 17
Clinics serving Hispanic seniors: 12
Federally Qualified Health Centers: 15
Evaluation
ACASAs: 31
Clinic survey: 29

13. Influenza and Pneumococcal Coverage Levels, Pre and Post Intervention, Chicago%
p < 0.001*
p < 0.01*
* Paired t-test

14. Influenza Coverage Levels, Pre and Post Intervention by Population Served, Chicago
* Paired t-test

15. Pneumococcal Coverage Levels, Pre and Post Intervention by Population Served, Chicago
* Paired t-test

16. Strategies Implemented, Clinic Survey
Number (%) of clinics
At least 1 strategy implemented
29 (100)
Provider reminders
22 (76)
Standing orders
13 (45)
Patient reminders
11 (38)
Physician champion
*29 of 31 clinics surveyed

17. Characteristics Associated with Changes in Influenza Coverage Levels
Clinics with a committed physician champion with or without a non physician champion had greater increases in coverage
Clinics receiving influenza vaccine in amounts that best approximated their population > 65 years had greater increases in coverage

18. Summary
Clinics serving African American and Hispanic senior citizens increased influenza and pneumococcal immunization coverage levels after participating in a quality improvement intervention based on AFIX
Clinics serving Hispanic senior citizens had the largest increases in influenza immunization coverage levels

19. Summary All clinics reported adopting at least one new strategy
Clinic characteristics that were associated with larger increases in coverage levels included:
Having an active physician champion
Receiving quantities of influenza vaccine that closely approximated the clinic population > 65 years

20. Conclusions
Immunization levels for AA and Hispanic elderly can be improved using an AFIX strategy
Physician champions and provision of vaccine are important components of office based efforts to improve adult immunization levels

21. Acknowledgements CDPH University of Illinois
Qiana Woodson
Enrique Ramirez
Alicia Siston
Maribel Chavez-Torres
University of Illinois
Maya Nash
Janine Lewis
Theresa Whittington
Illinois Foundation for Quality Health Care
Linda Brown
Carol Krohm