1. Continuous Quality Improvement: Making follow-up work
Lynn Bahta
Minnesota Department of Health

2. Acknowledgements
Abstract submitted by Emily Litt, R.N., MSN, PHN

3. Background On average, 800 active providers in Minnesota
MDH contracted with local public health to conduct site visits
The program combined VFC site visits and assessment components and called the program Immunization Practices Improvement

4. Immunization Practices Improvement
VFC requirements
Vaccine management
Program compliance
Assessment of immunization practices
Vaccine administration
Provision of resources
Assessment of practices to improve immunization rates
Reducing missed opportunities
Tracking, reminder/recall activities
Use of registry
Assessment of immunization rates ( CASA/ CoCASA)

5. IPI Program background continued
Two tools were developed for data collection for reports and evaluation
Questionnaire: filled out ahead of visit by provider
Checklist: filled out by IPI Advisor during site visit
Letter templates for feedback were created for local public health IPI Advisors
Training to Advisors is conducted annually, either via interactive videoconference or regional sessions
Program resources put on the web

7. IPI Program Quality Assurance
Two levels
Local public health
Provider
Evolving
Focus shifted based on findings
Coordinator position unstable
CDC guidance becoming more specific

8. Findings, 2001-2005 Local public health issues Provider issues
Inconsistent documentation: findings vs feedback, using templates as “one size fits all”
Lack of follow-up
Lack of documentation of action taken
Provider issues
Storage and handling
Exceeding vaccine administration fee cap
Lack of reminder/recall
Recommendations were not being implemented consistently

9. Vaccine Management Indicators, 2003 and 2004
Percent of Clinics

10. If an administration fee is charged, what is the fee per immunization?
Number of Clinics

11. Clinical Immunization Practices Indicators, 2004
Percent of Clinics

12. Recall Activities, 2004 Percent of Clinics
Among 212 clinics who are able to identify patients
who are due/overdue for shots.

13. Needs Identified: Improve Accountability
Assure that LPH advisor was providing feedback consistent with their findings
LPH needed more authority to elicit changes from the clinic
A venue was needed to make documentation of actions and plans easier and more efficient

14. Solution
Create a process that enhances the public/private collaboration into workable plans
Create a tool that categorizes observation and assessment data into standards
Utilize terminology familiar to the healthcare provider/field that would facilitate action
Enhance the reward/recognition for those who demonstrate immunization excellence

15. Continuous Quality Improvement Plan
Five standards identified
Includes an area to document action taken, as well as specific plans agreed upon between advisor and provider
Prompts for specific action timelines if necessary:
Storage and handling mishaps
VFC non-compliance
Vaccine administration fee cap
Eligibility screening
NCVIA requirements

16. CQI Launched in June via regional trainings
Solicited feedback after IPI Advisors used the tool
Consolidated feedback and other issues identified and revised tool to current form

17. CQI Issues Identified Issues Response
Local public health IPI Advisors were concerned about perception of regulatory role
Discussed provider familiarity of CQI terminology
Softened heading terminology
Encouraged them to continue to be consultative
Pushback about one more form to use
Eliminated feedback letter requirement
Confusion about follow-up expectations
Offered one-on-one consultation
Developing SOG that include MDH/LPH responsibilities

18. Evaluation of CQI Plan tool
Currently ongoing, qualitative evaluation in 2008
Anecdotal:
Storage and handling mishaps are no longer discovered after paperwork comes in, being addressed on the spot
More consistent reporting and documentation of interventions
Providers are following up on identified issues
LPH are identifying and working with MDH on issues regarding:
Vaccine administration fees
VFC eligibility screening

19. Evaluation of CQI tool cont.
MDH’s IPI Program database
Similar to VFC/AFIX evaluation in CoCASA
Web-based application
Rolling out to LPH this year
To feature feedback prompts depending on response entered
Ability to provide qualitative data for further evaluation

20. Contact and resources
IPI forms and tools:
IPI Coordinator: Sue Turner, CPNP