Improving the Translation of Evidence-Based Recommendations of Client Reminder/Recall for

Childhood Immunizations

Gary Wheeler, MD, Principal Investigator

Tereasa Holmes, Project Manager

Role of Vaccines

• More than a 90% decline in vaccine preventable diseases when compared to pre-vaccine era

• Effectiveness tested and need for vaccination reinforced during recent outbreak of measles in California in 2008

The Economics of Vaccination

• For every $1 spent on vaccination, $16.50 is saved

• According to the 317 Coalition, “For every birth cohort who receives seven vaccines . . . society saves $9.9 million in direct health care costs; 33,000 lives are saved and 14 million cases of disease are prevented.”

• Keeps parents working, keeps many as productive citizens

Cost Effectiveness

FY 2011 Congressional Justification Safer Healthier PeopleTM Immunization and Respiratory Diseases Budget Request. http://www.317coalition.org/learnmore/FY11_Presidents_Budget_Congressional_Justification.pdf

Arkansas Statistics

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10

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60

70

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90

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4+DTaP 3+ Polio 1+ MMR 3+Hib 3+ HepB

1+ Var 3+PCV

2007

2008

2009

Chart adapted from CDC data: “Estimated Vaccination Coverage with Individual Vaccines and Selected Vaccination Series Among Children 19-35 Months of Age by State and Local Area US, National Immunization Survey.” 2007-2009.

Currently in Arkansas . . .

• Vaccine registry housed in ADH—called the Immunization Network for Children.– Currently, a child is entered at birth allowing

authorized users to access the age and vaccination status of those under 22.

– Difficulty Tracking patients

• Lack of use of current recall systems in Arkansas

Results from other studies

• Other studies demonstrate improvement in vaccination rate and preventive services.

• 80% effective

• Increase in immunization rate ranging from 5-20%

• Vaccine “champion”

Barriers

Identified Problems• Lack of time to learn a

system• Lack of staff• Lack of funding• Inability to identify

children who are under-immunized

• Physicians who don’t vaccinate

Proposed Solutions• AFMC will provide

training• Outsourcing may be a

solution• Working with ADH to

allow for better patient tracking

• Encourage patients to get vaccinated

Project Goals

• To increase the adoption of recall systems in physician practices in various geographic regions of Arkansas with diverse socioeconomic characteristics

• To increase practice vaccination rates

Study Design

How will we increase the use of recall

Programs in practicesWho treat kids <2?

Control GroupN=34

Office-based recallN=34

Out-sourced recall center

N=34

All Groups

• Pre and Post Surveys

• Informed Consent for participation

• Business Agreements

• Patient list for RATE database

Intervention Groups

∙ AFMC call center will scan registry weekly for under-vaccinatedPatients

∙ Attempts will be made 3 times and each method will be recordedby the call center staff

∙ Complete pre and post surveys

∙ Generate rate lists

∙ Generate recall lists for new patients 2 and under

∙ Identify modes of contact

∙ Quarterly monitoring for sustainability

∙ Business agreements

∙ Informed Consent

Office-Based Out-sourced

∙ Academic detailers will asses each office and will offer modifications to make use of the vaccine registry.

∙Hands on registry demonstration

∙ Weekly monitoring of registry by office staff with contact attempts and records for under-vaccinated kids.

∙ Business plans to estimate costs

∙

Modes of Communication

Evaluation

• Evaluation of changes in knowledge, attitude and practices of participating physicians

• Changes in vaccination rate

Benefits

• Maintenance of Certification

• Possibly Pay for Performance in future

• Application to other physician practices

• Benefit to your patients

Future Implications

• May apply to other preventive care measures

• Could translate this to older population for Varicella Zoster or Pneumovax vaccines

• Reminder system

• Toolkit

AFMC Key Players

• Gary Wheeler, MD, Principal Investigator

• Tereasa Holmes, Project Manager

• Mick Tilford, PhD

• Zoran Bersac, PhD

• Statistics Team

• Academic Detailers

Sources

• Committee on Practice and Ambulatory Medicine and Council on Community Pediatrics. “Increasing Immunization Coverage.” Pediatrics. 2010; 125; 1295-1304.

• FY 2011 Congressional Justification Safer Healthier PeopleTM Immunization and Respiratory Diseases Budget Request. http://www.317coalition.org/learnmore/FY11_Presidents_Budget_Congressional_Justification.pdf

• “Immunization Coverage in the U.S.” Children NIS Data 2007, 2008, 2009. CDC Online. http://www.cdc.gov/vaccines/stats-surv/imz-coverage.htm

• “Outbreak of Measles --- San Diego, California, January--February 2008.” MMWR. February 29, 2008; 57(08);203-206. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5708a3.htm

• Shaw KM, Barker LE. “How do caregivers know when to take their child for immunizations?” National Immunization Program, CDC. Atlanta, Georgia. BMC Pediatrics. http://www.biomedcentral.com/content/pdf/1471-2431-5-44.pdf

• Szilagyi PG, Bordleyy , Vann JC, Chelminski A, Kraus RM, Margolis PA, Rodewald LE. “Effet of Patient Reminder/Recall Interventions on Immunization Rates, A Review.” JAMA, October 11, 2000. Vol 284, No 14. 1820-1826,

• Tierney CD, Yusaf H, McMahon SR, Rusinak D, O’Brien MA, Massoudi MS, Lieu TA. “Adoption of Remind and Recall Messages for Immunizations by Pediatricians and Public Health Clinics.” Pediatrics. 2003; 112; 1076-1082.