How Who Why When What Quality Improvement Projects to Increase Immunization Rates

Topics: QI Activities selected on AFIX questionnaires from Clinic Reviews The Who, What, When, Why, and How’s of selecting and implementing a QI activity at your clinic DPHHS sponsored QI activities Additional QI Activities Questions

Why do we always talk about coverage rates? To keep children protected against diseases The only way to do this is to make sure they are immunized against the disease

QI Activities Selected on AFIX Questionnaire: Top 5 QI Activities Selected 1.Do you have a reminder/recall process in place for pediatric/adolescent patients? 2.Do you routinely measure your clinic’s immunization coverage levels and share the results with staff? 3.Do you inactive patients in the IIS who are no longer seen by your practice? 4.Do you schedule the next vaccination visit before the patients/parents leave the office? 5.Do you contact patients/parents within 3-5 days when a well-child or immunization only visit is no show and reschedule if for as soon as possible?

Reminder/Recall Process in Place: Who: The clinic, county, the state What:Implementing a reminder/recall process When:It’s never to late to start! Why:It is proven that a R/R can increase immunization rates by 10 to 20%. How:This can be done by phone, text, mail, any way to reach your population at your clinic.

Key Points and Recommendations: Key Points: Recall messages can increase vaccination rates Reduce the time children remain at risk for vaccine- preventable disease Effective R/R activates are conducted on a schedule (monthly/quarterly) Help identify patients who are at risk for not receiving comprehensive primary care Recommendations: Determine which method of r/r is most appropriate Use data to determine which patient population or vaccine to focus on Measure progress or map processes to tweak to make the R/R most effective

Examples: Tickler Based o Postcards Automated o Phone Calls o Text o Postcards o Letters

How many people use a R/R system? A.Use a tickler based r/r system B.Use an automated r/r system C.Do not currently remind or recall patients

Tickler Based Reminder/Recall Pilot Project Sponsored by DPHHS: Purpose is to increase the immunization coverage rate at each clinic by using a R/R postcard & phone call system with an emphasis on the 4 th DTaP. Clinics that are participating: Holy Rosary Billings Clinic Miles City Southwest Butte Community Health Center Riverstone County Health Department

Automated Reminder/Recall Pilot Project Sponsored by DPHHS: Purpose is to increase the immunization coverage rate at each clinic by using an automated r/r system provided by Televox. All patients included in this pilot will receive a post card and a phone call. Clinics that are participating: All Flathead County Clinics

Measure your IZ rates and share: Who: The clinic and staff at the clinic and state What:Share results so staff can be involved in suggesting & developing ideas/improvements to increasing coverage rates When:Anytime! Staff/Nurse meetings, informational documents Why:To raise staff awareness of coverage levels confirms efforts are being worked on and shows were areas can be emphasized, such as specific ages and vaccines How:EHR reports, imMTrax generated report, reports provided by DPHHS

Key Points and Recommendations: Key Points: Clinics can identify certain vaccines with lower coverage rates Root causes for missed opportunities Certain age groups with lower coverage rates Monitor trends over time and evaluate where interventions are needed Recommendations: Determine which system you want to use Determine schedule and assign responsible staff Determine patient population Use data to plan improvement activities

Examples of how to Measure IZ Rates: Electronic Health Record (EHR) o Generated from your EHR Request Imm Coverage in imMTrax o Generated based off what clinic criteria needs/wants

Examples of how to Measure IZ Rates continued: Home graph in imMTrax o Generated from imMTrax data CoCASA Bi-Annual/Site Visit AFIX Reports o Generated based off imMTrax data

How many people currently use one of these options to measure their IZ rates? A.Use clinic E H R B.Use imMTrax graph C.Use bi-annual reports D.Use all of the above E.Use none of the above

Inactivating Patients in the IIS: Who: The clinic staff/state staff What:Keep patient lists in imMTrax up-to-date When:On going Why:Patients are assigned to the correct primary & secondary providers How:imMTrax

Key Points and Recommendations: Key Points: Defines provider’s patient population Defines the clinics immunization coverage rates Accurate patient lists generated Accurate r/r generated Recommendations: Have key staff manage the fields in imMTrax Status Medical Home Association Use the states criteria of “who” is your patient Last seen in your clinic within the last 24 months Moved or gone elsewhere for care

Examples of how to inactive patients: Ways to review patients o Reports provided by DPHHS o Search patients using the Medical Home Association Field Ways to update patients o Medical Home Association Field o Status Field

Schedule the next vaccination appt: Who: Staff at the clinic What:Schedule patients before they leave the office When:When the patients is due for their next immunization visit Why:To ensure the patient returns for immunizations How:Schedule appointment

Key Points and Recommendations: Key Points: Ensures that they have the opportunity to select a convenient time and date Once scheduled the clinic can remind the patient Easier to track patients who schedule, but no show Recommendations: (If clinic currently does not do this and is open) Does your EHR or scheduling allow visits to be scheduled months in advance? If not, can this be changed? Direct patients to leave through the reception area Have the scheduling staff make contact with each patient before they walk out or have staff walk patients to the scheduling area

Examples of scheduling the next vaccination appointment: Train front desk/scheduling staff when to schedule appointments Minimum intervals/ Appropriate time to immunize How far in advance does your clinic schedule appts. Let nurses have access to EHR scheduler Nurse escorts patients to the schedule desk

Examples of scheduling the next vaccination appointment continued : Nurse provides the patient with a card for when their next appointment is due for the front desk Remind patients of future IZ clinics being held Work with other programs (WIC) to schedule those patients next visits

Contact patients within 3-5 days of no show: Who: Staff at the clinic What:Phone calls or text messages When:Within 3-5 days after missed appointment Why:To reschedule patients that have no showed to bring them in for the recommended vaccines How:Refer to appointment schedule and patients that no shows

Key Points and Recommendations: Key Points: Rescheduling with short time of missed appointments stresses the importance of immunizations Less patients catching up on immunizations Less missed opportunities Recommendations: Appoint a team lead Identify how will no shows be tracked Identify how you will be contacting no shows Identify when no shows will be contacted

Examples of how to contact patients within 3-5 days of no shows: When patients schedule appointments verify contact information Review the previous days schedule for no shows Review list of well child exams Train front desk staff to make contact with patients Phone Text Messages Make two phone calls before mailing postcard/letter

Other Strategies to Increase Coverage Rates: Do you have an IZ Champion at your clinic? Motivate and track progress towards goals Must have institutional support for quality improvement Time, resources, commitment High turnover in staff Is your IZ staff knowledgeable and comfortable with current ACIP recommendations, intervals, contraindications, etc.: Stress the clinic wants to keep patients as protected as possible Administer all ACIP recommended vaccines on time every time Know minimum intervals between doses and ages Less missed opportunities EHR’s can assist with forecasting what is due or coming due

Hmmmmm: What QI Activities is your clinic going to select to improve your Immunization Coverage Rates?

Tucker & Tanner

Questions: Katie