A quality improvement program provided by the Ohio Chapter, American Academy of Pediatrics, Ohio Department of Health, CDC’s National Immunization Program and your Local Health Department MOBI Maximizing Office Based Immunization 39 th National Immunization Conference Washington DC March 21, 2005

Christopher Rizzo MD FAAP Program Director, MOBI 2500 MetroHealth Dr. H455 Cleveland, Ohio (216) Christopher Rizzo MD FAAP Program Director, MOBI 2500 MetroHealth Dr. H455 Cleveland, Ohio (216) Presenter

Grant from Ohio Dept of Health to Ohio Chapter, American Academy of Pediatrics 100 trainers statewide Required annual MOBI training AFIX training offered Quarterly newsletter Ongoing trainer support 20 trainers observed/evaluated annually Grant from Ohio Dept of Health to Ohio Chapter, American Academy of Pediatrics 100 trainers statewide Required annual MOBI training AFIX training offered Quarterly newsletter Ongoing trainer support 20 trainers observed/evaluated annually MOBI Program

One hour presentation  Immunization update  Evidence-based strategies to raise rates  Storage & handling, documentation, VIS Continuing education All practice physicians and staff Resource pack for each attendee Pink Book/General Recommendations One hour presentation  Immunization update  Evidence-based strategies to raise rates  Storage & handling, documentation, VIS Continuing education All practice physicians and staff Resource pack for each attendee Pink Book/General Recommendations MOBI Presentation

Program History 1996 – Program began 1999 – Became an Ohio AAP program 1999 – 40 practices 2003 – 300 practices 2004 – 400 practices, 4000 attendees 1996 – Program began 1999 – Became an Ohio AAP program 1999 – 40 practices 2003 – 300 practices 2004 – 400 practices, 4000 attendees

Leveraging Incentives Local health districts commit to a certain number of MOBI/AFIX through their immunization grant applications Controlled content Trainers observed Presentation updated at least annually Tailored to the needs of the practice Local trainers primarily promote program Local health districts commit to a certain number of MOBI/AFIX through their immunization grant applications Controlled content Trainers observed Presentation updated at least annually Tailored to the needs of the practice Local trainers primarily promote program

Assessment – CASA Feedback – MOBI  Decrease missed opportunities  Eliminate office barriers  Reminder/recall Choose a strategy One month follow-up Incentives – Improvement eXchange Assessment – CASA Feedback – MOBI  Decrease missed opportunities  Eliminate office barriers  Reminder/recall Choose a strategy One month follow-up Incentives – Improvement eXchange AFIX

Recall fails or no PCP Registry Local solutions  Community lay workers  Immunization coalitions  Local public health departments Recall fails or no PCP Registry Local solutions  Community lay workers  Immunization coalitions  Local public health departments Community Outreach

Attributes of Successful Local Coalitions Dedicated paid staff Effective leadership team Enough members to do the work Strategic plan Multiple sources of funding Dedicated paid staff Effective leadership team Enough members to do the work Strategic plan Multiple sources of funding

Raise rates to >90% at 2 years of age: Safety net – primary care provider  Keep children in the medical home  Improve rates in practices/clinics (recall)  Registry Community outreach Raise rates to >90% at 2 years of age: Safety net – primary care provider  Keep children in the medical home  Improve rates in practices/clinics (recall)  Registry Community outreach Raising Rates in Communities

___ Have an assessment of rates (CASA/AFIX) ___ Become a VFC provider ___ Give all vaccines that are due ___ Follow true contraindications and precautions ___ Update policies/procedures to reduce barriers ___ Institute a reminder/recall system ___ Have an assessment of rates (CASA/AFIX) ___ Become a VFC provider ___ Give all vaccines that are due ___ Follow true contraindications and precautions ___ Update policies/procedures to reduce barriers ___ Institute a reminder/recall system Choose a Strategy

2004 Results 400 – presentations 250 – follow-up information 111/250 (44%) had CASA 400 – presentations 250 – follow-up information 111/250 (44%) had CASA

N=250 No Commitment (+ CASA) 21 (8%) Made a Commitment 195 (78%) No Commitment (No CASA) 34 (17%)

? total practices What Did Practices Commit To?

? 29/76 12/17 85/106 85/109 14/43 22/73 Success of Each Strategy

? 195 total practices / What Changed?

1.Does your practice have someone you consider your immunization expert? 2.Has your practice had an assessment of its immunization rates within the past year? 3.Is your practice a VFC provider? 4.Does your practice have a plan for saving vaccine in case of a power outage? 1.Does your practice have someone you consider your immunization expert? 2.Has your practice had an assessment of its immunization rates within the past year? 3.Is your practice a VFC provider? 4.Does your practice have a plan for saving vaccine in case of a power outage? 2005 MOBI Best Practices

5.Does your practice provide a Vaccine Information Statement (VIS) to parents for every shot at every visit and allow them to take it home? 6.Does your office use an immunization reminder and/or recall system for every patient? 7.Has your office received training on Ohio’s Immunization Registry, IMPACT-SIIS? 5.Does your practice provide a Vaccine Information Statement (VIS) to parents for every shot at every visit and allow them to take it home? 6.Does your office use an immunization reminder and/or recall system for every patient? 7.Has your office received training on Ohio’s Immunization Registry, IMPACT-SIIS? 2005 MOBI Best Practices

As a rule, does your practice: 8.give hepatitis B #1 in the newborn period, prior to hospital discharge? 9.give all vaccines that are due, regardless of the number of injections? 10.give shots to children with minor illnesses, like colds, diarrhea and low grade fever? 11.give shots to children at sick visits? 12.allow patients to come in the same day for an immunization-only nurse visit? As a rule, does your practice: 8.give hepatitis B #1 in the newborn period, prior to hospital discharge? 9.give all vaccines that are due, regardless of the number of injections? 10.give shots to children with minor illnesses, like colds, diarrhea and low grade fever? 11.give shots to children at sick visits? 12.allow patients to come in the same day for an immunization-only nurse visit? 2005 MOBI Best Practices

Office Strategies Improve Immunization Rates 1.Identify your office vaccine expert 2.Determine your immunization rates 3.Reduce missed opportunities 4.Eliminate office barriers 5.Reminder & Recall What will your practice do to improve? 1.Identify your office vaccine expert 2.Determine your immunization rates 3.Reduce missed opportunities 4.Eliminate office barriers 5.Reminder & Recall What will your practice do to improve?

Reduce Missed Opportunities 1.Is a vaccine due? Check every visit. 2.Is there a reason to withhold vaccine? 3.Give all vaccines that are due 1.Is a vaccine due? Check every visit. 2.Is there a reason to withhold vaccine? 3.Give all vaccines that are due

Eliminate Office Barriers Provide immunizations even if a well check or physical exam is due Fast-track immunization-only requests Provide same day immunization-only visits Give nurses authority to immunize if due Provide immunizations even if a well check or physical exam is due Fast-track immunization-only requests Provide same day immunization-only visits Give nurses authority to immunize if due

It’s Up to You! ___ CASA/AFIX assessment of rates ___ Become a VFC provider ___ Check immunization status at every visit ___ Give vaccines even if a mild illness is present ___ Give all vaccines that are due ___ Update policies/procedures to reduce barriers ___ Institute a reminder/recall system ___ Sign up and use IMPACT SIIS (Ohio’s registry) ___ CASA/AFIX assessment of rates ___ Become a VFC provider ___ Check immunization status at every visit ___ Give vaccines even if a mild illness is present ___ Give all vaccines that are due ___ Update policies/procedures to reduce barriers ___ Institute a reminder/recall system ___ Sign up and use IMPACT SIIS (Ohio’s registry) One month follow-up with MOBI Trainer

Raise rates to >90% by 2 years of age: 1.Identify office vaccine expert 2.Routinely measure your rate 3.AFIX (CASA/MOBI) 4.Enroll and use immunization registry Avoid missed opportunities Reduce office barriers Reminder & recall 5.Share experience with other providers 6.Support development of a community- wide immunization action plan Raise rates to >90% by 2 years of age: 1.Identify office vaccine expert 2.Routinely measure your rate 3.AFIX (CASA/MOBI) 4.Enroll and use immunization registry Avoid missed opportunities Reduce office barriers Reminder & recall 5.Share experience with other providers 6.Support development of a community- wide immunization action plan Raising Rates in Communities Begin by Maximize Office Based Immunization

What worked  Focus on evidence-based improvements  Give what they WANT and what they NEED  Promoting public-private relationships What didn’t work  Practice immunization champion must attend  Help practice make changes, not just tell them What worked  Focus on evidence-based improvements  Give what they WANT and what they NEED  Promoting public-private relationships What didn’t work  Practice immunization champion must attend  Help practice make changes, not just tell them Key Lessons Learned

Barriers that need to be overcome  Trainer anxiety about public speaking  Getting in the practice door, CASA anxiety Future barriers  Vaccine payment issues  Incorporating registry tools into EMR Future plans  Identify strategies offices are already doing  Use CASA results as evaluation  Help local trainers target practices Barriers that need to be overcome  Trainer anxiety about public speaking  Getting in the practice door, CASA anxiety Future barriers  Vaccine payment issues  Incorporating registry tools into EMR Future plans  Identify strategies offices are already doing  Use CASA results as evaluation  Help local trainers target practices Key Lessons Learned

Christopher Rizzo MD FAAP Program Director, MOBI 2500 MetroHealth Dr. H455 Cleveland, Ohio (216) Christopher Rizzo MD FAAP Program Director, MOBI 2500 MetroHealth Dr. H455 Cleveland, Ohio (216)