Southeast Michigan PARTNERS PROJECT Evaluation of Inpatient Immunization in Michigan Hospitals Carla A. Winston, PhD, MA Megan C. Lindley, MPH Pascale M. Wortley, MD, MPH

Background Partners Project started in 2000 Overall Goals: Build collaborative relationships Enhance delivery of evidence-based preventive health care services Establish lasting public/private partnerships at the local level

SE MI Partners Project Alliance of Community Health Plans (ACHP) Blue Care Network Blue Cross Blue Shield Care Choices CDC DaimlerChrysler Detroit Regional Chamber Ford Motor Company General Motors Corporation Greater Oakland Visiting Nurses Association Health Alliance Plan HealthPlus of Michigan M-CARE Michigan Department of Community Health Michigan Health and Hospital Association MPRO (Michigan’s Quality Improvement Organization) Michigan Medical Society PPOM (physician network) Southeast Michigan Visiting Nurses Association United Auto Workers

2003-2004 Inpatient Pilot Project Standing orders effective Hospital vaccination coverage low (Bratzler et. al. 2002) 1.9% influenza vaccination 1% pneumococcal vaccination Change in Federal Register, 2002 Accrediting organizations use immunization rates as quality measures

Pilot Implementation Facilitate web training Secure volunteer hospitals Kick-off meeting June 2003 Provide ongoing technical assistance Process, structure, components Policy guidance and templates CD-Rom available

Participating Hospitals Hospital A: Nurse standing order Hospital B: Assessment and order by MDs Hospital C: Nurse standing order Hospital D: Nurse standing order Hospital E: No standing orders implemented Hospital F: Flagship hospital, standing orders since 2001

Initial Successes Five of six participating hospitals have active programs Positive hospital feedback Qualitative interviews Independent evaluation through MPRO Compare 2002 vs. 2003 vaccination coverage

Chart Abstraction Date of birth Date of discharge ICD-9 Codes Gender Payment Source Vaccine Assessment Form Influenza and Pneumococcal Vaccination

Inpatient Evaluation Hospitals pulled random samples of 100 charts age 50-64 discharged Nov 2002 100 charts age 65+ discharged Nov 2002 100 charts age 50-64 discharged Nov 2003 100 charts age 65+ discharged Nov 2003 Exclusion criteria Pneumonia diagnoses Died in hospital or received only hospice Transferred to another short-term facility Discharged against medical advice (AMA)

Use of Vaccine Assessment Forms, 2003 Hospital A Hospital B Hospital C Hospital D n=90 n=87 n=49 n=114 n=95 n=96 n=91 n =98

Vaccination Rates Among Eligible Patients Eligible patients were those without a history of allergy to vaccine or components, and those not vaccinated prior to admission Numerator: Eligible patients vaccinated in hospital Denominator: (influenza) All eligible patients

Influenza Inpatient Vaccination among Eligible Patients 50-64 Hospital A Hospital B Hospital C Hospital D 6 3 8 5 7 1 1 n=93 n=84 n=36 n=32 n=92 n=69 n=94 n=66

Influenza Inpatient Vaccination Rate among Eligible Patients 65+ Hospital A Hospital B Hospital C Hospital D 10 9 6 7 5 4 1 n=93 n=68 n=71 n=60 n=78 n=44 n=69 n=60

Using CMS Measures Numerator: Patients vaccinated in hospital + patients refused + patients with allergies + patients vaccinated prior to admission Denominator: (influenza) All patients

Influenza CMS Measures among Patients 50-64 Hospital A Hospital B Hospital C Hospital D 68 54 25 42 16 18 3 1 2002n=93 2003n=90 2002n=39 2003n=49 2002 n=109 2003n=95 2002 n=112 2003n=91

Influenza CMS Measures among Patients 65+ Hospital A Hospital B Hospital C Hospital D 74 70 59 34 50 37 30 2002n=93 2003n=87 2002n=98 2003 n=114 2002 n=110 2003n=96 2002 n=102 2003n=98

Challenges for Inpatient Immunization Physician/nursing support Champion critical Training and education ACIP recommendations Contraindications Reimbursement Public payer: process too cumbersome Private payer: hospitals not reimbursed Tracking assessments and immunizations

Conclusions Continue to promote vaccination Focus on reimbursement and Assessment rates increased dramatically Vaccination rates increased modestly Focus on reimbursement and electronic systems Evaluate program changes over time Share lessons with other hospitals

Thank you Terrisca Des Jardins, Project Manager John Spiegel, ACHP MPRO HOSPITALS AND PARTNERS