38th National Immunization Conference Thursday, May 13, 2004 Adult Immunization Pocket Registry With a Twist Betsy S. Frazer, RN, BS, QI Specialist Alabama Quality Assurance Foundation 38th National Immunization Conference Thursday, May 13, 2004 Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

“IZ Alabama Covered?” Flu & Pneumonia Prevention Campaign This campaign officially began 10/2002 and is slotted to continue through 10/2005. Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

Background In Alabama 730,000 Medicare beneficiaries 1,200 flu & pneumonia deaths/yr Of these deaths, 90% are age 65 and over Alabama has an estimated population of 4.5 million people. To prepare for this QIO responsibility, many things transpired. QIO and community leadership interviews were held. Past QIO interventions were explored, extensive literature research, along with outcomes analysis were completed. There was an extensive literature research. As one example, Missouri (QIO) completed a literature search, publishing the summary regarding “Effectiveness of Intervention Strategies: What Works?” This campaign reflects a collection of the most effective efforts listed in this research, “multiple interventions”. And the volunteers are the opinion leaders doing the academic detailing. The timely reminders are kept in the pocket; the Medicare Card Cover. Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

Primary Campaign Objective To develop and implement a coordinated grassroots effort to increase pneumonia and flu vaccination rates, with a focus on the Medicare population - Statewide - Alabama Quality Assurance Foundation

Three-fold Strategy 2. Provide unique infrastructure & support Build statewide network to: Distribute Medicare Card Covers Share message 2. Provide unique infrastructure & support 3. Utilize mass media to reinforce and enhance promotional impact Alabama Quality Assurance Foundation

Campaign Membership “Movers & Shakers” Campaign volunteers signed up for this effort bringing what they had to the table, talent and time. No two volunteers were the same. The only thing they all had in common is that they cared about someone or a group that had Medicare. The oldest volunteer is 82 years of age and the youngest is 5 years old. With each face-to-face presentation an invitation was given to get involved, showcasing ways each person could make a difference. The only requirement; they had to find love for someone or a group, ages 65 or older. Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

Campaign Membership “Movers & Shakers” Assisted Living Facilities Business & Politics Community IZ Providers (CIPs) Community Coalitions Consumers Educators Home Health Agencies Hospitals Individuals Nurses Pharmacists Physicians Public Health Campaign volunteers signed up for this effort bringing what they had to the table, talent and time. No two volunteers were the same. The only thing they all had in common is that they cared about someone or a group that had Medicare. The oldest volunteer is 82 years of age and the youngest is 5 years old. With each face-to-face presentation an invitation was given to get involved, showcasing ways each person could make a difference. The only requirement; they had to find love for someone or a group, ages 65 or older. Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

(2003) Ms.Senior Jefferson County & Gilbert The most famous volunteer & her dummy were looking for a mission. Since June 2003, she has presented the IZ issues in 19 events, to over 1,090 participants in and around Jefferson County, Alabama. Through public TV she has reached 150,000 viewers. Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

Innovative Methodology The Medicare Care Cover addresses five key principles guiding successful strategies: Record keeping Recommendations & reinforcement Reminder & recall to patients Reminder & recall to providers Reduction of missed opportunities Found in the CDC Pink Book; Strategies for Health Care Practices & Providers, 7th Edition, pg 32-37 or www.cdc.gov Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

Cost: Yellow Adult IZ Record = 7 cents/ea. Nurse Practitioner & campaign volunteer said “this product gives a fresh opportunity to educate & vaccinate.” Cost: Yellow Adult IZ Record = 7 cents/ea. Plastic Card Cover (depends on purchase volume) = 21 cents/ea. Note cost (depends on purchase volume) = 1 cent/ea. Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

Literature Search Summary Effectiveness of Intervention Strategies Most Effective Multiple Interventions Academic Detailing – Opinion Leaders Reminders Audit & Feedback Interactive Education Administrative Interventions CME-Didactics-Direct Mailings Least Effective Effectiveness of Intervention Strategies came from a published Literature Search entitled “Quality Improvement: What Works?” by Kathryn (Kay) Strom, RNC, BSN, Missouri Patient Care Foundation (QIO) This campaign reflects a collection of the most effective efforts listed in this research, “multiple interventions”. And the volunteers are the opinion leaders doing the academic detailing. The timely reminders are kept in the pocket; the Medicare Card Cover. Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

We compare the weakened immune system with the loss of “snow”. A common question from medical professionals was - ” Other than, those with an egg allergy for the flu vaccine, who is NOT a candidate for the flu and/or pneumonia shot?” This is a clinical picture of that patient who will not profit from flu or pneumonia vaccinations. We compare the weakened immune system with the loss of “snow”. Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

Flu & Pneumonia Prevention Campaign Certificate of Appreciation “IZ Alabama Covered?” Flu & Pneumonia Prevention Campaign Certificate of Appreciation This certifies that ___________________________ Is a special RSVP volunteer who assisted in the statewide effort to educate and vaccinate senior adults, an activity that may help protect 1000’s of lives across Alabama. In gratitude for your support, Betsy Frazer, R.N., B.S. Quality Improvement Specialist Alabama Quality Assurance Foundation This is a sample certificate given to campaign volunteers for service rendered. It has also been used to showcase nurse community involvement with performance evaluations. The same concept could be used by healthcare company leadership to encourage professionals flu and pneumonia shot compliance. This material was prepared by Alabama Quality Assurance Foundation under contract with the Centers for Medicare & Medicaid Services (CMS). Contents do not necessarily represent CMS policy. 7SOW-AL-IMM02-48 Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

Marketing and Education Universal Truth in Marketing and Education A simple message Repeated over time By credible source(s) Will influence behavior Alabama Quality Assurance Foundation

The “IZ Alabama Covered?” Membership Today… Includes over 1,336 formal volunteers 240,000 Medicare Card Covers distributed Volunteers in 49 of the 67 Alabama counties Extensive media coverage This campaign is registered as the coalition for the state of Alabama, through www.immunize.org. All volunteers were given a chance to self-nominate for a statewide award. The ceremony took place in February 2004. Eight volunteers completed the application process with very compelling stories. No audience, strategy or account is even close to the same. Each person may or may not have considered him or herself a “community leader”. The vast majority of volunteer comments were something like this – “I have not done anything special or extra. I have just done what I do anyway, with a special gift to show that I care.” But each person could touch one common thread; they cared for a group of people with Medicare. Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

Media Outreach [8/02 – 3/04] Newspapers, Newsletters & Magazines - 34 articles 1.8 million Circulation Radio - 2 interviews on 2 radio stations 600,000 Listeners TV - 19 interviews on 7 different TV stations 3.3 million Viewers Website - 5 presentations on 5 websites 2,500 Hits It is a known fact in the world of marketing that the 65+ generations grew up reading the paper daily, now have time to spill their morning coffee on it daily and believe it to be truth most of the time. Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

Volunteer Saturation Volunteers found in 49 (Green) Counties. Age 65 and older per county Volunteers per county (1/04) Alabama Quality Assurance Foundation

Preliminary Outcomes - Flu 66% Increase (88,440 More Shots) The statewide preliminary outcomes results were aggregated from the reports of the only two national community immunization providers (CIPs) working in Alabama and state health department. Please Note: All of the flu vaccination clinic activity was completed during a very sleepy 2003 season, prior to the “lightening strike” of the Colorado pediatric deaths. And these results are after only 13 months during a growing campaign activity. Here are the preliminary results: Alabama - total “pre-booked” flu vaccine doses used: 2002 = 133,627 2003 = 222,067 This shows a 66% increase in Alabama. This translates into 88,440 more lives protected by increased flu shots given in 2003. Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

No not yet, but we are working on it. Conclusions Medicare Card Covers work Grassroots networking offers powerful potential Media coverage reinforces network outreach activities Increased vaccine utilization is documented “IZ Alabama Covered” yet? No not yet, but we are working on it. This comprehensive multiple-level strategy including the unique carry-all product has demonstrated value that could be considered (in part or in total) as a successful template with nationwide potential. In the last 5 months, there have been interested leaders in over 20 states asking for more information.   The Connecticut QIO has replicated and is using the Medicare Card Cover. The Louisiana QIO is also using the Medicare Card Covers to enhance their current efforts with their “Medicare Welcome Packet” promotion. “Imitation is the sincerest of flattery.” Charles Caleb Colton (1780 - 1832), Lacon, volume I, no. 183 Alabama Quality Assurance Foundation Alabama Quality Assurance Foundation

Our challenge is to help protect lives through vaccinations Our challenge is to help protect lives through vaccinations. “They always say time changes things, but you actually have to change them yourself.” Andy Warhol (1928 - 1987), The Philosophy of Andy Warhol Alabama Quality Assurance Foundation

Questions / Comments ?? For more information, please contact: Betsy Frazer RN, BS (800) 760-4550, option #7 Email bfrazer@alqio.sdps.org Web www.aqaf.org This material was prepared by Alabama Quality Assurance Foundation under a contract with the Centers for Medicare & Medicaid Services (CMS). Contents do not necessarily represent CMS policy. 7SOW-AL-IMM-04-01 Alabama Quality Assurance Foundation

What is a Quality Improvement Organization (QIO)? Established in 1982 by Congress to improve effectiveness, efficiency, & quality of Medicare services [Statutory Authority: Titles XI & XVII of Social Security Act] Under the direction of the the Centers for Medicaid & Medicare (CMS) QIO in each state; in Alabama called “Alabama Quality Assurance Foundation” Alabama Quality Assurance Foundation