Implementation and Evaluation Planning of the Oregon and Washington 4th DTaP Initiative Focus on the Fourth DTaP Initiative Karen Elliott, Oregon Partnership to Immunize Children Ginny Heller, Immunization Action Coalition of Washington Mary Beth Kurilo, Oregon State Public Health Michele Perrin, Washington Department of Health In collaboration with: Desautel Hege Communications Deschutes County Health Department Thank you for joining us today. As you just heard, 4 of us are here to talk about “Implementation and Evaluation Planning of the Oregon and Washington 4th DTaP Initiative.” We want to be sure to acknowledge all the partners in this effort – it really is the many skills and abilities that everyone brings to the table that has made this project such a success. We hope you can use our model as a way to do your own health promotion work.

We just wanted to quickly show you on this map of the United States where Oregon and Washington are situated. As you can see these two states dominate the northwest and cover a very large geographic area. This graphic representation has been important when sharing this information with other states.

6,068,996 people living in 71,303 square miles Washington: 6,068,996 people living in 71,303 square miles 18th largest state 2004 NIS 4:3:1:3:3 = 77.7% Oregon: 3,521,515 people living in 98,386 square miles 9th largest state 2004 NIS 4:3:1:3:3 = 78.9% US 2004 NIS 4:3:1:3:3 = 80.9% Here is some more specific information on our states. Together we cover close to 170 thousand square miles and have almost 9.5 million people, both in urban centers and many rural areas. It is important to note that both states immunization rates are below the national average, although we continue to increase and narrow the gap every year.

Differences in 3rd & 4th DTaP Immunization Rates U.S. National Immunization Survey 2004 Project impact on NIS data would likely appear in 2+ years

Increased Pertussis Disease Pertussis (whooping cough) increasing in Oregon and Washington Pertussis incidence higher than national average* National: 7.2 per 100,000 Oregon: 16.0 cases per 100,000 Washington: 13.5 cases per 100,000 Infants and young children at greater risk for severe complications Pertussis is the only vaccine preventable disease that is increasing. What is really important about pertussis is protecting our infants – they are at the greatest risk from serious disease. WA and OR rates are much higher than national averages. This increase, combined with the lower 4th DTaP immunization rates, leaves our young children at risk. Older children and adults often don’t know they are infected – they may only have a minor cough – but they can easily pass it on to young children. Infants who get pertussis often have to be hospitalized and have high risks of serious complications like pneumonia and seizures. *2005 Provisional Pertussis Surveillance Report, CDC, 1/20/06

WOW! The Washington Oregon Workgroup Collaborative effort between Washington and Oregon’s Immunization Programs and Coalitions Multiple stakeholder involvement (Local and State Health, Coalition Members, Vaccine Manufacturers, etc.) Conference calls Face to face meeting to develop strategic plan using logic model

Tips on Regional Partnership Build on existing relationships and common partners Define the problem and shared needs Develop joint written plan Be flexible – some activities will be done together, and some will be on your own Schedule regular meetings Involve coalition members

Benefits of a Regional Approach Fosters innovative strategies Strengthens partnerships Maximizes resources Increases credibility and impact Takes advantage of similar population demographics and public health structure

Goal and Methods Goal – Methods – Increase Washington and Oregon immunization rates by increasing the timely administration of the 4th DTaP vaccine and protect young children against pertussis. Methods – Regional action plan developed based on data and best practices Collaboration with public and private health partners Instituted a two state 4th DTaP initiative

What Works Multi-faceted interventions Client reminders and recalls Provider reminders and recalls Assessment and feedback for vaccination providers (e.g., AFIX) Administer the 3rd DTaP on time, 4th DTaP is more likely to be on time Take advantage of every medical encounter Sources: Briss et al. Am J Prev Med 2000 Jan;18(1 Suppl):97-140; Strine TW, Luman ET, Okoro CA, et al. Predictors of Age-Appropriate Receipt of DTaP Dose 4. AJPM 2003;25(1):45-49; Gaudino et al., The risk and protective factors for incomplete childhood vaccinations in the U.S.: A comprehensive literature review, 1980-1996. Earlier findings presented at the annual CDC/HRSA MCH Epidemiology Conference. Currently unpublished; The Task Force on Community Preventive Services. Reviews of Evidence Regarding Interventions to Improve Vaccination Coverage in Children, Adolescents and Adults. Am J Prev Med 2000:18:100-103.

Initiative Activities Developed, shared, and distributed educational and media materials Joint and individual activities in WA and OR Provider articles Websites Materials support local health efforts during pertussis outbreaks Shared discussion and planning for evaluation strategies

Parent and Provider Materials

Media Materials TV, radio and print PSAs in English and Spanish Billboard New Release and press conference

Evaluation Includes process measures, short term outcomes, and long term outcome Media statistics (# articles, # times PSA played) Website hits Parent surveys Vaccine doses distributed Immunization registry data Future National Immunization Survey data

Using Oregon and Washington Immunization Information Systems Target providers and geographic areas for outreach and education Targeting joint promotion efforts Assist in selection of underserved population Assist providers in 4th DTaP work Reminder/recall and forecasting tools Measure and evaluate success Show improvement in immunization rates Increase tracking 4th DTaP rates in individual provider offices

One Facet of Oregon’s Evaluation Effort Subset: Outcome Evaluation Matrix Outcome Evaluation Goal Tool/Method Schedule of Completion Responsible Party Increase the 4th DTaP UTD rates in local public health departments by an average of 5% Conduct pre/post measurement using ALERT data and AFIX methodology Q2, 2007 State Immunization Program and local health departments

AFIX, Local Health Departments Oregon uses 100% IIS (registry) data for AFIX assessments Local Health Departments are assessed and measured every year Baseline measure for 2004: 68.2% Average of 35 Oregon Counties Interim measurement - June 2006 Final measurement - June 2007

Further Analysis Explore differential local health department rates based on: Media sites (placement of billboards, airtime for TV/radio PSAs) Inclusion of 4th DTaP goals in County Annual Plans Dissemination of print materials to public and private sites

One Facet of Washington’s Evaluation Effort Subset: Outcome Evaluation Matrix Short-term and Intermediate Evaluation Goal Tool/Method Schedule of Completion Responsible Parties Parent KAB (knowledge, attitude, behavior) Importance of DTaP series Contact provider about child’s vaccine status Parent Surveys: Pre/post test convenience sample of MCH resource line Added 4th DTaP question to a biannual statewide health promotion survey State immunization program and community partners 2005- Activities completed 2006 - Data analysis

Parent Survey CHILD Profile System - Statewide health and safety mailings to parents of children birth to six 4th DTaP parent fact sheet included in the one-year mailing – reaching ~70,000 Biennial CHILD Profile parent survey – added 4th DTaP question Limitations: response rate, possible selection bias of parents who choose to complete survey Michele

Results from Health Promotion Survey CHILD Profile sent you a flyer about the 4th DTaP vaccine. After receiving it, did you: % N Talk with your child’s Dr. about the 4th DTaP 13% 62 Call the toll-free # listed 0.4% 2 Visit the website listed Get a 4th DTaP for my child 8% 39 Keep it to refer to later 16% 76 Didn’t use it. I already know my child’s imms are UTD 38% 184 Don’t remember getting it 27% 131 I got it, but didn’t read 6% 27

What’s Next Continued WOW calls Planning for year two of the initiative Incorporation of Tdap education Continued media work and material distribution Continued evaluation activities Disseminate findings Future OR/WA partnerships

Contact Information Karen Elliott, JD Oregon Partnership to Immunize Children 971-673-0285 or Karen.r.Elliott@state.or.us Ginny Heller, MSW Immunization Action Coalition of Washington 206-830-5168 or ginnyh@hmhbwa.org Mary Beth Kurilo, MSW, MPH Oregon Department of Human Services 971-673-0294 or mary.beth.kurilo@state.or.us Michele Perrin, MPH, CHES Washington Department of Health 360-236-3720 or michele.perrin@doh.wa.gov WA 4th DTaP website: www.doh.wa.gov/cfh/Immunize/dtap.htm OR 4th DTaP website: www.oregon.gov/dhs/ph/imm/opic