The Coalition Training Institute At The Center for Pediatric Research Promoting Evidence-Based Health System Change: A Role for Coalitions 36th National Immunization Conference Denver, CO May 1, 2002 R. Clinton Crews, MPH, Ardythe L. Morrow, Ph.D., and Frances D. Butterfoss, Ph.D. The Coalition Training Institute At The Center for Pediatric Research Norfolk, VA

Objective: To review activities of immunization coalitions and assess whether they are conducting or promoting nationally recommended evidence-based practices.

Learning Objective: To describe how coalitions can enhance community capacity and affect health systems changes through the use of evidence-based practices.

Background: Immunization Coalition Survey (10/1999) To identify active immunization coalitions To assess status and stability of coalitions To correlate coalition activities to the CDC’s immunization program components

Background Con’t Methods A self-administered survey was mailed distributed to known immunization coalitions in the US Areas of inquiry included structure, stability, funding, overview of projects and outcomes

Background Con’t Results 104 Surveys mailed with phone follow-up 64 surveys were returned Response Rate = 62% 74% of coalitions were formed during the years of 1994 - 98 88% were immunizations only coalitions

Evidence-Based Practices Define: Initiatives that have been systematically reviewed for scientific evidence of effectiveness and recommended for implementation

Evidence-Based Immunization Strategies Guide to Community Preventive Services http://www.thecommunityguide.org/home_f.html

Recommended and Strongly Recommended Community Demand Client reminder/recall Multi-component interventions that include education Vaccination requirements for child care, school, college

Recommended and Strongly Recommended Access Reducing out-of-pocket costs Multi-component interventions (including expanded access) WIC linkage Home visits

Recommended and Strongly Recommended Provider-based Provider reminder/recall Assessment and feedback for vaccination providers Standing orders for adult immunization

Process of Coalition Effectiveness Implement Evidence-Based Strategies Community Capacity Outcomes Coalition Building Assess and Plan Reminder/recall WIC linkage Etc. Evaluate Immunization Outcomes

Methods The 64 surveyed coalitions were reviewed for evidence-based practices through secondary data analysis Initiatives were identified and grouped into the 3 immunization evidence-based practice categories Simple frequencies and means were calculated

Results Review for Evidence-Based Practices 421 Evidence-Based initiatives were reported by surveyed coalitions 72% of coalitions reported one or more evidence-based initiatives

Results Con’t Review for Evidence-Based Practices 48% - Increased Community Demand 28% - Increased Access to Services 24% - Provider-Based Practices

Results Con’t Review for Evidence-Based Practices Coalitions that indicated one or more evidence-based initiatives reported improved immunization rates Rates ranged 1 - 42% over baseline

Discussion Limitations of the analysis Immunization outcomes could not be linked directly to any specific evidence-based initiative Not all coalitions reported outcomes data Outcomes data ranged in reporting dates and methods Survey was conducted before the Guide to Community Preventive Services’ report on Evidence-Based Immunization Strategies, 2000

Discussion Con’t 52 % of coalition initiatives focused on health system changes prior to the report on evidence-based practices (28% - Increased Access to Services) (24% - Provider-Based Practices)

Discussion Con’t Surveyed coalitions with one or more evidence-based initiatives reported on average a 17 % increase in immunization rates

Conclusion Coalitions in the 21st Century have a new standard: Accountability Organizationally competent Population representative Evidence-based in process and services

“In democratic countries the science of associations is the mother science; the progress of all the rest depends upon the progress it has made.” Alexis De Tocqueville Originally published in Democracy in America (1835)

Coalition Training Institute R. Clinton Crews, M.P.H. 757-668-6430 ccrews@chkd.com Coalition Training Institute At The Center for Pediatric Research Eastern Virginia Medical School Children’s Hospital of The King’s Daughters Norfolk, Virginia