Improving the Translation of Evidence-Based Recommendations of Client Reminder/Recall for Childhood Immunizations Gary Wheeler, MD, Principal Investigator Tereasa Holmes, Project Manager

Role of Vaccines More than a 90% decline in vaccine preventable diseases when compared to pre-vaccine era Effectiveness tested and need for vaccination reinforced during recent outbreak of measles in California in 2008

The Economics of Vaccination For every $1 spent on vaccination, $16.50 is saved According to the 317 Coalition, “For every birth cohort who receives seven vaccines... society saves $9.9 million in direct health care costs; 33,000 lives are saved and 14 million cases of disease are prevented.” Keeps parents working, keeps many as productive citizens

Cost Effectiveness FY 2011 Congressional Justification Safer Healthier PeopleTM Immunization and Respiratory Diseases Budget Request.

Arkansas Statistics Chart adapted from CDC data: “Estimated Vaccination Coverage with Individual Vaccines and Selected Vaccination Series Among Children Months of Age by State and Local Area US, National Immunization Survey.”

Currently in Arkansas... Vaccine registry housed in ADH—called the Immunization Network for Children. –Currently, a child is entered at birth allowing authorized users to access the age and vaccination status of those under 22. –Difficulty Tracking patients Lack of use of current recall systems in Arkansas

Results from other studies Other studies demonstrate improvement in vaccination rate and preventive services. 80% effective Increase in immunization rate ranging from 5-20% Vaccine “champion”

Barriers Identified Problems Lack of time to learn a system Lack of staff Lack of funding Inability to identify children who are under-immunized Physicians who don’t vaccinate Proposed Solutions AFMC will provide training Outsourcing may be a solution Working with ADH to allow for better patient tracking Encourage patients to get vaccinated

Project Goals To increase the adoption of recall systems in physician practices in various geographic regions of Arkansas with diverse socioeconomic characteristics To increase practice vaccination rates

Study Design How will we increase the use of recall Programs in practices Who treat kids <2? Control Group N=34 Office-based recall N=34 Out-sourced recall center N=34

All Groups Pre and Post Surveys Informed Consent for participation Business Agreements Patient list for RATE database

Intervention Groups ∙ Complete pre and post surveys ∙ Generate rate lists ∙ Generate recall lists for new patients 2 and under ∙ Identify modes of contact ∙ Quarterly monitoring for sustainability ∙ Business agreements ∙ Informed Consent ∙ AFMC call center will scan registry weekly for under- vaccinated Patients ∙ Attempts will be made 3 times and each method will be recorded by the call center staff Office-BasedOut-sourced ∙ Academic detailers will asses each office and will offer modifications to make use of the vaccine registry. ∙ Hands on registry demonstration ∙ Weekly monitoring of registry by office staff with contact attempts and records for under- vaccinated kids. ∙ Business plans to estimate costs ∙

Modes of Communication

Evaluation Evaluation of changes in knowledge, attitude and practices of participating physicians Changes in vaccination rate

Benefits Maintenance of Certification Possibly Pay for Performance in future Application to other physician practices Benefit to your patients

Future Implications May apply to other preventive care measures Could translate this to older population for Varicella Zoster or Pneumovax vaccines Reminder system Toolkit

AFMC Key Players Gary Wheeler, MD, Principal Investigator Tereasa Holmes, Project Manager Mick Tilford, PhD Zoran Bersac, PhD Statistics Team Academic Detailers

Sources Committee on Practice and Ambulatory Medicine and Council on Community Pediatrics. “Increasing Immunization Coverage.” Pediatrics. 2010; 125; FY 2011 Congressional Justification Safer Healthier People TM Immunization and Respiratory Diseases Budget Request. “Immunization Coverage in the U.S.” Children NIS Data 2007, 2008, CDC Online. “Outbreak of Measles --- San Diego, California, January--February 2008.” MMWR. February 29, 2008; 57(08); Shaw KM, Barker LE. “How do caregivers know when to take their child for immunizations?” National Immunization Program, CDC. Atlanta, Georgia. BMC Pediatrics. Szilagyi PG, Bordleyy, Vann JC, Chelminski A, Kraus RM, Margolis PA, Rodewald LE. “Effet of Patient Reminder/Recall Interventions on Immunization Rates, A Review.” JAMA, October 11, Vol 284, No , Tierney CD, Yusaf H, McMahon SR, Rusinak D, O’Brien MA, Massoudi MS, Lieu TA. “Adoption of Remind and Recall Messages for Immunizations by Pediatricians and Public Health Clinics.” Pediatrics. 2003; 112;