1. Disseminating Evidence-Based Strategies Associated With Improved Immunization Rates Denise H. Benkel, MD, MPH Bureau of Immunization New York City Department of Health and Mental Hygiene

2. NICHQ National Initiative for Children’s Healthcare Quality Not-for-Profit Partners with AAP, ABP, and IHI Mission: To reduce the gap between what is and what could be in healthcare for all children.

3. Estimated vaccination coverage among NYC children 19 to 35 months of age NIS Results

4. Evidence-based strategies to improve immunization delivery Parent reminders for upcoming visits and recall notices Nurse and/or physician reminders/prompts Parent education and expanded access to services, such as after-hours/weekends Quality improvement efforts, including repeated measurement of immunization levels of an office practice’s one and two-year-olds Standing orders for RN’s, PA’s, and medical assistants Multi-component interventions

5. Gap between evidence and practice Much is known about how immunization delivery should be conducted, but… Knowledge of what should be done does not always translate into practice, and… There are many reasons for this gap

6. Improving immunization delivery in New York City Identify evidence-based best practices Design a strategy for effective dissemination to all NYC childhood immunization providers Dissemination Strategy Document toolkit facilitated “peer-to-peer” spread Create a relatively easy way to assess change

7. Steps Performance measurement and feedback Creation of office team and selection of goals Testing changes Spread of effective changes to entire practice Tools Clinical guidelines, academic detailing sheets Materials tailored to office routines Training and support (clinical and QI) Initially, on-site visits NICHQ Practice Assistance Approach to improvement

8. Phases of the project Phase I EQuIP Collaborative: April 2002—April 2003 Phase II Dissemination Strategy: current Phase III Development: next Phase IV Implementation: future

9. Phase I: EQuIP Collaborative April 2002-April 2003 Nineteen pediatric healthcare providers 6: preventive services 13: asthma Successful strategies coordination of immunization reminders with WIC visits use of preventive services prompting sheets telephone reminder systems use of Citywide Immunization Registry (CIR) enthusiasm, will, and collaboration

11. Phase II: Dissemination Strategy Interviews to generate ideas EQuIP Collaborative teams DOHMH staff health policymakers Design Team DOHMH NICHQ local clinical consultants

12. Workgroup 1: Practice Outreach and Assistance Lessons learned from current system: QI tools must be seamless and useful Strategies for change patient pre-set list online Registry bring online CIR access to large facilities access to physicians-in-training recall features contact/fine non-reporters

13. Workgroup 2: Communication Lessons learned from current system: There are many communication tools Strategies for change information and feedback should be better coordinated key messages should be well-timed and regularly repeated highlight common problems, while tailoring to individual provider’s needs

14. Workgroup 3: Measurement Lessons learned from current system: Is difficult but extremely important Strategies for change special programming of Registry for regular monitoring of coverage process and outcome measures grouping of providers customized reports for monitoring and feedback

15. Design Meeting Public and private sectors Managed care Professional medical organizations Advocacy

16. Phase III: Development Customize the NICHQ toolkit to NYC Recruit leaders and champions Develop communication and linkages to key organizations Build technical infrastructure refine CIR programming refine staffing issues

17. Phase IV: Implementation DOHMH outreach staff Site field staff Incremental expansion Continuous assessment of overall program performance