1. Registry driven recruitment for adult influenza and pneumococcal vaccination: A comparison of strategies Richard Tucker Richard Bennett David Johnson Jim Davis Casey May

2. Objectives Understand adult vaccination treatment gapUnderstand adult vaccination treatment gap Appreciate adult vaccine registriesAppreciate adult vaccine registries Recognize health plan/medical group collaborationRecognize health plan/medical group collaboration

3. Goals Who we areWho we are Context/historyContext/history Results of present interventionResults of present intervention

4. Wenatchee Valley Clinic Locations Washington State

5. Pilots PDSA Spread Measurement Work smarter…not harder ActPlan StudyDo Quality and theWVMC

6. Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Functional & Clinical Outcomes Delivery System Design Decision Support Clinical Information Systems Self- Management Support Health System Resources & Policies Community Organization of Health Care Chronic Care Model

8. Disease Management Registries Microsoft Access databaseMicrosoft Access database Imported billing (ICD9, CPT), lab CPTs, pharmacyImported billing (ICD9, CPT), lab CPTs, pharmacy Custom generated tablesCustom generated tables Automated monthly updateAutomated monthly update

9. Disease Management Registries: WVMC CardiovascularCardiovascular DiabetesDiabetes Women’s healthWomen’s health SeniorsSeniors RespiratoryRespiratory High risk flu/pneumoniaHigh risk flu/pneumonia

11. Use of Registries for Flu Project 2000 Provider specific flu risk reportsProvider specific flu risk reports Patient reminders mailed per PCP approvalPatient reminders mailed per PCP approval

12. Use of Registries for Flu Project 2001-2002 Provider specific flu risk reportsProvider specific flu risk reports Patient reminders mailed unless MD refusedPatient reminders mailed unless MD refused

13. Intervention Timeline Flu & Pneumovax High Risk Registry Reports distributed (September 2001/2002) Postcard mailing & email to Physicians (early October 2001/2002) Patient Postcards mailed (mid October 2001/2002) Follow-Up to Physicians and Patients (November 2001/2002)

14. 2001 High Risk Registry Report 21,461 patients indicated for flu vaccine 19,035 indicated for pneumonia vaccine Diabetes, Cardiovascular, Respiratory, Oncology 57 primary care providers Physicians experienced with Diabetes Registries 8,577 (40%) received a mailed reminder Remainder (12,884) served as control 486 were also in Premera registry

15. Mailed reminders

16. Physician Communication

17. In House Communication

18. Patient communication

19. Received Did not Receive 43% 20% Mailed survey Influenza Vaccine Results 2001 P<0.0001

20. Mailed survey Pneumococcal Vaccine Results 2001 19,035 patients in registry 7,245 received reminder; 273 (3.8%) got pneumonia vaccine 11,790--no reminder; 199 (1.7%) got vaccine

21. Mailed survey Pneumococcal Vaccine Results 2001

22. Is linkage a mistake?

23. Piloted Eliza voice recognition calls in 2001 High risk flu patients identified Unique identifiers matched to WVMC high risk registry Allowed comparison of strategies

24. 2001

25. 2001 Vaccine project 486 shared registry patients Calls and mailed reminders, alone and in combination were equally effective All were more effective than no intervention

26. 2001 Vaccine project

27. Conclusions Use of disease management registry data improved immunization rates in adults with chronic illness We need more tools in adult vaccination Phone and mailed reminders have similar effectiveness

28. Conclusions Influenza and pneumococcal linkage may be problematic Registries assist in orderly distribution of inventory Information flow is key Collaboration is a win-win

29. Lessons Learned Change requires local physician champion and support staff.Change requires local physician champion and support staff. Success requires multiple system interventionsSuccess requires multiple system interventions Follow-up and support is required.Follow-up and support is required. Provider control/flexibility is important for acceptance.Provider control/flexibility is important for acceptance.

30. Sources of Washington State Immunization Rates

31. BRFSS--overly sensitive Claims--data under sensitive

33. Rich Tucker, MD Associate Medical Director Quality Improvement and Education Wenatchee Valley Clinic 820 N Chelan Wenatchee WA 98801 (509)663-8711 x5403 rtucker@wvclinic.com Questions/Comments?