1. Adolescent Immunization Competition March 27, 2011 North Carolina Community Health Center Association Marti Wolf, RN, MPH Clinical Programs Director

2. North Carolina National > 1 Td or Tdap 73.8 %76% >1 Tdap 54.7 %56% >1 Mening 46.8 % 54% >1 HPV 50.3% 44% > 3 doses HPV 30.5%27% http://www2a.cdc.gov/nip/coverage/nisteen/nis_iap.asp?fmt=v&rpt=tab01_iap&qtr=Q1/2009-Q4/2009

3. North Carolina Meningococcal Vaccine Rates (4/2005 -6/2009): < 10% 70 - 89% 30 - 40% 50 – 69% 10 – 20 % > 90% Mening Data courtesy of SanofiPasteur

4. Step 1: Recruitment Informational Webinar ◦ Adolescent immunization schedule ◦ Rules for participation ◦ Using NCIR Clinical Newsletter Random annoying emails Follow up, follow up, follow up

5. Who participated? 18 primary care practices ◦ MDs ◦ FNPs ◦ 1 pediatric NP All were Community Health Centers (Federally Qualified Health Centers) Locations included: Carrboro, Siler City, Burlington, Moncure, Hendersonville, Asheboro, Yanceyville, Murfreesboro, Wilson, Ahoskie, Lumberton, Fairmont, Maxton, Hendersonville

7. Step Two: Baseline Data

8. Adolescent population size by clinic

9. Starting rates by vaccine % immunized

11. Step 3: Intervene Tap into existing Quality Improvement ◦ PDSAs- Collaboratives ◦ TOTS Provide resources ◦ Information ◦ Patient education materials ◦ Automated call back systems ◦ Recall mailers ◦ Weekly emails, website ◦ Encouragement

12. Interventions: AFIX A = assessment - or the assessment reports for initial and follow-up rates F = feedback - data, such as the missing immunization reports to identify who was missing vaccines I = incentive - in this case, the contest X = exchange - the trainings on the NCIR, the best practices, and the

13. Relative Improvement Rates

14. Lessons Learned Recall Works ◦ Letters to parents ◦ Front desk making phone calls AFIX process works ◦ Use the NCIR to identify/track/follow up Overall improvement during April was 26% (using same calculation method as for determining Relative Improvement Rates)

15. Next Steps

16. Acknowledgements & Resources NC Immunization Program SanofiPasteur http://www.immunizenc.com/Providers.htm http://www.cdc.gov/vaccines/programs/cocasa/default.htm New partner Cervical Cancer Free NC