1. Influenza Vaccination of Healthcare Personnel The Indian Health Service Experience Amy Groom, MPH and Cheyenne Jim, MS IHS Immunization Program Division of Epidemiology and Disease Prevention

2. Indian Health Service (IHS) Part of the Dept. of Health and Human Services since 1955 Federal health care provider for eligible AI/AN –Member of federally recognized tribes (560+) –Not an entitlement program Healthcare to 1.4 million AI/AN –~60% of AI/AN Census population (1 race only) Highly de-centralized system Per capita healthcare expenditures*: - $1,600 (IHS) - $3,900 (Medicaid) - $3,800 (Prison) - $5,200 (VA) *Source: U.S. Medicine May 2005 http://www.usmedicine.com/article.cfm?articleID=1071&issueID=74

3. Indian Health Service (IHS) Cont. IHS Funded “I/T/U” system (35 States) – Indian Health Service facilities – Tribal health facilities – Urban Indian health facilities

4. Albuquerque Portland Billings California Phoenix Oklahoma Nashville Navajo Tucson Alaska Indian Health Service Administrative Regions AberdeenBemidji User Population: 1.4 Million

5. Healthcare Personnel (HCP) Influenza Vaccination Initiative HP 2010 Goal for HCP influenza vaccination coverage: 60% 2007 coverage of HCP (nationally): < 50% Department of Health and Human Services (DHHS) initiative for 2008/09 flu season to improve HCP influenza vaccination rates Each HHS agency asked to track and report HCP flu vaccination coverage HCP defined as ALL staff who work in a healthcare facility

6. IHS – The Process Established an inter-disciplinary working group Each IHS Area designated an Area influenza coordinator Agency wide web-based informational session held on Oct. 25 th, 2008 –Influenza transmission - Employee health records –Influenza vaccination - Strategies for vaccinating HCP –Definition of HCP IHS materials on website –Guidance for Areas and facilities re: tracking –Tracking and reporting forms –PowerPoint presentations re: importance of HCP vaccination for clinical, lay, and administrative personnel –Link to HHS HCP Flu Vaccination Toolkit www.ihs.gov

7. Data Collection Area influenza coordinators collected data from I/T/U sites in their IHS Area –IHS facilities required to report –Tribal and Urban programs encouraged Aggregate Area reports submitted to the IHS Immunization Program Follow up survey re: vaccination strategies administered via Survey Monkey

8. Coverage Results

9. HCP Flu Vaccination Results Reports from all 12 IHS Areas Total HCP in each Area ranged from 49 to 5555 Number of facilities Number of HCP % Vaccinated IHS Facilities7212,67574.5% Tribal Facilities5310,06869.6% Urban Facilities1267043.5% All Facilities13723,41371.5%

10. Influenza Vaccination Coverage by IHS Area (I/T/U facilities) HP 2010 Goal 60%

11. Refusals/Unknown by Area (I/T/U Facilities)

12. Survey on Strategies The Flu Pumpkin – IHS Division of Epidemiology and Disease Prevention

13. Results 113 facilities responded to the survey 80% targeted the HCP influenza initiative to ALL HCP 58% had tracked HCP flu vaccination prior to this initiative Majority (54%) tracked coverage manually –35% used electronic medical record Majority (60%) used multiple strategies 27% used the resources available on the IHS website

14. Strategy% of facilities On-site flu clinics79% Educational presentations to staff38% Declination forms35% Mobile vaccination carts22% Individual follow up with staff14% Information/Reminders via email8% Feedback of coverage rates/competition between departments 6% Provide flu information and/or flu shots at staff meetings 4% Combined flu shots with other wellness activities3% Incentives2% Posted information around the facility2% HCP Influenza Vaccination Strategies

15. Next Steps Develop final report and disseminate to Areas Develop targets for next year –Coverage goal –Decrease % unknown (currently 18%) –Increase # of tribal facilities reporting Improvements in data collection process –Track medical contraindications and refusals separately Update IHS Employee Manual Immunization Chapter