1. 38th National Immunization Conference Thursday, May 13, 2004
Adult Immunization Pocket Registry With a Twist Betsy S. Frazer, RN, BS, QI Specialist Alabama Quality Assurance Foundation
38th National Immunization Conference
Thursday, May 13, 2004
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

2. “IZ Alabama Covered?” Flu & Pneumonia Prevention Campaign
This campaign officially began 10/2002 and is slotted to continue through 10/2005.
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

3. Background In Alabama 730,000 Medicare beneficiaries
1,200 flu & pneumonia deaths/yr
Of these deaths, 90% are age 65 and over
Alabama has an estimated population of 4.5 million people.
To prepare for this QIO responsibility, many things transpired. QIO and community leadership interviews were held. Past QIO interventions were explored, extensive literature research, along with outcomes analysis were completed.
There was an extensive literature research. As one example, Missouri (QIO) completed a literature search, publishing the summary regarding “Effectiveness of Intervention Strategies: What Works?” This campaign reflects a collection of the most effective efforts listed in this research, “multiple interventions”. And the volunteers are the opinion leaders doing the academic detailing. The timely reminders are kept in the pocket; the Medicare Card Cover.
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

4. Primary Campaign Objective
To develop and implement a coordinated grassroots effort to increase pneumonia and flu vaccination rates, with a focus on the Medicare population
- Statewide -
Alabama Quality
Assurance Foundation

5. Three-fold Strategy 2. Provide unique infrastructure & support
Build statewide network to:
Distribute Medicare Card Covers
Share message
2. Provide unique infrastructure & support
3. Utilize mass media to reinforce and
enhance promotional impact
Alabama Quality
Assurance Foundation

6. Campaign Membership “Movers & Shakers”
Campaign volunteers signed up for this effort bringing what they had to the table, talent and time. No two volunteers were the same. The only thing they all had in common is that they cared about someone or a group that had Medicare. The oldest volunteer is 82 years of age and the youngest is 5 years old.
With each face-to-face presentation an invitation was given to get involved, showcasing ways each person could make a difference. The only requirement; they had to find love for someone or a group, ages 65 or older.
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

7. Campaign Membership “Movers & Shakers”
Assisted Living Facilities
Business & Politics
Community IZ Providers (CIPs)
Community Coalitions
Consumers
Educators
Home Health Agencies
Hospitals
Individuals
Nurses
Pharmacists
Physicians
Public Health
Campaign volunteers signed up for this effort bringing what they had to the table, talent and time. No two volunteers were the same. The only thing they all had in common is that they cared about someone or a group that had Medicare. The oldest volunteer is 82 years of age and the youngest is 5 years old.
With each face-to-face presentation an invitation was given to get involved, showcasing ways each person could make a difference. The only requirement; they had to find love for someone or a group, ages 65 or older.
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

8. (2003) Ms.Senior Jefferson County & Gilbert
The most famous volunteer & her dummy were looking for a mission. Since June 2003, she has presented the IZ issues in 19 events, to over 1,090 participants in and around Jefferson County, Alabama. Through public TV she has reached 150,000 viewers.
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

9. Innovative Methodology
The Medicare Care Cover addresses five key principles guiding successful strategies:
Record keeping
Recommendations & reinforcement
Reminder & recall to patients
Reminder & recall to providers
Reduction of missed opportunities
Found in the CDC Pink Book; Strategies for Health Care Practices & Providers, 7th Edition, pg 32-37 or
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

10. Cost: Yellow Adult IZ Record = 7 cents/ea.
Nurse Practitioner & campaign volunteer said “this product gives a fresh opportunity to educate & vaccinate.”
Cost: Yellow Adult IZ Record = 7 cents/ea.
Plastic Card Cover (depends on purchase volume) = 21 cents/ea.
Note cost (depends on purchase volume) = 1 cent/ea.
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

11. Literature Search Summary
Effectiveness of Intervention Strategies
Most Effective
Multiple Interventions
Academic Detailing – Opinion Leaders
Reminders
Audit & Feedback
Interactive Education
Administrative Interventions
CME-Didactics-Direct Mailings
Least Effective
Effectiveness of Intervention Strategies came from a published Literature Search entitled “Quality Improvement: What Works?” by Kathryn (Kay) Strom, RNC, BSN, Missouri Patient Care Foundation (QIO)
This campaign reflects a collection of the most effective efforts listed in this research, “multiple interventions”. And the volunteers are the opinion leaders doing the academic detailing. The timely reminders are kept in the pocket; the Medicare Card Cover.
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

12. We compare the weakened immune system with the loss of “snow”.
A common question from medical professionals was - ” Other than, those with an egg allergy for the flu vaccine, who is NOT a candidate for the flu and/or pneumonia shot?”
This is a clinical picture of that patient who will not profit from flu or pneumonia vaccinations.
We compare the weakened immune system with the loss of “snow”.
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

13. Flu & Pneumonia Prevention Campaign Certificate of Appreciation
“IZ Alabama Covered?”
Flu & Pneumonia Prevention Campaign
Certificate of Appreciation
This certifies that
___________________________
Is a special RSVP volunteer who assisted in the statewide effort to educate and vaccinate senior adults, an activity that may help protect 1000’s of lives across Alabama.
In gratitude for your support,
Betsy Frazer, R.N., B.S.
Quality Improvement Specialist
Alabama Quality Assurance Foundation
This is a sample certificate given to campaign volunteers for service rendered.
It has also been used to showcase nurse community involvement with performance evaluations.
The same concept could be used by healthcare company leadership to encourage professionals flu and pneumonia shot compliance.
This material was prepared by Alabama Quality Assurance Foundation under contract with the Centers for Medicare & Medicaid Services (CMS). Contents do not necessarily represent CMS policy. 7SOW-AL-IMM02-48
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

14. Marketing and Education
Universal Truth in
Marketing and Education
A simple message
Repeated over time
By credible source(s)
Will influence behavior
Alabama Quality
Assurance Foundation

15. The “IZ Alabama Covered?” Membership Today…
Includes over 1,336 formal volunteers
240,000 Medicare Card Covers distributed
Volunteers in 49 of the 67 Alabama counties
Extensive media coverage
This campaign is registered as the coalition for the state of Alabama, through
All volunteers were given a chance to self-nominate for a statewide award. The ceremony took place in February Eight volunteers completed the application process with very compelling stories. No audience, strategy or account is even close to the same. Each person may or may not have considered him or herself a “community leader”.
The vast majority of volunteer comments were something like this – “I have not done anything special or extra. I have just done what I do anyway, with a special gift to show that I care.” But each person could touch one common thread; they cared for a group of people with Medicare.
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

16. Media Outreach [8/02 – 3/04]
Newspapers, Newsletters & Magazines - 34 articles
1.8 million Circulation
Radio - 2 interviews on 2 radio stations
600,000 Listeners
TV - 19 interviews on 7 different TV stations
3.3 million Viewers
Website - 5 presentations on 5 websites
2,500 Hits
It is a known fact in the world of marketing that the 65+ generations grew up reading the paper daily, now have time to spill their morning coffee on it daily and believe it to be truth most of the time.
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

17. Volunteer Saturation Volunteers found in 49 (Green) Counties.
Age 65 and older per county
Volunteers per county (1/04)
Alabama Quality
Assurance Foundation

18. Preliminary Outcomes - Flu 66% Increase (88,440 More Shots)
The statewide preliminary outcomes results were aggregated from the reports of the only two national community immunization providers (CIPs) working in Alabama and state health department.
Please Note: All of the flu vaccination clinic activity was completed during a very sleepy 2003 season, prior to the “lightening strike” of the Colorado pediatric deaths. And these results are after only 13 months during a growing campaign activity.
Here are the preliminary results:
Alabama - total “pre-booked” flu vaccine doses used:
2002 = 133,627
2003 = 222,067
This shows a 66% increase in Alabama.
This translates into 88,440 more lives protected by increased flu shots given in 2003.
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

19. No not yet, but we are working on it.
Conclusions
Medicare Card Covers work
Grassroots networking offers powerful potential
Media coverage reinforces network outreach activities
Increased vaccine utilization is documented
“IZ Alabama Covered” yet?
No not yet, but we are working on it.
This comprehensive multiple-level strategy including the unique carry-all product has demonstrated value that could be considered (in part or in total) as a successful template with nationwide potential. In the last 5 months, there have been interested leaders in over 20 states asking for more information.
The Connecticut QIO has replicated and is using the Medicare Card Cover. The Louisiana QIO is also using the Medicare Card Covers to enhance their current efforts with their “Medicare Welcome Packet” promotion.
“Imitation is the sincerest of flattery.”
Charles Caleb Colton
( ), Lacon, volume I, no. 183
Alabama Quality
Assurance Foundation
Alabama Quality Assurance Foundation

20. Our challenge is to help protect lives through vaccinations
Our challenge is to help protect lives through vaccinations. “They always say time changes things, but you actually have to change them yourself.” Andy Warhol ( ), The Philosophy of Andy Warhol
Alabama Quality
Assurance Foundation

21. Questions / Comments ?? For more information, please contact:
Betsy Frazer RN, BS
(800) , option #7
Web
This material was prepared by Alabama Quality Assurance Foundation under a contract with the Centers for Medicare & Medicaid Services (CMS). Contents do not necessarily represent CMS policy. 7SOW-AL-IMM-04-01
Alabama Quality
Assurance Foundation

22. What is a Quality Improvement Organization (QIO)?
Established in 1982 by Congress to improve effectiveness, efficiency, & quality of Medicare services
[Statutory Authority: Titles XI & XVII of Social Security Act]
Under the direction of the the Centers for Medicaid & Medicare (CMS)
QIO in each state; in Alabama called
“Alabama Quality Assurance Foundation”
Alabama Quality
Assurance Foundation