1. Implementation and Evaluation Planning of the Oregon and Washington 4th DTaP Initiative
Focus on the Fourth DTaP Initiative
Karen Elliott, Oregon Partnership to Immunize Children
Ginny Heller, Immunization Action Coalition of Washington
Mary Beth Kurilo, Oregon State Public Health
Michele Perrin, Washington Department of Health
In collaboration with:
Desautel Hege Communications
Deschutes County Health Department
Thank you for joining us today. As you just heard, 4 of us are here to talk about “Implementation and Evaluation Planning of the Oregon and Washington 4th DTaP Initiative.” We want to be sure to acknowledge all the partners in this effort – it really is the many skills and abilities that everyone brings to the table that has made this project such a success. We hope you can use our model as a way to do your own health promotion work.

2. We just wanted to quickly show you on this map of the United States where Oregon and Washington are situated. As you can see these two states dominate the northwest and cover a very large geographic area. This graphic representation has been important when sharing this information with other states.

3. 6,068,996 people living in 71,303 square miles
Washington:
6,068,996 people living in 71,303 square miles
18th largest state
2004 NIS 4:3:1:3:3 = 77.7%
Oregon:
3,521,515 people living in 98,386 square miles
9th largest state
2004 NIS 4:3:1:3:3 = 78.9%
US 2004 NIS 4:3:1:3:3 = 80.9%
Here is some more specific information on our states. Together we cover close to 170 thousand square miles and have almost 9.5 million people, both in urban centers and many rural areas. It is important to note that both states immunization rates are below the national average, although we continue to increase and narrow the gap every year.

4. Differences in 3rd & 4th DTaP Immunization Rates
U.S. National Immunization Survey 2004
Project impact on NIS data would likely appear in 2+ years

5. Increased Pertussis Disease
Pertussis (whooping cough) increasing in Oregon and Washington
Pertussis incidence higher than national average*
National: 7.2 per 100,000
Oregon: cases per 100,000
Washington: cases per 100,000
Infants and young children at greater risk for severe complications
Pertussis is the only vaccine preventable disease that is increasing. What is really important about pertussis is protecting our infants – they are at the greatest risk from serious disease. WA and OR rates are much higher than national averages. This increase, combined with the lower 4th DTaP immunization rates, leaves our young children at risk. Older children and adults often don’t know they are infected – they may only have a minor cough – but they can easily pass it on to young children. Infants who get pertussis often have to be hospitalized and have high risks of serious complications like pneumonia and seizures.
*2005 Provisional Pertussis Surveillance Report, CDC, 1/20/06

6. WOW! The Washington Oregon Workgroup
Collaborative effort between Washington and Oregon’s Immunization Programs and Coalitions
Multiple stakeholder involvement (Local and State Health, Coalition Members, Vaccine Manufacturers, etc.)
Conference calls
Face to face meeting to develop strategic plan using logic model

7. Tips on Regional Partnership
Build on existing relationships and common partners
Define the problem and shared needs
Develop joint written plan
Be flexible – some activities will be done together, and some will be on your own
Schedule regular meetings
Involve coalition members

8. Benefits of a Regional Approach
Fosters innovative strategies
Strengthens partnerships
Maximizes resources
Increases credibility and impact
Takes advantage of similar population demographics and public health structure

9. Goal and Methods Goal – Methods –
Increase Washington and Oregon immunization rates by increasing the timely administration of the 4th DTaP vaccine and protect young children against pertussis.
Methods –
Regional action plan developed based on data and best practices
Collaboration with public and private health partners
Instituted a two state 4th DTaP initiative

10. What Works Multi-faceted interventions Client reminders and recalls
Provider reminders and recalls
Assessment and feedback for vaccination providers (e.g., AFIX)
Administer the 3rd DTaP on time, 4th DTaP is more likely to be on time
Take advantage of every medical encounter
Sources: Briss et al. Am J Prev Med 2000 Jan;18(1 Suppl):97-140; Strine TW, Luman ET, Okoro CA, et al. Predictors of Age-Appropriate Receipt of DTaP Dose 4. AJPM 2003;25(1):45-49; Gaudino et al., The risk and protective factors for incomplete childhood vaccinations in the U.S.: A comprehensive literature review, Earlier findings presented at the annual CDC/HRSA MCH Epidemiology Conference. Currently unpublished; The Task Force on Community Preventive Services. Reviews of Evidence Regarding Interventions to Improve Vaccination Coverage in Children, Adolescents and Adults. Am J Prev Med 2000:18:

11. Initiative Activities
Developed, shared, and distributed educational and media materials
Joint and individual activities in WA and OR
Provider articles
Websites
Materials support local health efforts during pertussis outbreaks
Shared discussion and planning for evaluation strategies

12. Parent and Provider Materials

13. Media Materials TV, radio and print PSAs in English and Spanish
Billboard
New Release and press conference

14. Evaluation
Includes process measures, short term outcomes, and long term outcome
Media statistics (# articles, # times PSA played)
Website hits
Parent surveys
Vaccine doses distributed
Immunization registry data
Future National Immunization Survey data

15. Using Oregon and Washington Immunization Information Systems
Target providers and geographic areas for outreach and education
Targeting joint promotion efforts
Assist in selection of underserved population
Assist providers in 4th DTaP work
Reminder/recall and forecasting tools
Measure and evaluate success
Show improvement in immunization rates
Increase tracking 4th DTaP rates in individual provider offices

16. One Facet of Oregon’s Evaluation Effort
Subset: Outcome Evaluation Matrix
Outcome Evaluation Goal
Tool/Method
Schedule of Completion
Responsible
Party
Increase the 4th DTaP UTD rates in local public health departments by an average of 5%
Conduct pre/post measurement using ALERT data and AFIX methodology
Q2, 2007
State Immunization Program and local health departments

17. AFIX, Local Health Departments
Oregon uses 100% IIS (registry) data for AFIX assessments
Local Health Departments are assessed and measured every year
Baseline measure for 2004: 68.2%
Average of 35 Oregon Counties
Interim measurement - June 2006
Final measurement - June 2007

18. Further Analysis
Explore differential local health department rates based on:
Media sites (placement of billboards, airtime for TV/radio PSAs)
Inclusion of 4th DTaP goals in County Annual Plans
Dissemination of print materials to public and private sites

19. One Facet of Washington’s Evaluation Effort
Subset: Outcome Evaluation Matrix
Short-term and Intermediate Evaluation Goal
Tool/Method
Schedule of Completion
Responsible
Parties
Parent KAB (knowledge, attitude, behavior)
Importance of DTaP series
Contact provider about child’s vaccine status
Parent Surveys:
Pre/post test convenience sample of MCH resource line
Added 4th DTaP question to a biannual statewide health promotion survey
State immunization program and community partners
2005- Activities completed
Data analysis

20. Parent Survey
CHILD Profile System - Statewide health and safety mailings to parents of children birth to six
4th DTaP parent fact sheet included in the one-year mailing – reaching ~70,000
Biennial CHILD Profile parent survey – added 4th DTaP question
Limitations: response rate, possible selection bias of parents who choose to complete survey
Michele

21. Results from Health Promotion Survey
CHILD Profile sent you a flyer about the 4th DTaP vaccine. After receiving it, did you: % N
Talk with your child’s Dr. about the 4th DTaP
13% 62
Call the toll-free # listed
0.4% 2
Visit the website listed
Get a 4th DTaP for my child 8% 39
Keep it to refer to later
16% 76
Didn’t use it. I already know my child’s imms are UTD
38%
184
Don’t remember getting it
27%
131
I got it, but didn’t read 6% 27

22. What’s Next Continued WOW calls
Planning for year two of the initiative
Incorporation of Tdap education
Continued media work and material distribution
Continued evaluation activities
Disseminate findings
Future OR/WA partnerships

23. Contact Information
Karen Elliott, JD
Oregon Partnership to Immunize Children or
Ginny Heller, MSW
Immunization Action Coalition of Washington or
Mary Beth Kurilo, MSW, MPH
Oregon Department of Human Services or
Michele Perrin, MPH, CHES
Washington Department of Health or
WA 4th DTaP website:
OR 4th DTaP website: