1. The Coalition Training Institute At The Center for Pediatric Research
Promoting Evidence-Based Health System Change: A Role for Coalitions 36th National Immunization Conference Denver, CO May 1, 2002
R. Clinton Crews, MPH, Ardythe L. Morrow, Ph.D., and Frances D. Butterfoss, Ph.D.
The Coalition Training Institute
At The Center for Pediatric Research
Norfolk, VA

2. Objective:
To review activities of immunization coalitions and assess whether they are conducting or promoting nationally recommended evidence-based practices.

3. Learning Objective:
To describe how coalitions can enhance community capacity and affect health systems changes through the use of evidence-based practices.

4. Background: Immunization Coalition Survey (10/1999)
To identify active immunization coalitions
To assess status and stability of coalitions
To correlate coalition activities to the
CDC’s immunization program components

5. Background Con’t Methods A self-administered survey was mailed
distributed to known immunization coalitions
in the US
Areas of inquiry included structure, stability,
funding, overview of projects and outcomes

6. Background Con’t Results 104 Surveys mailed with phone follow-up
64 surveys were returned
Response Rate = 62%
74% of coalitions were formed during
the years of
88% were immunizations only coalitions

7. Evidence-Based Practices
Define: Initiatives that have been systematically reviewed for scientific evidence of effectiveness and recommended for implementation

8. Evidence-Based Immunization Strategies
Guide to Community Preventive Services

9. Recommended and Strongly Recommended
Community Demand
Client reminder/recall
Multi-component interventions that include education
Vaccination requirements for child care, school, college

10. Recommended and Strongly Recommended
Access
Reducing out-of-pocket costs
Multi-component interventions (including expanded access)
WIC linkage
Home visits

11. Recommended and Strongly Recommended
Provider-based
Provider reminder/recall
Assessment and feedback for vaccination providers
Standing orders for adult immunization

12. Process of Coalition Effectiveness
Implement
Evidence-Based Strategies
Community
Capacity
Outcomes
Coalition
Building
Assess
and Plan
Reminder/recall
WIC linkage
Etc.
Evaluate
Immunization Outcomes

13. Methods The 64 surveyed coalitions were reviewed
for evidence-based practices through
secondary data analysis
Initiatives were identified and grouped into
the 3 immunization evidence-based
practice categories
Simple frequencies and means were
calculated

14. Results Review for Evidence-Based Practices
421 Evidence-Based initiatives were
reported by surveyed coalitions
72% of coalitions reported one or more
evidence-based initiatives

15. Results Con’t Review for Evidence-Based Practices
48% - Increased Community Demand
28% - Increased Access to Services
24% - Provider-Based Practices

16. Results Con’t Review for Evidence-Based Practices
Coalitions that indicated one or more
evidence-based initiatives reported
improved immunization rates
Rates ranged % over baseline

17. Discussion Limitations of the analysis
Immunization outcomes could not be linked directly to any specific evidence-based initiative
Not all coalitions reported outcomes data
Outcomes data ranged in reporting dates and methods
Survey was conducted before the Guide to Community Preventive Services’ report on Evidence-Based Immunization Strategies, 2000

18. Discussion Con’t
52 % of coalition initiatives focused on health system changes prior to the report on evidence-based practices
(28% - Increased Access to Services)
(24% - Provider-Based Practices)

19. Discussion Con’t
Surveyed coalitions with one or more evidence-based initiatives reported on average a 17 % increase in immunization rates

20. Conclusion Coalitions in the 21st Century have a new standard:
Accountability
Organizationally competent
Population representative
Evidence-based in process and services

21. “In democratic countries the science of associations is the mother science; the progress of all the rest depends upon the progress it has made.”
Alexis De Tocqueville
Originally published in Democracy in America (1835)

22. Coalition Training Institute
R. Clinton Crews, M.P.H.
Coalition Training Institute
At The Center for Pediatric Research
Eastern Virginia Medical School
Children’s Hospital of The King’s Daughters
Norfolk, Virginia