1. Strategies for Late Season Flu Vaccination 40th National Immunization Conference of CDC March 7, 2006
Victoria Davey, RN, MPH
Office of Public Health and Environmental Hazards
Department of Veterans Affairs
Washington, DC

2. VA Health Care 5.1 million patients/year 7.5 million enrolled for care
1,300 Sites-of-Care
158 medical centers or hospitals,
850 clinics, long-term care, domiciliaries, home-care programs
$27.4 billion budget
193,000 Employees (~15,000 MD, 56,000 Nurses, 33,000 Allied Health Professionals)

3. VA Health Care Affiliations with 107 Academic Health Systems
Additional 25,000 affiliated MD’s
Largest provider of health professional education
Most US health professionals (70% MD’s) have some training in VA
$1.7 Billion Research Program
Basic, Clinical (Cooperative Studies), Rehabilitation, Health Services Research

4. VA Health Care A truly “national” healthcare system
Increasingly recognized as leader in quality of care:
Heart disease
Diabetes
Prosthetics
HIV
Hepatitis C
Fully deployed Electronic Health Record—uniform throughout U.S.

5. Annual Flu Vaccination
How does VA do?

6. VA Patient Flu Immunization Rates Chart Review
02-03
03-04
04-05
VA Performance Goals
03-05
HP 2010 Goal
Veterans
(> 49 yo, or w/ chronic illness)
70%
75%
79-82%
90%
Source: External Peer Review Program Surveys, , 11 clinics + SCI & D

7. VA Patients’ Self-Reported Flu Vaccination Rates
FY 03
All (> 49 yo) 75%
>64 yo %
NH Whites %
NH Blacks %
Non-VA vaccine 45%
n=102,347
FY 04
All (> 49 yo) 82%
>64 yo %
NH Whites %
NH Blacks %
Non-VA vaccine 38%
n=159,142
Source: Survey of Healthcare Experiences of Veterans (SHEP)

8. VA Staff Flu Vaccination Rates
Anecdotes: rates of 80-90% of facility staff (this season)
Probably a very wide range
System-wide survey this year

9. Seasonal Flu: VA’s Annual Actions
Annual Under Secretary for Health Directive
Communicates priorities, implementation issues
Setting goals/performance measures for flu vaccination—advised by VA “Flu” Group
Purchase / distribution of flu vaccine supplies
Dissemination of VA Influenza Toolkit
VA Influenza Vaccine Advisories
Regular reminders, guidance
Leadership speaks
Infection: Don’t Pass It On Campaign

10. VA’s Priority Groups 05-06 Flu Season
Pts >65yrs old
Pts of any age with comorbid conditions
Residents of VA’s long term care facilities (including group or shelter situations)
Pregnant women veterans
Personnel who work in VA healthcare facilities
Veteran household contacts and out-of-home caregivers of children aged <6months

11. VA’s Goals for Season
Increase rates of vaccination in personnel at all sites
Maintain/Increase rates of vaccination of veteran patients
Provide pneumococcal vaccination where indicated
Involve all staff and providers in promoting influenza vaccination
Promote nonvaccine methods of preventing infection (hand/respiratory hygiene)

12. Seasonal Flu: VA’s Annual Actions
Annual Under Secretary for Health Directive
Communicates priorities, implementation issues
Setting goals/performance measures for flu vaccination
Purchase / distribution of flu vaccine supplies
Dissemination of VA Influenza Toolkit
Regular reminders, guidance
VA Influenza Vaccine Advisories
Leadership speaks
Infection: Don’t Pass It On Campaign

13. VA’s Flu Vaccine Purchases
Year
Doses Purchased
1998
986,530
1999
1,163,250
2000
1,461,280
2001
1,841,760
2002
1,587,250
2003
2,049,750
2004
2,070,790
2005
2,240,000

14. Seasonal Flu: VA’s Annual Actions
Annual Under Secretary for Health Directive
Communicates priorities, implementation issues
Setting goals/performance measures for flu vaccination
Purchase / distribution of flu vaccine supplies
Dissemination of VA Influenza Toolkit
VA Influenza Vaccine Advisories
Regular reminders, guidance
Leadership speaks
Infection: Don’t Pass It On Campaign

15. Methods to improve staff and patient vaccination rates
Vaccine Information
Inactivated influenza, LAIV, pneumococcal
Methods to improve staff and patient vaccination rates
88% of veterans >64; assessing staff rates this year
Tools for Flu Prevention
Buttons, stickers, posters
Frequently asked questions
Eligibility for vaccine, HIV/AIDS, vaccine storage, LAIV
Resources, references, and web sites

16. Toolkit materials sent to
8 key contact groups at each VA medical center
Influenza vaccination (“flu”) coordinators
Occupational health clinicians
Prevention coordinators
Infection control professionals
Public affairs officers
Patient educators
Patient safety officers
Education contacts

17. Seasonal Flu: VA’s Annual Actions
Annual Under Secretary for Health Directive
Communicates priorities, implementation issues
Setting goals/performance measures for flu vaccination
Purchase / distribution of flu vaccine supplies
Dissemination of VA Influenza Toolkit
VA Influenza Vaccine Advisories
Regular reminders, guidance
Leadership speaks
Infection: Don’t Pass It On Campaign

18. USH Flu Vaccine Advisories
VA Influenza Vaccine Advisory #4 for the Influenza Season   VA_Flu_Vaccine_Advisory_4_ pdf  (220k PDF file)   VA_Flu_Vaccine_Advisory_4_ tif  (233k TIFF image file) VA Influenza Vaccine Advisory Attachment Revised/renamed fact sheet: Prevention and Treatment of Seasonal Influenza A and B Using Oseltamivir, updated January 2006    PxandRxofSeasonalFluwoseltamivir.Jan2006.pdf   (43k PDF file)
Seasonal Influenza
VA will follow CDC recommendation against the use of amantadine and rimantadine this season
Continue the VA Influenza Vaccination Program this season
Use public health measures to prevent and control seasonal influenza
Under Secretary for Health
Issues new guidance, advice, feeds back data, and thanks the “field”
7 in season
4 in to date

19. More system-wide strategies…
Ongoing reminders
Weekly ed “VA Flu Campaign TIP OF THE WEEK”
Ideas solicited from VA clinicians
Mid-October to February
Sent in a nicely-designed to 1000s of staff
National focus groups
Held twice in January
What works for your site’s flu campaign?
How can VA Central Office help?
Infuenza A – early passage

20. More system-wide strategies…
Ongoing production and dissemination of “tools”
A lower reading level VIS
For use with the CDC version
Posters tailored to VA audiences
Including CDC materials (thanks)
Web-based survey to evaluate Flu Toolkit
Ideas for next year
Infuenza A – early passage

21. Seasonal Flu: VA’s Annual Actions
Annual Under Secretary for Health Directive
Communicates priorities, implementation issues
Setting goals/performance measures for flu vaccination
Purchase / distribution of flu vaccine supplies
Dissemination of VA Influenza Toolkit
Regular reminders, guidance
VA Influenza Vaccine Advisories
Leadership speaks
Infection: Don’t Pass It On Campaign

22. Infection: Don’t Pass It On
Non-vaccine preventive measures encouraged in an active national campaign
hand hygiene, respiratory hygiene

23. Late season vaccination—how does VA do?

24. 2004-2005 Flu Vaccine Utilization
As of April 6, 2005
1,874,176 doses used (91%)
16% was administered mid January-March
Metrics for being collected
For VA patients
For VA health care facility staff

25. Summary--strategies to achieve late season vaccination
Set system-wide goals—specific to the season
Make flu vaccination of patients a performance measure for health care facilities
Keep leadership visible and vocal throughout the season
Communication, communication, communication
Establish multidisciplinary “key” contacts
Listen to the advice of staff and patients and share/act on it
Act quickly when policy changes are needed
Invest resources
Toolkits, promotional items, awards to field
staff who contribute or innovate

26. VA Web Resources www.publichealth.va.gov/flu/