1. NVPO Webinar Series: Project Successes and Challenges July 18, 2013

2. Welcome and Overview Bruce Gellin, M.D., M.P.H. Shary M. Jones, Pharm.D., M.P.H., BCPS CDR— U.S. Public Health Service National Vaccine Program Office Alaysia Phillips, M.P.H.—JBS International, Inc.

3. Presenters Nichole Bobo, M.S.N., R.N.—National Association of School Nurses David Kaelber, M.D., Ph.D., M.P.H., F.A.A.P., F.A.C.P.— MetroHealth System (Case Western Reserve University) Jacob Bueno de Mesquita, CDC P.H.A.P.—Union County Health Department Karen Hegranes—Langlade County Health Department

4. Bruce G. Gellin, M.D., M.P.H. Deputy Assistant Secretary for Health and Director National Vaccine Program Office U.S. Department of Health and Human Services Insert video here

5. National Association of School Nurses HPV - Enhancing School Nurse Knowledge to Support Informed Adolescent Vaccine Decision-making Nichole Bobo, M.S.N., R.N. Director of Nursing Education National Association of School Nurses nbobo@nasn.org

6. Successes Resources for school nurses Enthused content for review: – NASN IZ Advisory Committee – CDC Preteen/Teen NASN support builds our IZ platform – Executive Director – Director of Research (evaluation metrics) – Director of Continuing Education (navigating new ANCC requirements) Launching Date

7. Challenges Competing priorities Meeting task timeline – New implementation of ANCC guidelines – Unable to engage reviewer – NASN Bi-Annual Board Meeting & Annual Conference (6/22-7/1) – Learning management system School environment

8. Lessons Learned/Best Practices CNE development Challenges ≠ developing this resource Immunization partners = strength & quality Schools and school nurses are part of the medical neighborhood

9. Evaluation/Measurable Outcomes Process measures channel the work Outcome measures Current recommendations Influencing factors Recommended interventions CNE Knowledge Outcomes Pretest Posttest 30 day assessment Geographic location Student population Tracking Interventions used School Nurse Reach & Practice Outcomes Pre-CNE 30 day assessment Immunization website traffic (http://www.nasn.org/Tools/Resources/Immunizations )http://www.nasn.org/Tools/Resources/Immunizations

10. Closing Next Steps ‒Launch & advertise CNE/revised website ‒Collect evaluation metrics ‒Efforts to sustain

11. MetroHealth System (Academically affiliated with Case Western Reserve University) Using Electronic Health Record Technologies to Improve Vaccinations David Kaelber, M.D., P.h.D., M.P.H., F.A.A.P., F.A.C.P. Associate Professor, Internal Medicine, Pediatrics, Biostatistics, and Epidemiology dkaelber@metrohealth.org

12. Successes Standing orders approved for diphtheria, HPV, influenza, pertussis, pneumovax, and tetanus (not herpes zoster) Health Maintenance Reminders built for diphtheria, HPV, influenza, pertussis, pneumovax, and tetanus (not herpes zoster) Smart Sets built for diphtheria, HPV, influenza, pertussis, pneumovax, and tetanus (not herpes zoster) “Model” site for immunization decision support as designated by Epic corporation

13. Challenges Vaccine administration and tracking for Herpes Zoster and Tdap are VERY COMPLEX because of the reimbursement mechanism (Part D Medicare) Operationalizing vaccinations for people who are behind

14. Lessons Learned/Best Practices Focus on immunizations that can be given (and reimbursed) in the clinic only Couple Health Maintenance Reminders with Best Practices Alerts (reminder that immunization (s) needs to be given with “1-click” solution to order immunization (s)) Develop complete work flow: – Health Maintenance Reminders/Best Practice Alerts – Standing Orders – Patient Messaging – In-Clinic Immunizations – Evaluation and Monitoring

15. Evaluation/Measurable Outcomes Still data gathering Process Measures – Number of patients with adult immunization Health Maintenance Reminders – Numbers of times adult immunization Best Practice Alerts fired – Number of times adult immunization smart set used – Number of adult immunization messages sent Outcome Measures – Pre-Post improvement in adult immunization rates for diphtheria*, herpes zoster*, human papilloma virus, pertussis*, pneumovax, and tetanus* *Impossible to track immunizations given in pharmacies

16. Closing Next Steps ‒Messaging patients ‒Continued evaluation ‒Healthcare system-wide operationalization after the grant

17. Union County Health Department HPV Immunization Campaign Jacob Bueno de Mesquita, CDC P.H.A.P. Union County Health Department Nursing Division alex.jones@uchd.net

18. Successes Emphasized education on HPV and HPV vaccine -Education to nursing staff and target population Collected survey data on knowledge and attitudes toward HPV Vaccination Reduced economic barriers by enrolling eligible Medicaid Family Planning clients Targeted VFC eligible clients to provide free vaccine Expand access through community outreach and reduce economic barriers Educate on HPV disease, risks, and vaccine Improve vaccination series completion Project Goals:

19. Challenges Lack of money to immunize privately insured youth – In Union County, 38% of children are either uninsured or on Medicaid Only able to use VFC vaccine for this population Through outreach/education, our socially conservative county was more receptive than expected. However, igniting our BRAND is a process as well as trying to access schools Integrating routine HPV vaccination across all care providers

20. Lessons Learned/Best Practices Branding! Incentives for survey completion Recruit more survey takers! Offer vaccine to all eligible clients, who come into the health department Educational Materials: -Quick Facts -Merck Info -CDC Info

21. Evaluation/Measurable Outcomes Called 750 uninsured (eligible) boys & girls about starting or completing the HPV series Surveys (n=17) – 41% agreed to take the vaccine Cited a desire to protect health against a preventable disease – 59% declined the vaccine Cited lack of knowledge Completed Doses: Number of boys receiving vaccine is up by two-fold compared to previous years!

22. Closing Anticipate back to school increase in numbers. Collect more data – assess barriers Next Steps:

23. Langlade County Health Department Langlade County Adult Immunization Health Project Karen Hegranes, M.S.N., P.H.N. Clinical Supervisor of Public Health Langlade County Health Department khegranes@co.langlade.wi.uskhegranes@co.langlade.wi.us.

24. Successes Designed an Adult Immunization brochure and distributed it to our health care partners and community Increased awareness regarding adult vaccination opportunities using print and radio advertisements for adult clinics and reminder letters information individuals which vaccines they quality for due to age or uncompleted series. Alerting adults they may qualify for state provided vaccine which is administered without costs to adults uninsured and underinsured; this includes HPV and Pneumococcal Polysaccharide. Strengthened and improved relationships with local pharmacies and immunization providers for adults, through referrals and patient education

25. Challenges Database for reminder letters is not up-to-date for current addresses, so a % of letters to not make it to the clients. Benefits is that we can clean our resident database records of those moved out of the county. Cost of vaccine for Zoster is prohibitive for many seniors Many adults do not know they are eligible for vaccination

26. Lessons Learned/Best Practices Partnering with programs with matching demographics of target populations increases success. Working with the WIC program has been an excellent match. The Technical College clinics were held did not yield great vaccination numbers; it turned out the days selected had a low number of students and classes in the building.

27. Evaluation/Measurable Outcomes Quality improvement survey has given us monthly data regarding our adult immunization program Wisconsin Immunization Registry provides reports to quantify data

28. Closing Next Steps ‒Continue to incorporate adult vaccination in our clinics and look for new methods to communicate reminders to get immunized. Reminder calls, texting, and social media.

29. Question and Answer Session Please send questions via WebEx chat box.

30. Please visit http://nvpo.jbsinternational.com to view Webinar recordings and presentations. Next Webinar: July 18, 2013, 2:00 p.m. (ET)http://nvpo.jbsinternational.com