1. NVPO Webinar Series: Project Successes and Challenges June 10, 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 Luis Garza—Communidades Unidas Luana Scanlan, M.B.A.—American Samoa Cancer Coalition Stefan Shearer—Oregon Health Science University Barbara Jorgensen, M.S.N.—Yavapai County Community Health Services

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. Comunidades Unidas/Communities United Influenza Vaccine Project Luis Garza Executive Director Comunidades Unidas luis@cuutah.org

6. Successes Culturally & linguistically appropriate materials Distribution of information at strategic locations Text message reminder database Partnership with local businesses “Healthy Workplace Model” Focus not only on education but connecting community with available resources Prepare community for influenza season and free clinics

7. Challenges Project is being implemented outside influenza season: -Issue is not in people’s minds -Peer to peer outreach / education not as successful as planned -Promotoras are focused on other issues

8. Lessons Learned/Best Practices Build an understanding of the targeted community BEFORE starting the intervention Empower the community to take care of their own health Build collaborative, community-based partnerships Don’t be afraid to think outside the box! Develop thoughtful relationships with community members and organizations

9. Evaluation/Measurable Outcomes Outreach plan created to guide the program Informational materials developed and tested in the community Information displayed in 3 businesses 3 Promotoras (health outreach workers) trained 556 individuals reached thus far 119 individuals added to our reminder database

10. American Samoa Community Cancer Coalition Development of an Evidence-Based HPV Immunization Protocol for the American Samoa Immunization Program, for Delivery into Local Elementary Schools Luana Scanlan Project Coordinator, ASCCC lymyscanlan@yahoo.com lymyscanlan@yahoo.com

11. Alignment with Community Care Coalition (CCC) Goals The HPV Project supports the Cancer Prevention Goal by increasing community awareness of HPV vaccination and HPV related cancers using culturally tailored educational tools

12. Demographics Population of 55,519 (2010) 3.9% age 65+ 92% are Pacific Islanders Leading causes of death: Heart disease Diabetes Cancer Leading cancer types: Breast Lung Ovarian Prostate Healthcare: Block grant Medicare One hospital, 4 clinics 16 dialysis chairs running 24/7 All vaccines at Dept. of Health HPV dosage 2009-2012 is less than 1,000 90% of cancer patients have a less than 2-year survival rate (2010) 33.4% of pop. is age 0 – 14. As of January 2013, there are 3,062 children enrolled in public school grades 6 th – 8 th. 14% are targeted for HPV vaccination

13. Successes HPV project team of relevant stakeholders Established baseline data and developed data collection tools Established first HPV protocol Obtained approval for outreach from the Department of Education Obtained commitment from the Department of Health Nursing Director Worked on recall system Established several partnerships

14. Challenges Low prioritization by Department of Health Lack of data Lack of supporting infrastructure: -No protocol -No organized outreach -No dedicated medical staff Under-utilized data management system Poor leverage of partnerships and resources Result Low HPV literacy Low HPV vaccination rate

15. Evaluation/Measurable Outcomes HPV Vaccine Coverage Among Adolescents Age 11–14 in Registry 2012-2013 (n=928) 0123 459 Males372 81% 44 9.6% 25 5.5% 18 4% 469 Females226 48% 124 26% 74 16% 45 9.6% 928 Total598 64% 168 18% 99 11% 63 6.8% SOURCE: Immunization Registry, Feb. 2013 Baseline Data Complete HPV vaccine coverage is low: less than 4% in the Registry and 1% in the public school system compared to 27% nationally and approximately 25% in the target age range (WHO, 2011).

16. Evidence to Support Project Objectives Community based interventions implemented in combination to increase vaccination rates produce the highest impact when inclusive of community-wide Education Reminder and recall interventions are effective in improving vaccination coverage especially with multiple dose vaccines like the HPV vaccine Project Objectives 1.Expand access to HPV vaccine amongst kids age 11-14 (grades 6–8) 2. Ensure incoming freshman high school students have completed 3 doses of HPV vaccine 3. Increase community demand for HPV vaccination using parent/client education in DOE settings Project Tasks 1.Establish a systematic immunization schedule in DOE Schools 2.Improve ASIP HPV client reminder system 3.Develop parent-focused HPV education that ASIP will implement prior to ‘Immunization Day’ in each elementary school

18. Closing Next Steps: Developing tools: Department of Health nurses’ in-service Event planners Pre-Immunization Day education (Continuing Medical Educations) Parent-focused HPV education Our implementation plan: Piloting ‘Immunization Day’ in two elementary schools which have the most children reportedly not immunized per Registry

19. Oregon Rural Practice-based Research Network Rural Adolescent Vaccinations in Enterprise Quality Improvement (RAVE) Stefan Shearer Research Assistant Oregon Health Science University shearest@ohsu.edu

22. Challenges Technology -Reporting and recall functionality of State database has been malfunctioning for the past month IRB -IRB approval was delayed which caused the start date for outreach to be pushed back. In the end, the IRB determined no oversight was needed.

23. Lessons Learned/Best Practices It takes coordination on behalf of the entire care team (patient, front office, MA/RN, clinician) to begin improving immunization rates and keeping patients up to date Understanding each other’s role in the workflow and increased and closed-loop communication allow the care team to cross-monitor and prevent patients from “falling through the cracks”

24. Evaluation/Measurable Outcomes Outreach began on 5/20 – From 5/20 - 5/31, patients received:  1st HPV – 1 female  2nd HPV – 2 males – Lag time between outreach and immunization – First monthly report on outreach efforts due on 6/20/13 Up-to-date patients ages 11-18 n = 404 206 females 198 males Taken from baseline assessment on 3/1/13

25. Closing Next Steps – Continue outreach efforts (first report due on 6/20) – Continue to look for ways to improve upon workflow Questions?

26. Yavapai County Community Health Services Increasing routine HPV vaccination for adolescents/young adults Barbara Jorgensen, M.S.N. Section Manager, Family Health & Wellness Yavapai County Community Health Services Barbara.Jorgensen@yavapai.us

27. Successes Use of proven intervention strategies – Computerized record reminders for physicians – Mailed reminder postcards – Telephone reminders – Patient education Collaboration between Federally Qualified Health Center (FQHC) and Public Health Department

28. Post Cards/Movie Slides

29. Challenges Initial delay in getting contract signed/approved by the County Authority Delays occurred with contractor for EMR in making the changes/template enhancements Could not generate a list of patients/families for phone call reminders until EMR upgrades completed

30. Lessons Learned/Best Practices You cannot always be prepared for changes/challenges Allow the people with the most experience in a particular area to participate in decision making, etc. Using proven strategies should equate to improved outcomes

31. Evaluation/Measurable Outcomes Able to report numbers of outreach contacts for phone reminders and postcards Number of families reached by movie theater slides less tangible Know baseline number of patients in clinic who have ever had even one HPV vaccination prior to this project will compare this to the number of clients (within designated age group) who received HPV since project began

32. Closing Next Steps: – EMR template changes will remain – will develop physician/nurse training slides for new providers – Phone reminder calls will also continue – at least annually – Continue to monitor numbers – hope to see continued rise in HPV vaccination rates – AZ participation in 317 funding will make HPV vaccine available to uninsured/underinsured (19-26 year olds) Questions?

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

34. Please visit http://nvpo.jbsinternational.com to view Webinar recordings and presentations. Next Webinar: June 24, 2013, 2:00 p.m. (ET)http://nvpo.jbsinternational.com