1. 1 Reading Between the Rankings: A Case Study in Immunization Policy and Practice Presentation to the State Health Research and Policy Interest Group June 25, 2005 Boston, MA

2. June 2005Colorado Health Institute2 Translating research into policy options: New methods, old challenges 1) Striking while the iron is hot –Dealing with power surges and staying relevant 2)Bridging science with the messiness of the policymaking process –Can the scientist be truly comfortable with the translational process? 3)Once the bridge is built, moving information into an action agenda

3. June 2005Colorado Health Institute3 The Colorado Health Institute: An untested hypothesis Created by three conversion foundations in Colorado Established as a 501(c)3 nonprofit organization to be a community good Independent, nonpartisan and objective source of health and health care information Translational research, policy analysis, convener, and leadership

4. June 2005Colorado Health Institute4 Scoping the problem: Why is Colorado 50 th and what should be done about it? CHI asked to examine the immunization problem in light of the evidence … TABOR, constitutional spending limits CO public health infrastructure faltering Lots of finger pointing, not much useful information or policy solutions coming forward $$$ get allocated in 2004-05 with little discussion about nature of problem, targeting of dollars

5. June 2005Colorado Health Institute5 Being relevant, being timely CHI proposes a 4-month project to: Examine National Immunization Survey (NIS) data and CDC methods for calculating rates Conduct key informant interviews with CO immunization experts Identify idiosyncrasies with commonly cited rankings Review, analyze and report on CO laws and regulations, and vaccine purchasing policies Review policy and funding options based on the evidence collected, suggest strategies for public and private engagement to craft a statewide immunization agenda

6. June 2005Colorado Health Institute6 Methods Literature Review Data Analysis Key Informant Interviews Regulatory and Program Review Expert Consultation

7. June 2005Colorado Health Institute7 Estimated Vaccination Coverage for Individual Vaccines and Selected Vaccination Series Children 19-35 Months of Age, Colorado U.S. National Immunization Survey, 1997 - 2003

8. June 2005Colorado Health Institute8 Findings from the NIS Data Low CO 2-year-old rates on recommended vaccination series driven by 4+DTaP National DTaP shortage and state policy decisions contributed to 4+DTaP rates Otherwise, 2-year-old coverage rates for individual vaccines at/near federal goals Timeliness is an issue for all young children, especially vulnerable infants

9. June 2005Colorado Health Institute9 Key Informants expert consultation Provided anonymity Helped define scope of the data analysis Identified key literature to review – published and unpublished Provided Colorado and national context Provided scientific review of the final report

10. June 2005Colorado Health Institute10 CO regulatory & program review DTaP experience points to weak infrastructure Access most-often cited barrier, after poverty Provider barriers to VFC participation Client financial and logistical barriers persist Public funds/programs are fragmented, not coordinated Analytical capacity and data for planning lacking Successful public and private models do exist

11. June 2005Colorado Health Institute11 Options for Improvement Encourage state-level leadership and interagency coordination re: IM policy Invest in improved information systems – data for planning, outreach and QI Fund evidence-based programs

12. June 2005Colorado Health Institute12 Translational Research Challenges Deciding on the type of publication: length, depth of analysis, assumptions Finding the right voice: scientific vs. policymaker Integrating and citing the different types of data Implementing the review process

13. June 2005Colorado Health Institute13 Why the study was important to funders Desire to response to media coverage and the ranking of 50 th Recognition of an opportunity to improve population health Need for translation of the science to support the development of intervention strategies

14. June 2005Colorado Health Institute14 Beyond Immunization Policy While the policymakers debated policy changes needed, kids are not getting their shots Based on the States budget experience in recent years, it was unlikely that additional resources would be allocated to reach un- or under-immunized kids with timely immunizations

15. June 2005Colorado Health Institute15 Beyond Immunization Policy The Immunization White Paper prepared by an independent third-party gave the findings credibility Community organizations and funders could provide leverage to support needed policy changes Other funders could document the value of the intervention and make it a funding priority

16. June 2005Colorado Health Institute16 Anticipated Outcomes Raise awareness of the problem and solutions Generate new resources to address the problem Facilitate dialogue and action among public and policymakers Demonstrate the value of the objective analysis and translation of science for policymakers

17. June 2005Colorado Health Institute17 Methods re-visited, lessons learned It is more possible than often experienced to do timely and relevant translational research that moves information into action If the iron cools down, find an alternative outlet Dont be afraid to be bold in recommending a policy direction when the evidence can back you up

18. June 2005Colorado Health Institute18 For a copy of the CHI Immunization White Paper…. Please visit our web site at: www.coloradohealthinstitute.org If you have further questions about the study or CHI please contact: Sherry Walker, Director of Communications walkers@coloradohealthinstitute.org