1. Racial and Ethnic Adult Disparities in Immunization Initiative (READII) Update June 1, 2004 Lance E. Rodewald, MD Immunization Services Division, National Immunization Program, CDC

2. READII Project  Two-year (+), demonstration Project  Five sites: – Chicago, IL – Milwaukee, WI – 19 county region of Mississippi – Rochester, NY – San Antonio, TX  HHS initiative with collaboration of CDC, CMS, HRSA, AoA, and AHRQ

3. Underlying Principles  Local leadership  Communities need to engage critical partners  Evidence-based interventions – Providers – Community  Two season approach

4. Recommended Interventions

5. Programmatic Strategies  General strategies: – Increase demand – Increase access – Improve provider vaccination practices  Target multiple provider groups  Tailor specific interventions based on local needs and capacity  Key factors for choosing interventions: – Feasibility – Expected impact on target population

6. What’s been going on…  Sites and Agencies have formed new, partnerships and engaged their communities  Infrastructure needs/gaps are better understood  Evidence-based interventions are underway  Evaluation efforts are planned to look at both outcome and process measures  Formative research is generating ideas for targeted health education messages to patients and providers, including media campaigns  READII activities have been widely publicized

7. CDC Director Julie L. Gerberding holds up the READII Provider Tool Kit at a press conference. PHOTO CREDIT: Evan Vucci--AP Provider Tool Kit

8. Mid-Course Review Meeting – March 9-10, 2004 - Goals  Review and discuss successes and challenges thus far in the project  To allow discussion of issues and challenges with CDC, partners and invited panelists; and  To share site-specific project information with senior officials from HHS and other partners.

9. Invited Panelists’ Observations  Significant barriers to greater private provider participation include: – Multiple competing prevention priorities (i.e., “providers are slammed”) – Lack of financial incentives (e.g., to implement interventions) – Concern about financial risk (e.g., vaccine purchase) and sustainability

10. Invited Panelists’ Recommendations  Establish relationships with public health providers, targeted communities, and others to foster a prevention mindset for adults  Adopt an “intergenerational approach” to messages and vaccination  Develop “menu” of approaches to flu vaccination  Provide vaccine in a replacement model to avoid up-front provider costs

11. EvaluationEvaluation

12. READII Evaluations  Outcome evaluation: change in coverage at the population level  Evaluation of specific interventions

13. Outcome evaluation  Telephone survey of Medicare beneficiaries residing in project areas.  Wave 1 – Feb-May 2003 (analysis underway)  Wave 2 – Feb-May 2004 – (data collection complete)  Wave 3 – Feb-May 2005

14. Outcome evaluation  Topics – Vaccination – Provider recommendation – Knowledge – Attitudes  Objectives – Measure change over time – Understand relationship between R/E and various factors predictive of vaccination

15. Influenza Vaccination by READII Site and Race

16. Provider Recommendation and Influenza Vaccination Provider recommendedNo provider recommended % of participants

17. Influenza Vaccination by Belief about Illness Among Those Who Report Provider Recommendation *Never vaccinated excluded

18. Pneumococcal Vaccination by READII Site and Race %vac c inated

19. Provider Recommendation and Pneumococcal Vaccination Provider recommendedNo provider recommended % of participants

20. Evaluation of specific interventions  Standing orders in health departments  % of eligible persons vaccinated after implementation of SO  Practices targeted for assessment and feedback  % implementing change  pre and post coverage

21. Evaluation of specific interventions  Practices provided free vaccine  Provider attitudes towards receipt of free vaccine  Pre and post coverage  Pharmacist vaccination  Number of persons vaccinated each flu season, pre and post READII  Proportion of persons presenting for flu shot who are eligible for and receive pneumococcal vaccine

22. Evaluation of specific interventions  Reminder/recall  coverage pre and post implementation  Community immunization clinics  proportion of persons presenting for flu shot who are not “regulars”  proportion of eligibles who receive pneumococcal vaccine

23. What’s Next?  Programmatic activities end December 31, 2004;  Final wave of evaluation activities: January 2005  Dissemination of findings  Replication?

24. Extra Slides Start Here

25. Special Thanks to…  Staff at all 5 of the READII sites  Our Partners: HHS, CMS, HRSA, AoA, AHRQ  Our Contractor: AED  Our CDC and NIP staff: CDC Office of the Director and NIP Program, Communications and Evaluation staff

26. Challenges  Identification and engagement of key stakeholders  Effective Communications  Implementation of strategies  Evaluation  Sustainability

27. Ongoing Challenges  Raising adult influenza/pneumococcal immunization levels – particularly among minorities – is complicated and will likely require different partnerships and multiple, long-term strategies from those that were successful in childhood programs.  Misconceptions abound for both the public and health care providers about adult immunizations.

28. Thinking about the Future  Partners and partnerships -- need to be credible, strategic, and sustainable  “Free” is a powerful word and incentive – to both providers and targeted populations  Messengers need to be “trusted”-- and messages need to be strong, consistent, “localized,” and culturally sensitive