Adult Immunization Program and Initiatives Michigan Department of Community Health Division of Immunization

MDCH Adult Immunization Program: Outline • • • • • • • •

Michigan Uninsured Grant objectives – federal and state MDCH programs, resources, and tools Role of LHDs Partnerships – AIM, MACI, FAB, ACOG Coverage levels – federal and state Educational resources, projects, and websites Future directions and efforts

Uninsured in Michigan • The Uninsured in Michigan: • August 2010, http://www.michigan.gov/documents/mdch /The_Uninsured_in_Michigan_a_Profile_2 010FINAL_329679_7.pdf

Michigan Data • 2008 – 11.7 % of Michigan’s total population was uninsured, – 13.3 % of Michigan’s non‐elderly population was uninsured

• 2006‐2008 – 15.6 % of adults are uninsured – 5.2 %of children are uninsured. – Ages 18 to 34, 22.9 % are uninsured, the highest percent uninsured for all age brackets.

• Uninsured children – Michigan (5.2%) – United States (10.8 %).

Michigan Data • Lower percentage of uninsured residents than the majority of other states in the United States. • Michigan is ranked 14th among states in having a low percentage of uninsured residents at 12.7 % which is 4.8 % below the national average 17.5%.

Adult Immunization Grant Objectives – Federal and State

Immunization Program Operations Manual (IPOM) Chapter 7 • 2008-2012 current 5-year grant cycle • 3 recommended objectives – no requirements • 7.1 Work with partners (e.g., Quality Improvement Organizations, medical professional societies, hospital infection control practitioners) to promote the adoption of evidence-based approaches to increasing vaccination such as the use of immunization information systems (IIS) for client and provider reminder/recall, standing orders, assessment/feedback in settings including hospitals, long-term care facilities, and outpatient clinical settings.

Immunization Program Operations Manual (IPOM) Chapter 7 • 7.2 Work with partners (e.g., Joint Commission on Accreditation of Healthcare Organizations) to increase influenza vaccination of healthcare workers. • 7.3 As 317 funds permit, increase access to vaccines for high risk adults.

2012 Grant - Michigan • 7.1 Promote the establishment of an adult vaccination platform with immunization partners. – Educational messages, articles, toolkits, meetings, INE/PPEPI, website, MI-VRP, etc. – 10% increase in number of adults with a MCIR record – 15% increase in number of adult shot records in MCIR

2011 Grant - Michigan • 7.1 Work with partners to promote the adoption of evidence-based approaches to increasing vaccinations in settings including hospitals, long-term care facilities, and outpatient public and private-based clinical settings. – Educational messages, articles, toolkits, meetings, INE/PPEPI, website, MI-VRP, etc. – 10% increase in number of adults with a MCIR record – 15% increase in number of adult shot records in MCIR

2010 Grant - Michigan • 7.1 Work to establish internal and external partners (i.e., Quality Improvement Organizations, medical professional societies, hospital infection control staff, college-based health centers) to promote the adoption of evidence-based approaches to increasing vaccination such as the use of the registry (MCIR) for reminder/recall, standing orders, assessment/feedback in settings including hospitals, long-term care facilities, and outpatient clinical settings.

MDCH Programs, Resources & Tools for Adults

Michigan Care Improvement Registry (MCIR) • Currently nearly 3.8 million adult immunization records in MCIR • Over 21 million individual adult shot records in MCIR • Reporting is highly encouraged; best practice for immunization

www.mcir.org

Michigan Vaccine Replacement Program (MI-VRP) • Public vaccines (purchased by MDCH) administered through Local Health Departments – – – – –

Federally Qualified Health Centers (FQHCs) Tribal Health Centers Community Health Centers Migrant Health Centers Local Health Department (LHD) clinics

• Very specific eligibility criteria (unlike VFC, race/ethnicity is not a criteria)

MI-VRP Criteria • Patients must qualify in all four areas: – Age • Must be 19 years of age or older

– Lack of insurance • Uninsured or under-insured

– Need for specific vaccines • Vaccines offered: Tdap, Td, MMR, Hep A, Hep B

– Specific risk factors • Varies by vaccine

MCIR Documentation of MI-VRP

Role of Local Health Departments in Increasing Adult Immunization Rates

Role of LHDs • IAP Coordinators facilitate the MI-VRP program • LHDs partners in implementing one-time funding programs • Serve as point of reference for immunization providers on adult immunization issues pertaining to MCIR, MI-VRP,

el es s

no ne

Immunization Partners co ll e ge ST s D cl in ic s

ot he r

co rre sh el ct te io rs na lf ac ad ili t u ie lt LT s f os C te & rc nu ar rs e in g ho m es O H BG IV YN /A ID s cl in ic s ho sp it a ls

ho m

Percent of LHDs

Partners LHDs Collaborate with on Adult Immunizations IAP Report, Fall 2010

100

80

60

40

20

0

Adult Immunization Partnerships

Alliance for Immunization in Michigan (AIM) Coalition • Formed in 1994 in response to low childhood immunization coverage levels • Annual AIM Provider Toolkit printed since 1996 – Childhood, Adolescent, Adult, Vaccine Safety and Resources, Vaccine Storage and Handling, Flu (Online Only) – Around 4,000 kits printed each year

• AIM Website: www.aimtoolkit.org • Coalition at-large meets quarterly; subcommittees meet on regular basis

Mission of AIM • To promote immunizations across the lifespan through a coalition of health care professionals and agencies. • Representation from state health dept., local health depts., hospitals, health systems, health plans and insurance providers, private provider offices, visiting nurse associations, community vaccinators, and pharmaceutical industry

Goals of AIM • Raise the age appropriate immunization levels of all Michigan children to at least 90% • Raise awareness among health care providers and the public of the importance of immunization across the life span • Promote participation in the Michigan Care Improvement Registry (MCIR) by all health care providers • Expand education and development

www.aimtoolkit.org

Michigan Advisory Committee on Immunizations (MACI) • Advise MDCH on immunization programs and policies, including communicable disease rules • Representation from hospitals, health systems, nursing associations, OBGYNs, pediatricians, family practitioners, medical schools, Dept. of Education, Medicaid, local public health, and more • Quarterly face-to-face meetings

Flu Advisory Board (FAB) • Comprised of over 160 members representing public and private health • Formed in 2005 as an Extension of MACI • Member organizations from nurse associations, health systems, health plans, private medical practice, health advocacy groups, and local public health departments • Quarterly face-to-face meetings

ACOG Project: Increasing Immunization Practices among OBGYNs • 4 states: Indiana, Kentucky, Ohio, Michigan • Educational dinner session on March 22 – 7 practices in SE Michigan area – Peer-to-peer training

• In office follow-up through INE program – Vaccinating Women Across the Lifespan, VFC, MCIR, Storage and Handling

• Completion by August, 2011

Adult Immunization Coverage Levels

Adult Immunization Coverage NHIS 2009 vs. MCIR Comparison 70

60.6

60 50 Percent

40

US

33.7

MI

30 20

17.6 10.8

9.8

10

17.1 10

1.7

6.1

4.9

0 Pneumo,65+ Hep A,19-49 Hep B,19-49 Herpes yrs yrs,2 doses yrs,3 doses zoster,60+ yrs

HPV,19-26 yrs,1 dose

Age and Number of Doses Administered MCIR data current as of April, 2011

HPV Coverage – Adult Females MCIR Data as of April, 2011 12.0

10.7

Percent

10.0 8.0 6.1 6.0

4.6

4.0 2.0 0.0 1

2

3+

19-26 years

19-26 years

19-26 years

Age and Number of Doses Administered

Tdap Coverage – Adults

Percent

MCIR Data as of April, 2011 20.0 18.0 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0

18.9

8.5

8.3

8.6

2.4

19-26 years

27-49 years

50-59 years

60-64 years

Age and Number of Doses Administered

65+ years

Settings where Tdap Doses are Administered to Adults

Other, 7.92% Internal Medicine, 3.65% Pediatrics, 6.32% Private Hospital, 13.20%

Local Health Department, 17.19%

Family Practice, 51.72%

Adult Immunization Educational Resources, Projects, and Websites

CDC Features: Adult Vaccines www.cdc.gov/features

Adult Immunization Scheduler http://cdc.gov/vaccines/spec-grps/adults.htm

Adult Immunization Strategies http://www.cdc.gov/vaccines/recs/rate-strategies/adultstrat.htm

New CDC Posters! http://cdc.gov/vaccines/spec-grps/adults.htm

New CDC Posters! http://cdc.gov/vaccines/spec-grps/adults.htm

OBGYN Outreach www.immunizationforwomen.org

Updated IAC Pieces www.immunize.org

Hepatitis B Toolkit http://www.naccho.org/topics/HPDP/infectious/hepb.cfm

Resources for Patients, HCP, & Media www.adultvaccination.org

NFID Materials www.adultvaccination.org

Tdap Outreach & Education www.jointcommission.org/Tdap

MDCH Immunization Webpage www.michigan.gov/immunize

Michigan Immunization Timely Tips (MITT) Newsletter

MDCH Pertussis Webpage www.michigan.gov/immunize

Pertussis Letters from MDCH Chief Medical Executive

Birthing Hospitals OBGYNs Hospital CEOs

Helping Adult Clients Pay for Vaccines

www.michigan.gov/immunize www.aimtoolkit.org

Free Brochures www.healthymichigan.com

Future Directions & Efforts

Future Adult Immunization Efforts • MDCH Adult Immunization Website • Adult Immunization Best Practice Flyers – Targeted to various immunization settings (e.g., colleges/universities, pharmacies, private provider office, long term care facility, OBGYN, etc.)

• Adult Immunization Posters and Flyers • MCIR Data Entry, Tracking, Assessment • Online Training: NetConferences, Videos

Current Gaps Doctor-Patient Communication Breakdown • 90% physicians say they discuss vaccines with patients – Half of consumers cannot recall ever discussing vaccines with provider

• 99% physicians say they or their staff initiate vaccine conversations – 44% of patients agree

Current Gaps • Consumer familiarity with VPDs rose from 4% to 12% (compared to 2009) – Largest increase for pertussis vaccine – Pneumococcal vaccine – only VPD that did not register an increase

• Increase access to adult vaccines in primary care setting • Increase reporting of adult vaccines in MCIR • Health care personnel vaccination