First STEPS (Strengthening Together Early Preventive Screening) Learning Initiative:

Improving Immunization Rates Celebration Dinner

Friday Night LightsThe “I” Team-

There is no “I” in Team, Except Immunizations

Amy Belisle, MD, Sue Butts-Dion, Cassandra Grantham, MASeptember 2012

The First STEPS Learning Initiative is part of the Maine Improving Health Outcomes for Children demonstration grant awardedby the Centers for Medicare and Medicaid Services to MaineCare in partnership with the Maine Center for Disease Control and Prevention,

the Muskie School of Public Service at the University of Southern Maine, Vermont’s Medicaid Program, and the University of Vermont.The Celebration Dinner is Sponsored by the MaineHealth Childhood Immunization Task Force

Game Plan for the Evening

• The First Steps Highlight Reel• The 5th Quarter- The Work Continues• The Awards Ceremony

• The Booster Club- How Your Work Continues to Impact Immunization Rates and Improve the Lives of Children in Maine

First STEPS for the “I” Team- Identify why it is important to work on

Immunizations? Why now?

•Decreasing vaccine-preventable disease has been named one of the decade’s top ten greatest public health achievements •Maine, however, has experienced an increase in vaccine

hesitancy, refusals and delays• Several outbreaks of Pertussis and Measles the last 2 yrs• Immunization rates have stagnated: hovering between 62-

74% over the past ten years (4.3.1.3.3.1.4)•Maine is 41st in the country; In 2011, the state with the best

immunization rate in the US was CT, at 96%

First STEPS: Need to Get Everyone Moving Towards the Same “I” GoalNeed coordinated leadership and action to improve immunization rates, decrease preventable diseases, hospitalizations, deaths, and improve the quality of life of children and families.

Need to Build on Existing Payment Initiatives, Quality Improvement Infrastructure, and Metrics:• Improving Health Outcomes for Children (IHOC)/CHIPRA Grant •Accountable Care•Maine Universal Childhood Immunization Program, January 2012• Patient Centered Medical Home •Meaningful Use Immunization Metrics, CHIPRA 24 Metrics• Pathways to Excellence

Need to Identify the League

Maine CDC Maine Immunization Program Martin’s Point Health CareMaine Health Childhood Immunization Task Force Maine Vaccine Board 22 Pediatric and Family Medicine Practices & 2 Inpatient Pediatric Hospitalist Groups

Need to Organize the League: Maine Child Health Improvement Partnership (ME CHIP)

• Mission To optimize the health of Maine children by initiating and supporting measurement-based efforts to enhance child health care by fostering public/private partnerships.

• VisionAll practices providing health care to children will have the skills, support, and opportunities for collaborative learning needed to deliver high quality health care.

• Current ProjectOverseeing the First STEPS (Strengthening Together Early Preventive Services) Learning Initiative

Setting the “I” Goal:• First STEPS Aim Statement: To improve preventive

services for Maine's children. • Between Sept 2011 & Sept 2012, improve

immunization rates (2010) by > 4 percentagepoints in practices that serve a high volume of MaineCare.

• For each vaccine, we set a goal of increasing by 4 percentage points if baseline >80% up to 96% and >10 percentage points if baseline less than 80%; baseline data based on NIS data (not ImmPact 2- unavailable at the time)

• Outcome: By 7 months, we had reached 3 percentage point improvement overall. (Muskie evaluation based on April 15, 2012 data)

Recruit the “I” Teams

Norway –Western Maine Pediatrics

MMP Saco Pediatrics

PortlandMMP PortlandBBCH Pediatric and Med-Peds ClinicMMC Family Medicine Center-PortlandMMC Pediatric Hospitalists

MMP South Portland Pediatrics

MMP Westbrook Pediatrics

Ellsworth-Maine Coast Pediatrics

Rockland- PenBay Pediatrics

Bangor-Penobscot PediatricsHusson PediatricsEMMC Family MedicineEMMC Inpatient Pediatric Physicians

Bridgton Pediatrics

Falmouth-MMP FalmouthMMC Family Medicine Center

Lewiston-CMMC Pediatrics,CMMC Family Medicine

Brunswick:Martin’s Point Brunswick PediatricsBrunswick Pediatrics

Waterville PediatricsWinthrop PediatricsKennebec Pediatrics

•22 Practices•2 Hospitalist groups•96 physicians•30, 666 children with MaineCare covered by practices by Aug 2010 numbers

Run Practice Sessions• Very important to name the team captains-

office champions to run the project and leaders to work at the state and community level

• Develop a learning community- 2 conferences and monthly phone calls

• Review Monthly Data• Recruit and Organize the Coaches to work with

the practices• Develop education strategies to work with

children and families

Reviewing the Stats• Fifteen out of 21 practices (70%)

reporting in IMMPACT2 demonstrated improvement in overall immunization rates through April 2012

• Twelve practices (57%) increased their overall rates by 3 percentage points or more.

• These rates of improvement ranged from 0.4 to 16 percentage points from baseline

10

Source: Muskie School of Public Service, University of Southern Maine

The average percentage point change between each practice site's total immunization rates from September 2011-April 2012

Source: First STEPS Phase I Evaluation Report, Muskie School of Public Service, University of Southern Maine

16.0%

11.6%

6.3%

4.8%

4.7%

4.5%

4.3%

3.8%

3.6%

3.4%

3.2%

3.1%

1.7%

0.7%

0.4%

-0.3%

-0.7%

-1.4%

-1.5%

-1.8%

-2.6%

Avg. Change +3.0%

Site R

Site T

Site O

Site I

Site M

Site S

Site L

Site H

Site G

Site F

Site J

Site D

Site K

Site E

Site A

Site C

Site B

Site N

Site P

Site U

Site Q

Average percentage point change across First STEPS Phase I practices’ ImmPact2 combination and individual rates, 9/11 – 4/12.

Source: First STEPS Phase I Evaluation Report, Muskie School of Public Service, University of Southern Maine

2.0%2.6%

1.7%2.7%

2.4%

Up-to-date on all vaccinesDiphtheria, Tetanus & Pertussis

Measles, Mumps, & RubellaPolio

Varicella (chickenpox)

6-Year-Olds

Average Change +3.0%

7.3%7.0%6.9%

-0.3%

Up-to-date on MCV and TdapMeningococcal vaccine (MCV)

Tetanus, Diphtheria (Tdap)Human Papillomavirus (girls only)

13-Year-Olds

6.1%2.5%2.7%

5.8%4.5%

3.5%2.1%

3.7%-3.0%

3.6%

Up-to-date on all vaccinesDiphtheria, Tetanus & Pertussis

Haemophilus influenza type BHepatitis AHepatitis B

Measles, Mumps, & RubellaPneumococcal conjugate vaccine

PolioRotavirus

Varicella (chickenpox)

2-Year-Olds

Document the Game Plan: Change Package• Develop Champions throughout the Office Staff• Reach agreement at each practice on vaccination schedule,

catch up schedule, and contraindication lists• Develop systems to constantly update registries, standardize

recall/reminders system, and utilize MOGE document: increased from 25 to 72% in First STEPS

• Make immunization improvement part of office work flows and performance reviews

• Provide adequate staff training• Review data to guide work: increased from 40 to 82%

Spread the Change• Reward Immunization Work-Recognize all work of the

practices, coaches, and partners• Recognize Immunization Rates with Public Reporting-

Pathways to Excellence• Design infrastructure to support improvement

including Health information technology and ImmPact2 that can guide practices quality improvement

• Get the message out to families- VaxMaineKids Facebook, Twitter, Web site

5th Quarter

Booster Club

Award Ceremony

Vaccine Board Updates-from Dr. Losey

• 1st Year is Going Well under Universal Coverage Law• Working on assessment calculations for covered lives in a

calendar year• Vaccine supply Issues: Pentacell shortage has hit with variable

effect. Pro-Quad will again be available for us 10/1/12. • No word yet from ACIP on whether they will recommend GSK's

MCV/HIB combination. Vaccine Board is awaiting the ACIP recommendation. Unfortunately without Type B meningococcal coverage, you are missing a majority of the infant meningococcal cases.