Adult Vaccines and Registries

1
Adult Vaccines and RegistriesWorking With Long
Term Care Facilities

• Cheryl Stephens, Executive Director
• Liz Thom, RN, Regional Immunization Registry
  Coordinator
• Community Health Information Collaborative
• (North Central and Northeast Minnesota)
• 2003 Immunization Registry Conference

2
Workshop Objectives

• Discuss issues in recruiting long term care (LTC)
  facilities as registry users.
• Discuss how the needs of LTC can differ from
  primary care/pediatric practices.
• Present the lessons learned and next steps.

3
A little about CHIC and Minnesota

• CHIC Non-profit public-private organization
  created to improve the quality of health care
  through the use of information systems.
• Immunization registry the most visible project.
• Covers 18 counties and 29,000 sq. miles
• Minnesota Regional governance and provider
  recruitment/support statewide web-based
  application and database.

4
(No Transcript)
5
Why include adults in registries?

• VPD morbidity and mortality are generally higher
  in adults than children.
• High pneumococcal vaccine coverage rates in
  particular have proven elusive.
• Immunization histories are as scattered as
  pediatric histories.
• Medicare requirements for influenza and
  pneumococcal vaccinations.

6
Methods

• Selected 5 LTC facilities of different sizes and
  types.
• Visited each to interview about
• Immunization screening at admission
• Sharing immunization data
• Protocols for vaccine administration
• Current methods of tracking vaccines
• Perceived benefits and barriers to routinely
  using a registry

7
Findings Current Procedures

• All sites screen for flu and pneumococcal.
• A Medicare requirement
• Two screen for Td history One screens for BCG.
• Screen for Hepatitis B disease only.
• The family is not usually involved in vaccination
  decisions.

8
Findings Perceived Benefits

• Reduced ward clerk and nurse time
• Accurate information
• Reduced vaccine costs to the facility (avoiding
  unnecessary shots)
• Ease of reporting
• More accurate forecasting of next shot due
• More accurate histories than if from the mildly
  cognitive-deficient resident.

9
Findings Perceived Barriers

• Need to allocate staff time for record queries.
• Internet access not always at nursing/admission
  station.
• New information system for staff to learn
• Not a significant factor

10
Employee Health The Other Payoff

• Most desired benefit cited by the LTC sites
  Tracking Mantouxs,
• A Medicare requirement
• Tracking influenza is also important.
• As well as Hepatitis B, Varicella, MMR, Td for
  staff
• Occupational health contractors need registries
  for tracking vaccines required by different
  employers.
• Many also serve correctional facilities, which
  have both resident and staff vaccination
  requirements.

11
Lessons Learned To Date

• There is little sharing of immunization data
  among LTC and providers that treat seniors.
• May need to recruit internists and other groups
  to the registry.
• The benefits and barriers of registry
  participation are largely the same as for
  pediatric providers.
• Occupational vaccine tracking is a big issue.
• Registry screens and reports may need to be
  modified to better reflect adult vaccines.

12
Next Steps

• Find the CHAMPIONS for adult immunizations.
• Assess computer accessibility/internet access at
  the line-staff level of LTC facilities
• Partners needed for
• Education - public and professional groups
• Funding to prevent barriers to Registry
  participation
• Support to promote adult wellness
• To prevent vaccine preventable diseases