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Game Plan for the Evening

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Game Plan for the Evening

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  1. First STEPS (Strengthening Together Early Preventive Screening) Learning Initiative: Improving Immunization Rates Celebration DinnerFriday Night LightsThe “I” Team- There is no “I” in Team, Except ImmunizationsAmy 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 awarded by 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

  2. 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

  3. 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%

  4. First STEPS: Need to Get Everyone Moving Towards the Same “I” Goal Need 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

  5. Need to Identify the League Maine CDC Maine Immunization Program Martin’s Point Health Care Maine Health Childhood Immunization Task Force Maine Vaccine Board 22 Pediatric and Family Medicine Practices & 2 Inpatient Pediatric Hospitalist Groups

  6. Need to Organize the League: Maine Child Health Improvement Partnership (ME CHIP) • MissionTo optimize the health of Maine children by initiating and supporting measurement-based efforts to enhance child health care by fostering public/private partnerships. • Vision All practices providing health care to children will have the skills, support, and opportunities for collaborative learning needed to deliver high quality health care. • Current Project Overseeing the First STEPS (Strengthening Together Early Preventive Services) Learning Initiative

  7. 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 percentage points 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)

  8. Recruit the “I” Teams Lewiston- CMMC Pediatrics, CMMC Family Medicine • 22 Practices • 2 Hospitalist groups • 96 physicians • 30, 666 children with MaineCare covered by practices by Aug 2010 numbers Waterville Pediatrics Winthrop Pediatrics Kennebec Pediatrics Norway – Western Maine Pediatrics Bridgton Pediatrics Bangor- Penobscot Pediatrics Husson Pediatrics EMMC Family Medicine EMMC Inpatient Pediatric Physicians MMP Westbrook Pediatrics MMP South Portland Pediatrics Ellsworth- Maine Coast Pediatrics Portland MMP Portland BBCH Pediatric and Med-Peds Clinic MMC Family Medicine Center-Portland MMC Pediatric Hospitalists Rockland- PenBay Pediatrics Falmouth- MMP Falmouth MMC Family Medicine Center Brunswick: Martin’s Point Brunswick Pediatrics Brunswick Pediatrics MMP Saco Pediatrics

  9. 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

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

  11. 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

  12. 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

  13. 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%

  14. 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

  15. 5th Quarter Award Ceremony Booster Club

  16. 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.

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