New Jerseys Improving Preventive Services Project NJIPSP

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New Jerseys Improving Preventive Services
Project (NJIPSP)
Achieving, Sustaining and Spreading Improvements
in Immunization Delivery
Ruth Gubernick, Adrienne Millican, Arlene
Patrick, Dorothy Williams
40th National Immunization Conference March 6
9, 2006 Atlanta, GA
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Project AIM

• A collaborative project which supports use of the
  statewide immunization registry (NJIIS) to
  improve immunization service delivery at primary
  care practices. 

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Objective

• To present results from the pilot and initial
  spread phase of NJIPSP, a collaborative network
  of primary care practices, the NJ Dept. of Health
  and Senior Services, the American Academy of
  Pediatrics/New Jersey Chapters Pediatric Council
  on Research and Education (PCORE) and the
  National Initiative for Childrens Healthcare
  Quality (NICHQ)

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Methods

• The NJIPSP uses an enhanced Learning
  Collaborative model, with practice teams working
  with expert faculty during three learning
  sessions, utilizing a Model for Improvement,
  sharing innovative solutions, participating in
  monthly conference calls, a listserv and
  receiving on-site support. The NJIIS data is
  used to assess monthly improvement.

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NJIIS

• New Jersey Immunization Information System
• operating since 1997, is the established
  statewide
• immunization information system serving as the
  official repository of immunizations administered
  to children in New Jersey.
• 921,181 Children
• 6,294,931 Doses
• 1114 Active Users
• 400 Active Providers

Zina Kleyman _at_ NJDHSS, Jan 06
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Site selection Criteria

• Recruited from referrals by regional NJIIS
  Coordinators and pilot site participants
• Contract initiated 1 yr commitment
• Pre-work gathered before LS 1
• Formation of Practice team
• VFC Quality Assurance Review (QAR)
• Random (30) chart review
• Self-assessment (Walk-through)

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Monthly Improvement Measurement Categories

• Percentage UTD 24 Months
• Percentage UTD 19-23 months
• Percentage UTD 7-11 Months
• Percentage of children under 24 months with
• 2 shots in registry
• Percentage of doses reported to registry
• within 7 days of vaccine administration

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Sites Specifics Pilot (Jul 2004 Jun 2005)
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Results Pilot Sites(does not include Disp
measurement VFC vs Non-VFC)(monthly averages)

•  

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NJIIS Data Entry - Pilot sites
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Overall Results Pilot sites

• As a result of the pilot project
• 100 are now using the NJIIS to
•           Identify patients needs at every
  visit
•           Remind and recall patients
• 67-83 reported use of the NJIIS highly effective
  and 83-100 found it easily adoptable
•           50 increase (to 100) checking
  immunizations at sick
• visits.
•           33 increase (to 100) using chart
  prompts
•           33 decrease (to 0) pre-filling
  syringes
•           16 increase (to 100) conducting
  in-service trainings
• Mentoring opportunities in spread phase keep
  pilot practices engaged

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Initial Spread Phase Dec 2005 - present

• 8 additional sites Cumberland, Camden, Essex,
  Hudson, Middlesex (2), Morris, Union
• Private practices, Family Health Centers,
  Community Health Centers (FQHCs),
• Hospital- based Pediatric Clinic
• Same methodology and change package
• Focus on missed opportunities, physician
• prompts, timely assessments, reminder
  recall
• activities and data entry

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Results Spread sites (monthly averages)

•    

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NJIIS Data Entry - Spread sites
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Practice Participant Testimonial
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• Trinity Health Family Service Center
• Perth Amboy, NJ
• St. Johns Health Family Service Center
• New Brunswick, NJ

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Oh NoChildren!!!
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My Broken Heart
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SPREAD

• Achieving, Sustaining and Spreading Improvements
  in Immunization Delivery

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• SPREAD

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SPREAD

• S-Sharing Information

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SPREAD

• IDENTIFY PATIENT NEEDS
• FRONT OFFICE STAFF WAS TRAINED TO USE THE
  SCHEDULER DETAIL TO ACCESS THE CHILDS
  IMMUNIZATION NEEDS
• PROMPT CLINICIAN
• THE SCHEDULER DETAIL IS PLACED IN THE CHART
  PRIOR TO THE VISIT AND REVIEWED BY BOTH THE
  NURSES AND PHYSICIAN
• CHART COMPLETION FLOW SHEET

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Help interpret the complex immunization schedule
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CHART COMPLETION FLOW SHEET

• TRINITY HEALTH CENTER
• CHART COMPLETION FLOW SHEET
• DATE____________
• DR. ACEVEDO/ K. LABOSCO APN
• NURSE
• FRONT DESK
• Change of Address/Phone
• Change of Insurance
• No Show
• Completed

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SPREAD

• P-Passion

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Trinity Health Center Statistics
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SPREAD

• R-Research
• Plan Do Study Act
• (PDSA)

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SPREAD

• E-Encourage

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SPREAD

• A-Achieving

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Trinity Health Center Statistics
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SPREAD

• D-Deliver

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Improvement Project Surprises

• From small acorns, big trees grow. (The small
  task of printing the scheduler detail has
  increased our immunization rates and decreased
  missed opportunities)

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WHY?
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SPREAD
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Contact Information

• Arlene Patrick, RN
• Trinity Health Center
• 271 Smith Street
• Perth Amboy, NJ 08861
• [phone] Office
• [phone] Fax

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Conclusion

• Improvement of immunization delivery is possible
  with innovative technology and a commitment and
  plan for continuous quality improvement.
  Utilizing a registry supports easy improvement
  measurement. NJIPSP is a model to be spread to
  other practices seeking to improve immunization
  delivery.

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This collaborative project to improve
immunization and other preventive service
delivery has been developed and is being
facilitated by    
in Collaboration with the
National Initiative for
Childrens Healthcare Quality  We would
like to thank the above groups for their support
of this initiative Funded by the NJDHSS, Vaccine
Preventable Disease Program