Flu Season Vaccines in High Risk Populations

1
Flu Season Vaccines in High Risk Populations

• Dennis Spurlin, MetaStar, Inc.
• MetaStar is Wisconsins QIO
• Communications Department
• Coordinator, Wisconsin Adult Immunization
  Coalition

2
Immunization Overview

• 5th leading cause of death for 65
• 600,000 Medicare patients are hospitalized using
  4.2 inpatient days
• Pneumonia accounts for 500,000 emergency room
  visits by Medicare patients
• 1993, nearly 3.5 billion spent on pneumonia
  inpatient care for beneficiaries

3
Immunization Overview (cont.)

• Total yearly medical costs for pneumonia exceed
  4.6 billion
• Safe, effective vaccines are available that can
  prevent 70 percent of hospitalizations and 85
  percent of deaths

4
Inpatient Adult Immunizations Safe, Effective
and Vital

• Pneumonia and influenza are major causes of
  hospitalization and death
• Risk is highest in those 65 or hospitalized with
  another illness
• Important to assess immunization status and
  immunize patients right here, right now
• Flu and pneumonia immunization in hospital is an
  underutilized opportunity.

5
Hospital Inpatient Objectives

• Increase inpatient immunization assessment and
  vaccination
• Decrease morbidity and mortality from influenza
  and pneumonia
• Decrease emergency room visits
• Decrease total medical costs associated with
  pneumonia

6
Missed Opportunities

• Despite national recommendations for
  hospital-based immunization, Medicare patients
  and others at high risk often do not receive
  indicated influenza and pneumococcal vaccines.

7
Systems Changes Begin With Physicians

• A clear practitioner recommendation strongly
  influences patient immunization
• Implementing system-based strategies increases
  inpatient vaccination rates
• Standing immunization orders
• Admission assessment forms
• Patient education

8
Inpatient Adult Immunizations Safe, Effective
and Vital

• Evidence supports there is important work that
  needs to be done in the hospital setting
• Based on available information, MetaStar chose to
  conduct a teleconference for Wisconsin Providers

9
Objectives

• Develop and/or enhance inpatient immunization
  programs
• Use physician experts to share evidence-based
  information to support providing immunization in
  inpatient settings.
• Participants will use information to overcome
  barriers, develop new programs and enhance
  current efforts.

10
Teleconference details

• Teleconference was designed for
• Physicians, Medical Directors
• Infection Control Staff, Infectious Disease
  Specialists,
• Quality Improvement Professionals
• Continuing medical education credit for
  physicians
• Online registration at www.metastar.com

11
Details (cont.)

• Content included published studies discussing
  safety and value of inpatient immunization,
  recommendation and extensive QA session.
• Participants received guidelines, featured
  articles from speakers, intervention strategies
  and educational materials.
• An audiotape was made available to
  non-participants.

12
Teleconference Agenda

• Overview
• Dr. Jay Gold, Senior Vice President and Principal
  Clinical Coordinator, MetaStar
• Influenza Vaccination is Safe and Immunogenic
  When Administered to Hospitalized Patients
• Dr. Bruce Berry, Medical Director of Quality
  Improvement, Aurora Health Care, Milwaukee, WI.

13
Agenda (cont.)

• Guidelines and Recommendations
• Dr. Dennis Maki, Professor of Medicine, Head of
  Infectious Disease Section, University of
  Wisconsin Medical School
• Suttons Law Applied to Prevention
• Dr. Dale Bratzler, DO, MPH, Principal Clinical
  Coordinator, Oklahoma Foundation for Medical
  Quality
• Questions and Answers

14
Results and conclusions

• Some 49 providers, mostly hospitals
• Evaluation summary average was 4.2 (1-5 scale)
  for non-physicians
• Evaluation averaged 4.5 for 12 physicians
• Comments related to valuable information,
  clarification of controversial issues.
• Ten additional hospitals developed or enhanced
  inpatient programs.

15
Quality Indicator and Results - Influenza

• Proportion of inpatients with influenza screened
  or given influenza immunization
• CMS national baseline in was 14.3 percent
• Wisconsin baseline was 23 percent
• Most recent Wisconsin rate was 29.6 percent
• Statewide increase of 6.3 percent

16
Quality Indicator and Results - Pneumonia

• Proportion of inpatients with pneumonia screened
  or given pneumococcal immunization
• CMS national baseline was 11.2 percent
• Wisconsin baseline was 17.2 percent
• Most recent Wisconsin rate was 22.3 percent
• Statewide increase of 5.1 percent