Fighting the Flu and Pneumonia

Fighting the Flu and Pneumonia Influenza poses significant risks for the elderly. Yet only 60% of elderly whites were immunized in 1995, and rates were even lower for minority groups–50% for Hispanics and 40 percent for blacks. QIOs have been working on a range of projects to increase flu and pneumonia immunization, as well improve hospital treatment for pneumonia. Some examples: The West Virginia Medical Institute, the West Virginia QIO, successfully organized a statewide collaborative to improve inpatient influenza and pneumococcal vaccination rates. In 1999, West Virginia's hospitals rarely gave influenza or pneumonia vaccine and almost never screened inpatients for the vaccine. WVMI partnered with the majority of hospitals in West Virginia, the state hospital association and the state health department. Within one year, screening rates increased by 25-30% statewide for both vaccines, and hospital influenza vaccine use increased by 25%. For this effort, WVMI, along with the West Virginia Hospital Association, received the Jansen Pharmaceutical National Patient Safety Award in 2001. Lumetra, the California QIO, launched a campaign to develop long-term effective solutions to low pneumococcal immunization rates. Through a three-year campaign that targeted multiple ethnic groups and providers, California pneumococcal immunization rates increased 9.1%. Consequently, 152,784 more eligible Medicare beneficiaries in California were vaccinated against pneumococcal disease than at the commencement of the campaign. TMF Health Quality Institute’s 1998 immunization project targeted more than 560,000 Medicare beneficiaries in 44 Texas counties, with a goal of increasing flu and pneumonia vaccination (PPV) rates. TMF developed new partnerships with groups like the Texas Department of Health, area agencies on aging, hospital systems, and city/county health departments. All 44 counties experienced an increase in PPV claims, with some reporting double-digit increases. Carolinas Center for Medical Excellence., the North Carolina QIO, sponsors the Senior Vaccination Season Coalition, a collaborative effort of organizations working to increase influenza and pneumococcal immunizations. The coalition’s efforts have included partnering with local health departments statewide, offering North Carolina physicians immunization office toolkits to implement reminder systems in their offices, postage-paid reminder postcards to mail to their patients, and providing clinic location information to toll-free telephone numbers operated by the American Lung Association of North Carolina and the CDC’s Immunization Hotline to inform the public of available immunization clinics. Outpatient immunization rates showed significant improvement during the last three years thanks to the program. From 1998-2001, the influenza immunization rate increased 8.5%, from 63.9% to 72.4%; the pneumococcal immunization rate rose 11.0%, from 58.5% to 69.5%. Qualidigm, the Connecticut QIO, worked with providers to develop and distribute a clinical pathway for Medicare patients with community-acquired pneumonia. The project resulted in significant increases in the proportion of patients receiving antibiotics within eight hours, in use of blood cultures prior to antibiotics, and in oxygen assessment within 24 hours. In addition, in-hospital mortality, 30-day mortality and length of stay decreased. IPRO, the New York QIO, developed a comprehensive contact management system to assist in physician office quality improvement activities. The system contained over 5,000 high-volume Medicare physicians and tracked information such as performance on quality indicators, intervention materials ordered and received, and the physician offices’ progress towards implementation of quality improvement tools such as chart stickers and pre-printed orders. These activities, along with key partnerships and coalitions, assisted New York state in improving performance over the SOW6 on flu immunization rates from 64% to 70%, and on pneumococcal immunization rates from 50% to 64%. Quality Improvement Professional Research Organization, the Puerto Rico QIO, focused on delivering antibiotics to dual-eligible Medicare patients hospitalized for pneumonia within eight hours. A preliminary data analysis revealed that a disparity existed between dual-eligible and non dual-eligible patients. Interventions to reduce the disparity included face-to-face meetings, mailings of materials, and motivating hospitals to develop quality teams that studied the root causes of the disparity. Changes in protocols, development of new procedures and processes, and assignment of new responsibilities to emergency room physicians increased compliance for antibiotic administration within eight hours from 16.2% to 88.3%. FMQAI, the Florida QIO, took the lead role in establishing a collaborative of 29 Florida managed care organizations to work on flu immunization. FMQAI also launched a multilingual, multimedia effort to educate Medicare beneficiaries about the benefits of flu vaccines. The two efforts resulted in significant increases in influenza immunization rates. Since 1997, Quality Partners of Rhode Island, the Rhode Island QIO, has led the Ocean State Adult Immunization Coalition (OSAIC), which coordinates public education campaigns about influenza and pneumococcal targeting adults age 50 and older. The coalition also distributes a tool kit of current information about the vaccine, proper storage, and billing and reimbursement to physicians. For the past two years, free billing and reimbursement training workshops have been offered to physician offices and agencies. 67% of adults age 65 and older in Rhode Island reported receiving the pneumococcal vaccine in 2001, representing a 10.1% increase from 1999. Mountain-Pacific Quality Health Foundation, the Hawaii QIO, worked with more than 10 organizations in the local health care community to improve immunization rates for the pneumococcal vaccine. After two years of work—including a television ad campaign; legislative activities to improve immunization access; a direct mail campaign to pharmacies and physicians throughout the state; bus posters; presentations to native Hawaiian organizations and parish nurses, and other public awareness activities, data showed 74.9% pneumococcal immunizations coverage for Hawaii. This coverage rate represents a 40% relative improvement from 1999-2001—twice the national rate of relative improvement. The Colorado Foundation for Medical Care, the Colorado QIO, has used several strategies to keep Colorado strong in providing influenza/pneumcoccal immunizations. Colorado vaccination rates are among the highest in the nation, with some 78% of seniors age 65 and older being vaccinated for influenza while 69% received the vaccination for pneumococcal disease during the 2000-2001 influenza season. One component of Colorado's immunization strategy includes a collaboration between community vaccination providers and managed care companies that serve Medicare beneficiaries. The collaboration, facilitated by the Colorado QIO, allowed Medicare managed care beneficiaries to receive no-cost influenza vaccinations at grocery stores and other convenient settings. Carolinas Center for Medical Excellence, the South Carolina QIO, has worked with health departments, hospitals, and federally qualified health centers to coordinate a mailing to South Carolina’s 611,000 Medicare beneficiaries about the availability and locations of flu shots. The mailer has helped steadily increase immunization rates in the state. CMR also works with the state health department to sponsor an annual media campaign promoting immunizations through an award winning television commercial called Flu Shots Aren’t Just for Kids. Louisiana Health Care Review's, the Louisiana QIO, pneumonia media campaign, has dramatically increased the number of pneumonia shots given at community clinics. LHCR recorded an average 60% increase in pneumonia shots given at community clinics in 2001. The Kansas Foundation for Medical Care, the Kansas QIO, representing a largely rural state, recognized the importance of assisting small rural hospitals address quality improvement issues. In collaboration with the Kansas Hospital Association and the state rural health agency, KFMC launched a project to improve influenza and pneumococcal immunizations in patients discharged from Critical Access Hospitals. The team recruited 17 rural Critical Access Hospitals to participate in this effort. After implementation of a "rapid cycle" quality improvement program, assessment of influenza immunizations improved from 17% to 62% and assessment of pneumococcal immunizations improved from 36% to 51%. This project demonstrated the feasibility of working with small rural hospitals to make measurable improvements in quality. QSource, the Tennessee QIO, successfully organized a statewide collaborative with the state health department and other community partners to improve influenza and pneumococcal vaccination rates. QSource sponsored Medicare vaccination reimbursement workshops, launched media campaigns, and distributed community education and provider education immunization toolkits. QSource distributed more than 110 immunization resource binders to hospitals and clinics to help improve internal processes and implement new protocols. Efforts also included the development of an interactive Web site that provides information, resources and locations for immunization events. These initiatives and rapid cycle improvement projects helped increase outpatient flu immunization rates by 9% and pneumonia immunization rates by 14%. Ohio KePRO, the Ohio QIO, partnered with a regional medical association, local health departments and hospital wellness programs to provide a regional "Vote and Vaccinate" program for senior citizens on Election Day in 2000, 2001, and 2002. Due to influenza vaccine supply delays in 2000, influenza vaccinations were provided in 2001 and 2002. Pneumococcal vaccinations were provided all three years. Each year the number of immunizations administered has increased. In 2002, the state had a significant increase in the numbers of vaccinations provided. Senior citizen voters are becoming acclimated to having the nurses at polling sites and those voters have offered positive feedback about receiving their vaccinations in a "one stop," easy access situation. Primaris, the Missouri QIO, reports that three out of every four Medicare beneficiaries were vaccinated against influenza in 2001, a nearly 10% increase over two years. Multiple interventions caused this increase, including the efforts of the Show-Me State Adult Immunization Coalition. This strategic coalition of Primaris, private corporations, community organizations, and government agencies partnered with 27 local health departments to notify 40,000 beneficiaries in 32 Missouri counties with the lowest pneumococcal and influenza immunization rates about the need for immunizations and how to obtain them. The New Mexico Medical Review Association, the New Mexico QIO, developed a project aimed at the disparities in influenza and pneumococcal immunization status between Hispanic and non-Hispanic populations in the state. NMMRA conducted extensive research to identify the causes that underlie disparities in immunization status. Using this information, NMMRA developed culturally appropriate interventions targeting Hispanic Medicare beneficiaries, and lay health workers, or promotoras, disseminated the information. In addition, NMMRA developed a multimedia advertising campaign and practitioner materials in English and Spanish to reach this audience. Through the effort, the influenza vaccination rate increased from 23.6% during the 2000–2001 flu season to 41.6% during the 2001–2002 flu season. Of those who received the influenza immunization, the percent of Hispanics also increased from 57.9% during the 2000–2001 flu season to 65.7% during the 2001–2002 flu season.

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