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SIPS Bay Area Community Health

Social media greatly influences our patient population’s perceptions of healthcare and vaccinations. These influences are powerful and often leads our population to opinions that are difficult to change. Therefore, our proposal also includes education and outreach efforts through social media.

As previously mentioned, vaccine hesitancy is still high in patient population that doubt the safety and effectiveness of vaccines. Preconceived notions are quite challenging to influence. We hope that through participation in this program, we will increase patient trust levels at BACH.

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*Only sent small data in run chart form through mid-May

DO NOT INCLUDE

Something you learned about your patient population: Social media greatly influences our patient population’s perceptions of healthcare and vaccinations. These influences are powerful and often leads our population to opinions that are difficult to change. Therefore, our proposal also includes education and outreach efforts through social media.

Which standard did you focus on? ASSESS

AHA moments: •Realizing how many adult patients that are due for PCV also are being treated for  Diabetes. Its makes the ability to recall patients more efficient for more than one reason.  This is a good way to increase the health and longevity of our patients.

•Found there was no specific search and report for gaps in care

•Seeing the value of using each patient contact as an opportunity to close care gaps for  vaccines, not just for the specific visit reason

Most impactful intervention: •Manually using the small data tool to view each day patient by patient and view their  gaps in care. I made a list of the patients gathered from the review and shared them  with frontline staff to conduct pneumo and covid clinics

•This got me really involved with the schedule and patients of my target  group/clinic/provider

•Really getting to know this data really helped me to see the big picture (i.e. observing  clear relationship between diabetic patients and the need for the pneumo vaccine

SIPS Betances Health Center

At Betances we have recently learned that despite there being an increase in overall patients seen in 2022 from those seen 2021, there was a decrease in patients who received the Covid-19 vaccine (1,733 in 2021 to 956 in 2022). The same trend was noted with the Pneumococcal vaccine with less patients receiving this vaccination (623 patients in 2021 to 489 patients in 2022). Our patient population is also changing in another notable trend: the migrant population. At Betances we have always welcomed and treated patients without legal documentation and without health insurance but there was been a slight increase in migrant clients showing to our locations. We attribute this trend to our welcoming center and being beloved within the community to also to have a large number or providers and administrative staff that are bilingual in Spanish.

There are so many benefits from Betances participating in this program. It will give Betances the opportunity to continue learning how to effectively implement the CDC SAIP, to continue analyzing the data to build additional strategies and identify new goals to increase immunizations, and there will be less people becoming ill due to more people being protected from preventable diseases. It will also contribute with assisting with an increase in capacity to serve the patients coming in without medical insurance, language barriers, financial barriers, transportation barriers, and additional diseases including chronic diseases.

*Only sent in small data through mid-May, all 0’s for PCV

Something you learned about your patient population: At Betances we have recently learned that despite there being an increase in overall patients seen in 2022 from those seen 2021, there was a decrease in patients who received the Covid-19 vaccine (1,733 in 2021 to 956 in 2022). The same trend was noted with the Pneumococcal vaccine with less patients receiving this vaccination (623 patients in 2021 to 489 patients in 2022). Our patient population is also changing in another notable trend: the migrant population. There has been a slight increase in migrant clients showing to our locations. We attribute this trend to our welcoming center and being beloved within the community to also to have a large number or providers and administrative staff that are bilingual in Spanish.

Which standard did you focus on? During our Assess Standard phase of the project Betances immediately noticed there was  a documentation gap that when filled would contribute to improving our data collection  and in turn our ability as an agency to make decisions on vaccinations and their  distributions that would help increase the distributions of all the vaccines

AHA moment: •An “a-ha” moment occurred when we recognized the need for better record-keeping.  When speaking to the nurse manager about the issue they explained that with the lack  of time spent with each patient the notes would miss information such as this to ensure  all documents were submitted and the patient received the care they arrived for.

Most impactful intervention: •The use of a flyer created and posted both in-person at the center where permitted and  its posting on social media was the most fun. Despite not being able to have a  quantifiable impact it was our favorite. It allowed for the team to work with the staff and  show off the project and create new relationships amongst one another.

SIPS Camillus Health Concern

Camillus Health Concern has seen an increase in newly arrived migrants from the Caribbean, Central and South America who need vaccines. Many of these immigrants do not have the complete schedule of vaccines or have not started the recommended series. Given the increasing prevalence of hypertension, depression, diabetes and asthma in our patient population additional preventive education and vaccine awareness is paramount.

All staff with access to patients receiving vaccines learn and/or strengthen knowledge and competencies of the standards and their corresponding activities to increase vaccination rates.

*Submitted small data for full project dates, but only submitted denominators (or numerators all 0)

Something we learned about our patient population: Camillus Health Concern has seen an increase in newly arrived migrants from the Caribbean, Central and South America who need vaccines. Many of these immigrants do not have the complete schedule of vaccines or have not started the recommended series. Given the increasing prevalence of hypertension, depression, diabetes and asthma in our patient population additional preventive education and vaccine awareness is paramount.Which standard did you focus on? •Document: The Document standard improved significantly. We established consistent  and efficient processes to review vaccine histories and recommendations. This  information is transcribed into the IIS for accurate documentation and access for  providers and patients to make timely medical decisions. This implementation has  improved awareness of age and population specific vaccine recommendations.

Most impactful intervention: •We gathered the staff with access to the IIS to review updates to the system utilization  and documentation best practices. This included distribution of the most recent CDC  immunization schedules and placement in locations of high patient visibility.

SIPS CHC of Lubbock

We are starting to see patients return to the clinic in person. With this project, we will be able to provide vaccinations to more people.

This is a project that would improve our internal workflows to ensure the ability to increase access and ensure the ability to immunize more people in the region and the opportunity to educate more staff across the board. Another important gain would be the understanding of our staff on how to succeed at this project for the needs of our patients and have a more robust vaccination program.

SIPS Weekly Data_CHC of Lubbock_ 6.20.23 (1).xlsx

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*Submitted over full project timeline, numbers go up but are small

What would be a win: This is a project that would improve our internal workflows to ensure the ability to increase access and ensure the ability to immunize more people in the region and the opportunity to educate more staff across the board. Another important gain would be the understanding of our staff on how to succeed at this project for the needs of our patients and have a more robust vaccination program.

Which standard did you focus on? Recommend

AHA moment: •During the first chart audit, when we realized that a majority of patients did not have a  PCV or COVID Booster.

Most impactful intervention: •Pre work to evaluate for need of vaccine and assess Immtrac for outside vaccines.

SIPS MedLink Georgia

The elders in a family often set the tone for the direction of vaccinations. Not only are they an educational resource for their adult children, they are often caretakers of their grandchildren. A family elder's vaccination knowledge is an important influence for the acceptance of vaccines by the family unit.

Having the ability to review the need for change and to utilize those changes to improve organizational outreach and support to our communities surround vaccines. Increasing staff knowledge of adult vaccinations by empowering the staff with education would be a win for the organization and patients. Increasing community vaccination rates will further protect all persons within the community from preventable infections and improve community health as a whole.

SIPS Weekly Data_MedLink Georgia_6-19-23.xlsx

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*Submitted over full project timeline, numbers and percentages of patients vaccinated are small

Something you learned about your patient population: The elders in a family often set the tone for the direction of vaccinations. Not only are they an educational resource for their adult children, they are often caretakers of their grandchildren. A family elder's vaccination knowledge is an important influence for the acceptance of vaccines by the family unit.

Which standard did you focus on? Assess and Recommend

AHA moment: •Identifying that the pneumonia vaccine was only being offered at Annual Wellness visits.

Most impactful intervention: •Once we became aware that pneumonia vaccines were being offered only at AWV, we  discussed this with the provider to get further insight. Along with the provider we  determined the need of offering vaccines at every visit not just AWV as patients may not  come in for an AWV.

SIPS (NFP) Neighborhood Family Practice

As a result of the NFP Summer 2022 Patient Needs Assessment, we received 527 responses that assisted us in taking stock of our areas of improvement to better meet patient needs. A common thread emerged from these responses, showing that transportation and language remain significant barriers to patient care. Transportation was the most significant barrier to making and keeping appointments for 41% of responding patients, with 67 patients providing written comments about struggles relating to bus schedules, car availability, family conflicts, or ridesharing challenges. Regarding language, we received 34 survey comments about communication barriers creating difficulty in accessing health care services. Some patients requested more providers that speak their native language and 28% of Asian respondents noted that their healthcare team does not speak their language. We are hoping to meet these diverse language needs through mass text message translations and improved communication about interpretation services offered.

To build off the successes in the SAVE program and attain further wins in adult patient immunization, we seek greater collaboration between the population health and clinical teams to create quality improvement and Plan-Do-Study-Act (PDSA) cycles. Ultimately, a win would include increased quality metrics for COVID and PCV immunization across our patient population. Contacting patients attributed to us by two MCOs will be a significant win because some of these patients’ records have previously not been present in our EHR. This effort allows us to reach patients that have previously gone unreached and continue to expand our vaccination outreach efforts after the project period has ended. Additionally, improving our understanding of and implementation of the Standards for Adult Immunization Practice through this collaborative program will be a win as we will be able to share and apply the knowledge gained throughout the rest of the organization.

2023_06_27_SIPS_NFP.xlsx

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*Submitted over full project timeline, numbers are good but percentages are small

Something you learned about your patient population: As a result of the NFP Summer 2022 Patient Needs Assessment, we received 527 responses that assisted us in taking stock of our areas of improvement to better meet patient needs. A common thread emerged from these responses, showing that transportation and language remain significant barriers to patient care. Transportation was the most significant barrier to making and keeping appointments for 41% of responding patients, with 67 patients providing written comments about struggles relating to bus schedules, car availability, family conflicts, or ridesharing challengessignificant barriers to patient care. Regarding language, we received 34 survey comments about communication barriers creating difficulty in accessing health care services. Some patients requested more providers that speak their native language and 28% of Asian respondents noted that their healthcare team does not speak their language. We are hoping to meet these diverse language needs through mass text message translations and improved communication about interpretation services offered.

To build off the successes in the SAVE program and attain further wins in adult patient immunization, we seek greater collaboration between the population health and clinical teams to create quality improvement and Plan-Do-Study-Act (PDSA) cycles. Ultimately, a win would include increased quality metrics for COVID and PCV immunization across our patient population. Contacting patients attributed to us by two MCOs will be a significant win because some of these patients’ records have previously not been present in our EHR. This effort allows us to reach patients that have previously gone unreached and continue to expand our vaccination outreach efforts after the project period has ended. Additionally, improving our understanding of and implementation of the Standards for Adult Immunization Practice through this collaborative program will be a win as we will be able to share and apply the knowledge gained throughout the rest of the organization.

2023_06_27_SIPS_NFP.xlsx

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*Submitted over full project timeline, numbers are good but percentages are small

Which standard did you focus on? •Documentation for Pneumonia, COVID and Flu/ immunizations within our EMR on if a

patient was offered a vaccine or not.

AHA moment: •We learned that our documentation is not consistent or standard across staff. This  allowed us to note our documentation as an area of improvement.

Most impactful intervention: •We found that surveying our providers for the "Assess" standard enabled us to take  inventory of the current practices of our providers at our Ridge health center. We look forward to applying  these lessons more broadly across our other 6 sites. We will proceed with assessing how  providers and all those who interact with patients document immunizations offered  more broadly.

SIPS (NH) Neighborhood Health

2023_06_06_SIPS_Neighborhood.xlsx

*Submitted data through May, numbers are all small or zero

Which standard did you focus on? •We found that Recommend and Assess were the areas that most needed improvement.  Our pediatric MAs are very good at making recommendations, but adult MAs don’t  make as many recommendations as they should. The provider was not thoroughly  assessing each patient for which vaccines they could have (i.e. pneumococcal). She was  only looking to see if the patient needed a COVID vaccine.

AHA moment: •The nurse was surprised at how many people decline vaccines. The first chart audit  showed that 1/10 patients declined vaccines and the second chart audit showed that  5/10 patients declined vaccine. That’s because the nurse reinforced that declinations  should be explicitly documented. They were not necessarily documented before the  intervention.

Most impactful intervention: •The increase in communication between the MA and provider was impactful. There was  more collaboration between the two and they approached recommending and assessing  as a team.

SIPS Northeast Valley Health

Through patient interviews conducted from our participation in the NACHC CCI “Reducing Disparities in Adult Immunization” Human-Centered Design Learning Collaborative, NEVHC has learned that our low-income, predominantly Latinx patients are more receptive to receiving information from their assigned providers and families. Most of the information that patients have received about vaccines were based on posts they’ve seen on social media and word of mouth from families and friends. In order to provide accurate and relevant information regarding vaccine immunization, we have found that it is important to provide continuous education and keep patients informed with the most up-to-date information. One way that NEVHC has addressed this concern among our organization’s prenatal patient population is through our newly created “Patient Ambassadors Program” where pregnant/prenatal patients hear from pregnant/prenatal patients, creating a peer connection. This has shown to lower vaccine hesitancy and address concerns that many pregnant women have in regards to receiving their COVID-19 vaccines.

A win from participation in this program would be decreasing missed opportunity rates for adult covid vaccine and pneumonia vaccine. As mentioned above, there are many barriers that contribute to missed opportunities. However, by decreasing missed opportunities and mitigating vaccine hesitancy among vulnerable and/or high risk populations, i.e. low-income, Latinx pregnant women, NEVHC will be able to increase our overall vaccination penetration rates

SIPS Weekly Data_Northeast Valley.xlsx

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*Submitted data through full project period, numbers are small but percentages are higherWhich standard did you focus on? •Documentation for Pneumonia, COVID and Flu/ immunizations within our EMR on if a

patient was offered a vaccine or not.

AHA moment: •We learned that our documentation is not consistent or standard across staff. This  allowed us to note our documentation as an area of improvement.

Most impactful intervention: •We found that surveying our providers for the "Assess" standard enabled us to take  inventory of the current practices of our providers at our Ridge health center. We look forward to applying  these lessons more broadly across our other 6 sites. We will proceed with assessing how  providers and all those who interact with patients document immunizations offered  more broadly.

SIPS (NH) Neighborhood Health

In preparation for this application, we pulled our adult Covid-19 vaccination rates. Neighborhood Health’s adult patient Covid-19 vaccination rates are 25% for completed primary series and 14% for completed primary series plus bivalent booster. For adults over 50, those numbers are 21% and 22% respectively. There is definitely room for progress.

Increase our adult patient Covid-19 vaccination rates with special attention on increasing the bivalent booster uptake to ensure that our patients have the most up-to-date protection against Covid.

2023_06_06_SIPS_Neighborhood.xlsx

*Submitted data through May, numbers are all small or zero

Which standard did you focus on? •We found that Recommend and Assess were the areas that most needed improvement.  Our pediatric MAs are very good at making recommendations, but adult MAs don’t  make as many recommendations as they should. The provider was not thoroughly  assessing each patient for which vaccines they could have (i.e. pneumococcal). She was  only looking to see if the patient needed a COVID vaccine.

AHA moment: •The nurse was surprised at how many people decline vaccines. The first chart audit  showed that 1/10 patients declined vaccines and the second chart audit showed that  5/10 patients declined vaccine. That’s because the nurse reinforced that declinations  should be explicitly documented. They were not necessarily documented before the  intervention.

Most impactful intervention: •The increase in communication between the MA and provider was impactful. There was  more collaboration between the two and they approached recommending and assessing  as a team.

SIPS Northeast Valley Health

Through patient interviews conducted from our participation in the NACHC CCI “Reducing Disparities in Adult Immunization” Human-Centered Design Learning Collaborative, NEVHC has learned that our low-income, predominantly Latinx patients are more receptive to receiving information from their assigned providers and families. Most of the information that patients have received about vaccines were based on posts they’ve seen on social media and word of mouth from families and friends. In order to provide accurate and relevant information regarding vaccine immunization, we have found that it is important to provide continuous education and keep patients informed with the most up-to-date information. One way that NEVHC has addressed this concern among our organization’s prenatal patient population is through our newly created “Patient Ambassadors Program” where pregnant/prenatal patients hear from pregnant/prenatal patients, creating a peer connection. This has shown to lower vaccine hesitancy and address concerns that many pregnant women have in regards to receiving their COVID-19 vaccines.

A win from participation in this program would be decreasing missed opportunity rates for adult covid vaccine and pneumonia vaccine. As mentioned above, there are many barriers that contribute to missed opportunities. However, by decreasing missed opportunities and mitigating vaccine hesitancy among vulnerable and/or high risk populations, i.e. low-income, Latinx pregnant women, NEVHC will be able to increase our overall vaccination penetration rates

SIPS Weekly Data_Northeast Valley.xlsx

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*Submitted data through full project period, numbers are small but percentages are higher

Something you learned about your patient population: Through patient interviews conducted from our participation in the NACHC CCI “Reducing Disparities in Adult Immunization” Human-Centered Design Learning Collaborative, NEVHC has learned that our low-income, predominantly Latinx patients are more receptive to receiving information from their assigned providers and families. Most of the information that patients have received about vaccines were based on posts they’ve seen on social media and word of mouth from families and friends. In order to provide continuous education and keep patients informed with the most up-to-date information.

Which standard did you focus on? ASSESS

AHA moment: •Chart audits reinforced how complex the disease-specific pneumococcal  recommendations are.

Favorite intervention: •Implementing use of the PneumoRecs App

SIPS Peninsula Community Health

many of our adult patients have no idea there are vaccines recommended for adults. and, they expect their PCP to be the one to tell them all vaccine info

increase in pneumonia vaccination rates

SIPS Weekly Data_Peninsula Community Health Services_6.20.2023.xlsx

*Submitted data through second last week of June, numbers look good but percentages are lowerweek of June, numbers look good but percentages are lower

Something you learned about your patient population: many of our adult patients have no idea there are vaccines recommended for adults. and, they expect their PCP to be the one to tell them all vaccine info

Which standard did you find the most areas for improvement? •Assess – the many recent changes to pneumococcal vaccine recommendations have  made it hard for staff to know who needs what and if they are up to date or not

What is an AHA moment?

•When doing the chart audits we noticed that many eligible patients were not being  offered PCV20 even though they were not up to date on pneumococcal vaccines. We  realized that the quality tab in our EHR was not forecasting the current  recommendations.

Most impactful intervention: •When we noticed the issue with our quality tab, we were able to get it updated to  forecast correctly for both 19-64 year old patients and 65+ patients. The 19-64 year old  patients were the primary target of our intervention as many of these patients have  PPSV23 but now need PCV20 to be considered up to date. We also provided laminated  copies of the current pneumococcal vaccine recommendations with guidelines based on  age and disease states.

SIPS Premier Community Healthcare

Vaccine hesitancy due to the COVID Vaccine being a newer vaccine. Patient’s lack of understanding the importance of receiving the PCV vaccine and that it is a one-shot immunization now.

Best practices for patients with low healthcare literacy and ways to reduce vaccine barriers for improved compliance.

Premier_2023-06-30 SIPS Patients 65+ seen and PCV status to date with weekly data and overview to date.xlsx

*Submitted in own format

Data not worth sharingsharing

Something you learned about your patient population: Patient’s lack of understanding the importance of receiving the PCV vaccine and that it is a one-shot immunization now.

What is an “AHA” moment? •Although we have a process in place for reconciling immunizations in the patient’s chart with Florida  Shots, this process was not being followed consistently for patients that were not on the schedule and  chart prep was not completed prior to their appointment.

•Inconsistency in documentation of refusal, not always being documented.

What was your most impactful mini-intervention? •Mini intervention completed for Recommend. During the initial chart audit I identified that refusals  were not being documented consistently or at all. I met with the Office Manager and the Clinical Lead  and I recommended that the MA’s document refusal within the immunization tab in Intergy and to  keep reminder due so that the next time the patient comes it we will continue to ask. I also reviewed  with them the importance of ensuring all patient’s immunizations is reconciled with Florida Shots  during their appointment, as we had several patients who had a PCV on file with Florida Shots that we  were able to import into the patient’s chart.Something you learned about your patient population: Patient’s lack of understanding the importance of receiving the PCV vaccine and that it is a one-shot immunization now.

SIPS PrimeCare Community Health

Our pneumo vaccination rate for adults 65+ is double that of the rate of ages 18-64 with a qualifying condition

Getting to work with more teams across PrimeCare to learn about quality and improve care for our patients!

*Only submitted data through end of May, numbers are high, percentages are high but relatively stable throughout project periodInclude this data!

Include this data!

Something you learned about your population? Our pneumo vaccination rate for adults 65+ is double that of the rate of ages 18-64 with a qualifying condition

For which standard of adult  immunization practice did you find the  most areas for improvement?

•We saw the most improvement in the Assess standard because once we engaged the  Medical Assistants, they were determining which patients needed vaccines and were  more likely to then discuss it with the patients to later administer.What is one thing we

+ see data

SIPS Universal CHC

One thing UCHC recently learned about our population? Our pneumo vaccination rate for adults 65+ is double that of the rate of ages 18-64 with a qualifying condition

+ see data

SIPS Universal CHC

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patient population, is that their is hesitance and reluctance from residents in our service area, specifically in adults to get vaccinated against influenza.

A win from participating in this program would be the increased outreach and number of children, youth, and young adults immunized.

SIPS Weekly Data_Universal Community Health Center.xlsx

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*Submitted data through full project period, numbers are high but percentages are low (< 3%)

SP: Not sure this is really useful

For which standard of adult  immunization practice did you find the  most areas for improvement?

•Recommend & Document

•Gap noted for understanding when a patient was recommended the Tdap and declined.

•There is a drop down that staff uses when administering, but not always used when refused.

•One big “a-ha” moment: we realized we needed to look through the entire encounter to really determine if the  TDap vaccine was being offered so the staff can take credit for those efforts. We had to look through the  progress notes to rule this out. This information was not always available. When the schedule was full we  noticed lack of time was a factor.

•Another “a-ha” moment for one person when doing audits for Tdap was the moment they found the free text

proof in the progress note as well. It was a “there it is” moment.

Most impactful mini-intervention: •Confirming that each patient’s health record was reconciled with the CAIR history by merging in the vaccines to

the chart.

•This was really important and helpful in determining if vaccine was needed and an opportunity to look at  other critical vaccines that could be recommended. This helped staff determine vaccine eligibility more  effectively and print out the hard copy of the CAIR form which is also now scanned into the patient’s  chart.

One thing UCHC recently learned about our patient population, is that their is hesitance and reluctance from residents in our service area, specifically in adults to get vaccinated against influenza.

A win from participating in this program would be the increased outreach and number of children, youth, and young adults immunized.

SIPS Weekly Data_Universal Community Health Center.xlsx

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*Submitted data through full project period, numbers are high but percentages are low (< 3%)

SP: Not sure this is really useful. We had to look through the  progress notes to rule this out. This information was not always available. When the schedule was full we  noticed lack of time was a factor.

•Another “a-ha” moment for one person when doing audits for Tdap was the moment they found the free text

proof in the progress note as well. It was a “there it is” moment.

Most impactful mini-intervention: •Confirming that each patient’s health record was reconciled with the CAIR history by merging in the vaccines to

the chart.

•This was really important and helpful in determining if vaccine was needed and an opportunity to look at  other critical vaccines that could be recommended. This helped staff determine vaccine eligibility more  effectively and print out the hard copy of the CAIR form which is also now scanned into the patient’s  chart.