hpv-call-to-action...report card during afix visit. peer-peer webinars sessions (10) to providers....
TRANSCRIPT
HPV-Call-to-Action:
“Increasing HPV
Vaccination Through
Strengthening of
Adolescent AFIX.”
2PM ET
June 28th, 2017
$20.7 million 19 states | 2 cities
$20.7 million to 19 states and 7 cities to increase HPV vaccination coverage among adolescents through joint initiatives with immunization stakeholders, communication
campaigns, IIS-based re-minder/recall, assessment and feedback (AFIX), and strategies targeted to improve immunization providers’ knowledge, skills, and adherence to current
HPV vaccination recommendations. (AK, AZ, GA, IA, IL, KS, KY, MA, MI, MN, ND, NV, NY, OH, OR, RI, UT, WA, WI, Chicago, District
of Columbia (DC), Houston, New York City, Philadelphia, San Antonio, and Puerto Rico)
PPHF: Increasing HPV
Vaccination Coverage
3
oWelcome & Housekeeping
o Speaker Introductions
o Presentations: Houston, Puerto Rico,
Rhode Island
o Discussion
Agenda
Reminder: Webinar is being recorded
4
Webinar Tech-Tips
Click either:✓ “USE Telephone” for cell
phone or land line OR
✓ “USE Mic & Speakers” for computer audio and voice
Choose EITHER your telephone or your computer’s microphone and speakers.
If you are dialing in on telephone, enter audio pin #yourpin# .
www.immunizationmanagers.org
5
Discussion
Type question in
Question Box and AIM
Staff will read your
question to the panelist.
ALL Lines will be unmuted during the
discussion portion of the call.
PLEASE remember to mute your
line if you are not speaking
Mute the line by muting your
phone, or computer mic, or by
clicking the green microphone
button the Go To Webinar control
panel
www.immunizationmanagers.org
6
POLL QUESTION
Please Participate!
7
The City of Houston
LaTasha Hinckson Callis, MBAAs the Administration Manager for the Houston Health Department’s Immunization Bureau, Mrs. Callis provides leadership and oversight in the assessment of schools and child-care facilities to increase immunization rates and the overall health of children. In addition, she oversees Project Milestone—a partnership between the Immunization Bureau and WIC to increase immunization rates of clients through service linkage, immunization education and record screening, while also managing all immunization community and provider education and new initiative implementation across the city of Houston and Harris County. Mrs. Callis earned her MBA in Healthcare Administration from The University of Texas at Tyler, as well as her BA in Spanish from The University of Texas at Austin.
8
Puerto Rico
ANA LAURA VELÁZQUEZ-FERNÁNDEZ, MPH Ana Laura is the AFIX Adolescent Project Evaluator at the Puerto Rico Immunization Program. She has a Master’s degree in Public Health from the Medical Sciences Campus of the University of Puerto Rico. She has worked in clinical trial research protocols for mental health patients, and has also participated in research projects related to social stigma for HIV patients and mental health patients. As a public health professional, she is committed to contribute to the accessibility and quality improvement of essential health services, including primary health, preventive care, and mental health.
9
Rhode Island
Sue Duggan-Ball, MPASue has held the position of Quality Assurance Manager at RIDOH since December 2007, serving as both the AFIX and VFC Manager. Previously holding the position of Immunization Registry, KIDSNET, Provider Relations Manager for seven years. Before joining the Rhode Island Department of Health, Sue worked at Harvard Pilgrim Community Health of New England, at one of the health centers, where most of her time was dedicated to the Consumer Relations Department.
Increasing HPV Vaccine Coverage
by Strengthening Adolescent
AFIX Activities
LaTasha Hinckson Callis, MBAAdministration ManagerHouston Health Department, Management Analyst IVPresentation Date: June 28th 2017
Presentation Overview
• HPV Vaccination Rates in Houston
• Grant Overview:• Strategies
• Outcomes
• Next Steps
HPV Rates in Houston
(…and Doses Administered)
➢ TVFC Provider Rates Houston(2016):➢ HPV 1: 69%
➢ HPV 3: 40%
➢ **Objective: 5% increase in 2017
➢ NIS Rates 13-17 years Houston (2015):➢ HPV ≥1 (Female): 66.9%
➢ (National-62.8%)
➢ HPV ≥1 (Male): 58.6%
➢ (National-49.8%)
➢ HPV ≥3 (Female): 42.8%
➢ (National-41.9%)
➢ HPV ≥3 (Male): 22.7%
➢ (National-28.1%)
12
Strategy 1: Increase Adolescent
AFIX Visits
Increase the number and reporting of completed adolescent AFIX
visits by 25% or at least 50 visits, whichever is greater, compared with
Calendar Year 2016.
➢ Short Term: Conduct a needs assessment to identify providers who will
be selected
➢ Mid Term: VFC providers will select and begin execution on 2-3 quality
improvement (QI) strategies discussed during the initial assessment
➢ Long Term: VFC providers will maintain quality immunization services
and increase HPV coverage rates among patients with increased
involvement by physicians focused on AFIX
13
Strategy 1: Outcomes
Factors in needs assessment:
➢ AFIX adolescent coverage rates (2016)
➢ Doses administered for HPV only (2016)
➢ Comparative data of doses administered for HPV, Tdap, and Meningococcal (2016)
➢ Of the 50 providers identified in Cohort 1, 11 received an adolescent AFIX in 2016➢ MCV 1 Coverage (96%)
➢ Tdap 1 Coverage (96%)
➢ HPV 3 Coverage (38%)
Other updates:
➢ Adolescent AFIX: To date, 17 adolescent AFIX visits have been conducted in 2017
➢ Staffing: Public Health Educator & LVN hired
14
Strategy 2: Improve Quality of
Adolescent AFIX Visits
Improve the quality of adolescent AFIX visits.
➢ Short Term: AFIX reviewers and the AFIX coordinator will participate in
CDC led trainings.
➢ Mid Term: AFIX reviewers will receive training and shadowing from the
AFIX coordinator to ensure quality AFIX visit. AFIX reviewers will assist
providers with effectively communicating the importance of HPV
vaccination to parents.
➢ Long Term: AFIX reviewers and the VFC provider will participate in
continuous education and training to lead to improved HPV vaccination
rates meeting the Healthy People (HP) 2020 coverage rate of 80%.
15
Strategy 2: Outcomes
➢ CDC led trainings: ➢ 2 staff attended AFIX training in March
➢ AFIX Reviewer Training: ➢ AFIX Coordinator trained reviewers based on CDC training
➢ HPV You Call the Shots modules
➢ Scheduled observations (6 yearly) check-ins (2 monthly)
➢ Continuous Education of VFC Providers:➢ Adolescent/HPV Physician Toolkit
➢ Adolescent/HPV Parent Toolkit
16
Strategy 3: Implement Approaches
for Adolescent AFIX Visits
Implement one or more of the following approaches for adolescent
AFIX visits.
➢ Short Term: Increase provider awareness of adolescent coverage rates
within their practice and how their office compares to adolescent
coverage rates into current National, State, HP 2020 rates.
➢ Mid Term: New QI strategies will foster more “buy in” from providers
leading to more understanding of how improving HPV rates prevents
HPV-related cancers.
➢ Long Term: Increase provider knowledge of adolescent coverage rates in
VFC provider practices to encourage periodic self-assessment of coverage
rates.
17
Strategy 3: Outcomes
18
Activities:
➢ Disseminate Immunization Report Card during AFIX visit.
➢ Peer-peer webinars sessions (10) to providers.
➢ Quarterly educational webinars
➢ Newsletter spotlighting providers with high coverage rates
➢ Evaluation reports
➢ HPV Video
Next Steps
➢ Complete all initial and follow-up assessments in Cohort 1
(Cohort 2)
➢ Complete and distribute HPV Cohort 1 Newsletter
➢ Shoot and edit HPV Video
➢ Schedule peer-peer webinars
➢ Schedule educational webinars
➢ Distribute Report Cards & Toolkits
19
PROJECT PROGRESS: PUERTO RICOAna Laura Velázquez-Fernandez, M.P.H.
AFIX-Adolescent Project Evaluator
AIM HPV-Call-to-Action Webinar, “Increasing HPV
Vaccination Through Strengthening of Adolescent AFIX.”
June 28th, 2017
WE ARE HERE!
Puerto Rico■ Unincorporated territory of the USA
o Eligible for federal funding
■ Population: 3.5 million
■ 13 to 18 years old: 353,311
o 81% of this population (286,012 as of June/2016) is VFC eligible source: Puerto Rico Immunization Registry (IIS)
■ VFC providers: 230
o 84% (193) of them are eligible for AFIX visits.
■ Recent updates in public policy
o Mandatory HPV vaccination for 2018-2019 school year
■ Health insurance companies cover HPV vaccine
Puerto Rico Cervical Cancer Incidence Data
Period Age groupIncidence rate x
100,000
Mortality rate x
100,000
2006-2010*20 to 34 years old 15.0 11.9
34 to 49 years old 8.3 6.3
2008-2012†20 to 34 years old 16.3 16.4
34 to 49 years old 8.0 7.0
Sources: * Cancer in Puerto Rico, 2006-2010. Puerto Rico Central Cancer Registry. San Juan, PR.† Cancer in Puerto Rico, 2008-2012. Puerto Rico Central Cancer Registry. San Juan, PR.
Vaccination Adolescent Coverage from 13 to 17 years old, Puerto Rico, 2014-2015
81.7 83.5
49.9
23.7
91.2
82.587.9
42
30.8
94.5
0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
of
est
ima
ted
co
ve
rag
e
Antigen and Dosis2014 2015
Source: National Immunization Survey
AFIX Implementation in Puerto Rico
■ 8 regional coordinators
o 22 AFIX reviewers that also conducts VFC visits
■ Data gathered from PRIR (IIS) since 2015
■ AFIX only visits
o Face to face only
■ Calculation of both children and adolescent coverage and missed opportunities
o 2014: CoCASA
o 2015-Present: Puerto Rico Immunization Registry (IIS)
AFIX Puerto Rico Staff
AFIX Lead ReviewerProject Evaluator
Health Education and
Communication Specialist
AFIX ReviewersEvaluation and Quality
Assurance (EQAS) Team Lead
IMPROVING THE QUALITY OF ADOLESCENT AFIX
VISITS
AFIX-Adolescent Project Activities
Policies and Procedures
Guide
First Official P&P Guide for Puerto Rico
Contains every document necessary for AFIX implementation
Culturally adapted guide
Provides guidance with site visit implementation for reviewers
Includes communication strategies
AFIX Online Tool User
Guide
CDC’s AFIX Online Tool User Guide
translation
Added features
▪ More screenshots
▪ More specific instructions
User friendly
AFIX Site Visit Form
Spanish translation
Improvements
▪ Developer functions allow the provider to answer questionnaire beforehand
Format similar to the AFIX Online
Tool
▪ Facilitates data entry process
Provider Report Card
■ Updates and improvements to the PRC
o HPV coverage by age cohort
o User friendly format
o Promotion of the AFIX email
■ Missed Opportunities
o Advanced programming in Access-Excel databases
Vacc
inat
ion
Pro
vid
erC
ove
rage
Rep
ort
Vacc
inat
ion
Pro
vid
erC
ove
rage
Rep
ort
Mis
sed
Op
po
rtu
nit
ies
Pro
vid
erR
epo
rt
Trainings for Reviewers
■ Development of a training module
■ Divided into 2 sections (2 days of training)
o AFIX training
➢ AFIX overview
➢ Role plays
➢ New documents and tools for AFIX visits
o Visit documentation training
➢ AFIX Online Tool
➢ Provider coverage and missed opportunities
■ Audience divided into 3 regions
o 8-10 participants per group
o Better attend the needs of participants
INCREASE KNOWLEDGE AND USE OF CDC
RESOURCES AND AFIX STANDARDS
Resources for providers, patients and parents
Educational Materials
■ Data base of multiple resources
■ Selection of culturally adapted materials
■ Categorized for various population
o Providers
o Patients
o Parents
■ Accessibility through the PRDoHwebsite
o HPV section
AFIX Booklet
AFIX description and summary
Easy to understand
Culturally adapted
Targeted for providers to
promote participation in the
AFIX program
Promotion of AFIX email
AFIX Bulletin
Informative sheet dedicated to
clarify questions from providers and
reviewers
Published every 3 months
1st edition: Coverage and missed
opportunities
Vaccine Refusal Documentation Form
Spanish version from the
American Academy of Pediatrics
Helps with accurate
documentation
Useful tool for providers in the
implementation of QI strategies
Pro
vid
er-O
rien
ted
Ed
uca
tio
nal
Mat
eria
l
Pati
ent-
Ori
ente
d
Edu
cati
on
al M
ater
ials
COLLABORATIONS WITH STAKEHOLDERS
Increasing institutionalization of QI strategies and HPV
strong vaccination recommendation in provider offices.
Collaboration With Stakeholders
■ Centro Comprensivo del Cancer de Puerto Rico Puerto Rico Comprehensive Cancer Center
o Coalición para la Control del Cancer de Puerto Rico (Coalition for Cancer Control of Puerto Rico)
o Immunization Program Representation
➢ HPV Prevention Committee
■ Voces - Coalición de Vacunación de Puerto Rico Voices - Vaccination Coalition of Puerto Rico
o Immunization Conference (IMCO)
➢ Educational booth
➢ AFIX satisfaction survey for providers
➢ Presentation
• Quality Improvement in Provider Offices
• Communication Strategies for HPV
■ Ponce School of Medicine & Moffitt Cancer Center
o ID HPV series completion barriers and facilitators among caregivers of Spanish-speaking /Spanish-preferring in Tampa FL, and Ponce, PR
o Refine and assess acceptability of and HPV vaccine educational brochure content.
o Data sharing
o Instrument Feedback➢ Provider oriented variables
Collaboration with Stakeholders
Collaboration with Stakeholders
■ Puerto Rico Health Department’s Maternal, Child and Adolescent Health Program
o “Vacunarse es Vida” campaign (2016)
➢ Target audience: Adolescents
➢ Multiple outlets
• Cinema commercials
• Social Media
• Billboards
• Printed and digital press
• Key chains
AFIX HPV Project Evaluation■ 2 year evaluation plan
■ Reviewers evaluation
o Observational visits
o Proficiency of the AFIX reviewers to conduct the AFIX visits
o Reviewer’s self-evaluation
■ Provider’s input
o Perceptions, satisfaction and usefulness of the AFIX visits
o Satisfaction and usefulness of the Provider Report Card
o Assessment of technical assistance needs for providers
■ Analysis of strengths and barriers for the AFIX visit implementation
o Technical assistance for providers and reviewers
NEXT STEPS
Next Steps
■ AFIX site visits (3rd quarter 2017)
■ Project evaluation process
o Observational visits
o AFIX visit satisfaction survey for providers
o Process to identify technical assistance for AFIX reviewers and providers
■ Development of the CME’s system (1st quarter 2018)
■ Development of sustainable formal incentives structure and logistic
■ Adaptation of “Vacunarse es Vida” campaign for providers
■ Community outreach
■ Collaboration with Merck & Co.
o Train and encourage HPV vaccine promoters to adopt CDC language for quality improvement and communication strategies
Thank you!
Ana Laura Velázquez-Fernández, MPHAFIX-Adolescent ProjectImmunization Program
Puerto Rico Department of [email protected]
Increasing HPV Vaccine Coverage by Strengthening Adolescent AFIX Activities Presentation
June 28, 2017AIM Webinar
Grant Objectives
Approaches to Increase Physician Engagement
Improve the Quality of AFIX Visits
Distribution of CDC Resources, Educate and Increase Awareness
Approaches to Increase Physician Engagement
Peer to Peer visits conducted during non standard office hours: 7:30 AM, noon, 5 :00 PM
Peer to Peer model requires 1 physician attend the visit, all other staff are welcome to join
Initial exchange is conducted with practice staff, physician not required
Approaches to Increase Physician Engagement
Rhode Island AFIX Webinar
The webinar is available at a time convenient for the physician
Receive CME incentive
Follow up call to practice staff. Has physician shared AFIX QI activities agreed to with you? How is it going?
Initial exchange conducted w/practice staff, physician encouraged, not required to attend
Improve the Quality of Visits
Awardee Staff Training
Physician consultant trains awardee staff on most current HPV data and clinical knowledge behind the data
Consultant conducts follow up training and post test
Provide ongoing training as needed
Outcome: Awardee staff will conduct improved AFIX visits armed with most current data and knowledge
Distribution of CDC Resources
Talking with Parents about HPV Vaccine
HPV and Oropharyngeal Cancer
Genital HPV Infection- CDC Fact Sheet
Resources reviewed at awardee meetings Which resources are practices using the most ?
Awardee staff will be well versed on the most current CDC materials to share at visits
Additional Collaboration
Joined Partnership to Reduce Cancer in Rhode Island, HPV subgroup
Objective: Provide HPV and orpharyngeal cancer education & resources to dental community
Working with the RIDOH Oral Health Program Manager and dentist to collaborate on these efforts
Subgroup to develop education plan for Dental Hygienist Program students in Rhode Island colleges
Distribution of CDC Resources
Talking with Parents about HPV Vaccine
HPV and Oropharyngeal Cancer
Genital HPV Infection- CDC Fact Sheet
Resources reviewed at awardee meetings Which resources are practices using the most ?
Awardee staff will be well versed on the most current CDC materials to share at visits
Sample Material
New Cancers Caused by HPV per YearUnited States 2008-2012
Men (n = 11,600)
Anusn=1,60014%
Oropharynxn=9,10078%
Penisn=7006%
Rectumn=2002%
Rectumn=5003%
Women (n = 19,200)
Anusn=3,00016%
Cervixn=10,70056%
Vaginan=6003%
Vulvan=2,40013%
Oropharynxn=2,00010%
CDC, United States Cancer Statistics (USCS), 2008-2012
HPV Vaccination Coverage Rates
HPV Vaccination Coverage Rates
HPV Vaccination Coverage Rates
HPV Rate Increase 2014- 2016
Effective August 1, 2015 HPV required for school entry
Vaccinate Before You Graduate expanded into middle school to vaccinate the second dose of HPV vaccine, most adolescents received the first dose at the provider office
Peer to peer consultant began AFIX visits in RI, February 2015
Reminder/recall project 2016
Sue Duggan-Ball, MPAQuality Assurance ManagerOffice of ImmunizationCenter for Preventive [email protected]
70
All lines are open! Please place your phone on MUTE when not speaking!
Discussion--Please participate!!
71
Reminders
➢ Take the event evaluation that appears at the end of the
webinar.
Your feedback will help us improve!
➢Next HPV Call-to-Action: September 13th at 2 PM ET
• Featured topic: TBA