Racial and Ethnic Adult Disparities in Immunization Initiative READII

1
Racial and Ethnic Adult Disparities in
Immunization Initiative (READII)

• Tamara J. Kicera
• National Immunization Program
• Centers for Disease Control and Prevention

2
Project Genesis

• DHHS initiative to reduce racial-
  ethnicity-related health disparities
• Emphasis on prevention
• CDC asked for proposed program possibilities

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The Problem

• Approximately 36,000 adults die/200,000
  hospitalized from influenza and pneumococcal
  disease each year in the U.S.
• Adults 65 years and older have immunization
  coverage rates that are significantly lower than
  the Healthy People 2010 Goals of 90
• Significant racial and ethnic disparities in
  adult immunization coverage exist, and persist
  despite controlling for SES, access to care and
  insurance coverage

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Figure 1 Receipt of influenza vaccination during
the previous 12 months by race/ethnicity among
persons gt65, 1989-2003, National Health Interview
Survey
Healthy People 2010 Goal
2003 early release data
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Pneumococcal Vaccine Coverage by
Race/Ethnicity(2002 NHIS data)
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READII Project

• Multi-year Demonstration Project begun 2002, ends
  December 31, 2004
• Five sites
• Chicago, IL
• Milwaukee, WI
• Mississippi (19 county) Delta region
• Rochester, NY
• San Antonio, TX
• CDC lead with collaboration of CMS, HRSA, AoA,
  and AHRQ

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Underlying Principles

• Local buy-in
• Communities need to engage critical
  partners/stakeholders
• Evidence-based interventions
• Providers
• Community
• 3 (flu) season approach

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READII Activities

• Develop Community Plans
• Communications Research
• Local Community Roll-outs
• Implement interventions
• Evaluation

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Programmatic Strategies

• General strategies
• Improve provider vaccination practices
• Increase access
• Increase demand
• Target multiple provider groups
• Tailor specific interventions based on local
  needs and capacity
• Key factors for choosing interventions
• Feasibility
• Expected impact on target population

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Potential Interventions

• Standing orders
• Patient reminder/recall
• Provider reminders
• Expanded access at provider site collaboration
  with non-traditional providers
• Assessment and feedback
• Effective patient-provider interaction

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Challenges

• Identification and engagement of key (adult)
  stakeholders
• Effective Communications for Providers and
  Consumers
• Evaluation (process outcome)
• Feasibility/Sustainability

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Desired Outcomes

• Short term
• Feasibility demonstration
• Learning opportunity
• Long term
• Exportable, successful models
• Capacity building/Sustainability
• Reduce/eliminate disparities

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Early Findings/Feedback

• Significant differences between Pediatric Adult
  providers in terms of buy-in/engagement
• Attitudes of office nursing, support staff
  vaccination rates among providers
• Disorganization/Confusion re ACIP recs
• Target populations communities often lack mass
  immunization sites
• Tap into existing partner activities, rather than
  starting new initiatives/efforts

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Early Findings/Feedback (continued)

• Childhood program success may never be replicable
  with adults
• Capacity building May need to consider other
  models (e.g., collaboration between providers and
  mass immunizers)
• More research needed (i.e., universal flu
  recommendations? attitudes of support staff?
  provision of vaccines up-front? effects of
  increased reimbursement rates?)
• Effects of HIPPA on activities/efforts

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Questions?