Petaluma Health Center Childhood Immunization Workflow · 2019-08-28 · Petaluma Health Center...
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Petaluma Health Center Childhood Immunization Workflow PROMISING PRACTICE OVERVIEW AIM ACTIONS TAKEN MEASURES Petaluma Health Center (PHC) has been working to improve childhood immunizations for the past two years. The transition from CAIR 1 to CAIR 2 in 2017 brought to light existing interface and data issues with CAIR and eCW. PHC conducted frequent staff trainings and other interventions to improve data quality for immunizations and minimize missed opportunities for vaccines. They also developed a pocket guide with PHC’s immunization schedule (based on CDC recommendations) for care teams to use on a daily basis. They also developed a roadmap for patients ages 0-2 years to outline what is recommended. Recalls are done by phone calls which are time intensive and need to be done by an MA due to issues with data validity. Improving data validity by matching eCW to CAIR continues to be an ongoing process and PHC has conducted PDSAs on a couple of strategies and is sharing the workflow they developed. UDS Childhood Immunizations Numerator: Documentation of a full immunization on or before the second birthday; A full immunization is all of the following: 4 DTP/DTaP, 3 IPV, 1 MMR, 3 Hib, 3 HepB, 1 VZV, 4 Pneumococcal conjugate, 1 Hep A, 2 or 3 RV, and 2 influenza. Denominator: Patients who had their second birthday within reporting period; Had at least one medical visit during reporting period; Had at least one medical visit any time prior to the second birthday; Exclusion: contraindication for the vaccine or a history of illness. PHC has four Relevant reports used for this workflow and they were built so they capture vaccines that should have been completed: 1. Behind on vaccines ages 3-8mo 2. Behind on vaccines ages 9-11mo 3. Behind on vaccines ages 12-17mo 4. Behind on vaccines ages 18-23mo Improve the UDS immunization rate for Childhood Vaccines (up to date 2 years). PHC’s childhood immunization rate improved from 28% in December 2016 to 44% in November 2018. 1. Ongoing review of CAIR for new patients and patients overdue for immunizations is needed 2. Putting more time into data clean up vs. daily chart prep saves time and is more efficient 3. Same day appointments are still a challenge and more PDSAs are needed 4. MAs need to be on board with childhood immunizations as a urgent priority including improving flu vaccine rates In January 2018, PHC exported all of their patient records from CAIR and it took 6 months (~80 hours) to verify eCW data was accurate. PHC determined that the one time data export was a start but that ongoing reconciliation for all new patients and patients overdue for immunizations is needed. PHC conducted a PDSA with a pediatrician and the care team where they used their monthly population health team time (45 min) to review/reconcile all patients seen in the last three months, as well as patients 0-23 months that were overdue for vaccines. They determined that they could expect MAs to review about 5 charts in 45 minutes. PHC also engaged in staff and provider trainings around anticipatory guidance and communication with patients including scripting that uses the presumptive approach. PHC’s patient videos on growing up healthy: Spanish: https://vimeo.com/293223312 English: https://vimeo.com/293213271 LESSONS LEARNED Redwood Community Health Coalition Promising Practice WORKFLOW RESULTS TO DATE PHC conducted a PDSA where the Health Information Coordinator looked for patients that needed CAIR records more frequently throughout the day. They learned that putting more effort into the chart prep didn’t necessarily help because some patients did not show for their scheduled appointments. Since CAIR records did not match eCW, printing CAIR did not help and resulted in a lot of wasted effort to figure out what patients were due for. Ongoing review of all new patients and patients overdue for IZ, using the workflow outlined above, was most efficient. Needed IZ were documented in the chief complaint and addressed when the patient came into the health center. 11/8/2018 Child is scheduled for IZs Health Information Coordinator pulls CAIR report If record is not up to date, look in eCW and compare to CAIR and write what is due in the chief complaint This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number H2QCS30258, Health Center Controlled Networks, for $1,500,000. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Transcript of Petaluma Health Center Childhood Immunization Workflow · 2019-08-28 · Petaluma Health Center...
Petaluma Health Center Childhood Immunization Workflow
PROMISING PRACTICE OVERVIEW
AIM
ACTIONS TAKEN
MEASURES
Petaluma Health Center (PHC) has been working to improve childhood immunizations for the past two years. The transition from CAIR 1 to CAIR 2 in 2017 brought to light existing interface and data issues with CAIR and eCW. PHC conducted frequent staff trainings and other interventions to improve data quality for immunizations and minimize missed opportunities for vaccines. They also developed a pocket guide with PHC’s immunization schedule (based on CDC recommendations) for care teams to use on a daily basis. They also developed a roadmap for patients ages 0-2 years to outline what is recommended. Recalls are done by phone calls which are time intensive and need to be done by an MA due to issues with data validity. Improving data validity by matching eCW to CAIR continues to be an ongoing process and PHC has conducted PDSAs on a couple of strategies and is sharing the workflow they developed.
UDS Childhood ImmunizationsNumerator: Documentation of a full immunization on or before the second birthday; A full immunization is all of the following: 4 DTP/DTaP, 3 IPV, 1 MMR, 3 Hib, 3 Hep B, 1 VZV, 4 Pneumococcal conjugate, 1 Hep A, 2 or 3 RV, and 2 influenza.Denominator: Patients who had their second birthday within reporting period; Had at least one medical visit during reporting period; Had at least one medical visit any time prior to the second birthday; Exclusion: contraindication for the vaccine or a history of illness.
PHC has four Relevant reports used for this workflow and they were built so they capture vaccines that should have been completed:1. Behind on vaccines ages 3-8mo2. Behind on vaccines ages 9-11mo3. Behind on vaccines ages 12-17mo4. Behind on vaccines ages 18-23mo
Improve the UDS immunization rate for Childhood Vaccines (up to date 2 years). PHC’s childhood immunization rate improved from 28% in December 2016 to 44% in November 2018.
1. Ongoing review of CAIR for new patients and patients overdue for immunizations is needed
2. Putting more time into data clean up vs. daily chart prep saves time and is more efficient
3. Same day appointments are still a challenge and more PDSAs are needed
4. MAs need to be on board with childhood immunizations as a urgent priority including improving flu vaccine rates
In January 2018, PHC exported all of their patient records from CAIR and it took 6 months (~80 hours) to verify eCW data was accurate. PHC determined that the one time data export was a start but that ongoing reconciliation for all new patients and patients overdue for immunizations is needed.
PHC conducted a PDSA with a pediatrician and the care team where they used their monthly population health team time (45 min) to review/reconcile all patients seen in the last three months, as well as patients 0-23 months that were overdue for vaccines. They determined that they could expect MAs to review about 5 charts in 45 minutes.
PHC also engaged in staff and provider trainings around anticipatory guidance and communication with patients including scripting that uses the presumptive approach.
PHC’s patient videos on growing up healthy:Spanish: https://vimeo.com/293223312English: https://vimeo.com/293213271
LESSONS LEARNED
Redwood Community Health Coalition Promising Practice
WORKFLOW
RESULTS TO DATE
PHC conducted a PDSA where the Health Information Coordinator looked for patients that needed CAIR records more frequently throughout the day. They learned that putting more effort into the chart prep didn’t necessarily help because some patients did not show for their scheduled appointments. Since CAIR records did not match eCW, printing CAIR did not help and resulted in a lot of wasted effort to figure out what patients were due for. Ongoing review of all new patients and patients overdue for IZ, using the workflow outlined above, was most efficient. Needed IZ were documented in the chief complaint and addressed when the patient came into the health center.
11/8/2018
Child is scheduled
for IZs
Health Information
Coordinator pulls CAIR report
If record is not up to date, look in
eCW and compare to CAIR and write what is due in the
chief complaint
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number H2QCS30258, Health Center Controlled Networks, for $1,500,000. This information or content
and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
1 month 2 months 4 months 6 m
onths 9 months
Dental Appt 12 months 15 months
Healthy BeginningsImmunizatioins Up to Date
6 Months 12 Months 18 Months H H H
18
mon
ths
24 m
onth
s
Name
My Chadis Login
My Patient Portal
Poison Control Phone #: 800-222-1222
PHC Phone #: 707-559-7500 Available for Urgent Medical Calls 24 hours a day.
1179 N. McDowell Blvd. Petaluma, CA 94954
1 mes 2 meses 4 meses 6 m
eses 9 meses
Cita Dentat 12 meses 15 meses
Comienzos SaludablesInmunizaciones Actualizades 6 Meses 12 Meses 18 Meses H H H
18
mes
es
2
4 m
eses
1179 N. McDowell Blvd. Petaluma, CA 94954
Nombre
Mi Inicio de Sesión Chadis
Mi Portal Para Pacientes Número telefónico de control de envenenamiento: 800-222-1222
Número telefónico del Centro de Salud de Petaluma 707-559-7500 Disponible para llamadas médicas urgentes las 24 horas al día.
1179 N. McDowell Blvd. Petaluma, CA 94954
MA Vaccine Training: 8/15/2018
MA Vaccine Rooming Script:
Your child is due for …vaccines today. Here is the information about those vaccines.
How to Respond if Parent is Hesitant or Declines Vaccines:
“Ok, if it’s ok, I’ll leave the vaccine information here for you and your provider can talk to you more about it”
Let parents know which vaccines are required for school Combination vaccines help avoid additional pokes Handouts about vaccine safety
Vaccine Resources on the Wiki
Scenario #1:
Mom brining in a 2-month old for their Well Child Check. The child is due for PEdiarix (Dtap, Hep B, Polio), Hib, PCV13 and Rotavirus. Parent is agreeable to vaccines.
Scenario #2:
15 month old is coming in for a sick visit and is overdue for MMR and Varicella. Parent is hesitant to get vaccines.
Well Child Check & Immunization Schedule
0-2 years old
Diptheria, Tetanus,
& Pertussis(Dtap) Vaccine
Hepatitis A Vaccine
Haemophilus Influenzae
Type B(Hib) Vaccine
Pneumococcal (Pneumonia)
Vaccine
Rotavirus Vaccine (Oral)
Haemophilus Influenzae
Type B(Hib) Vaccine
Pneumococcal (Pneumonia)
Vaccine
Rotavirus Vaccine (Oral)
Haemophilus Influenzae
Type B(Hib) Vaccine
Pneumococcal (Pneumonia)
Vaccine
Hepatitis A Vaccine
Measles, Mumps Rubella &
Varicella Vaccine
Catch up on any
missingvaccines orscreening
tests.
Lead Screening Test
*The Pediarix Vaccine protects against 5 Preventable Diseases: Diptheria, Tetanus, Pertussis (Whooping Cough), Hepatitis B, and Polio
Annual Flu Vaccine is Recommended for everyone 6 months and older
Pneumococcal (Pneumonia)
Vaccine
Rotavirus Vaccine (Oral)
At Birth 2 Months 4 Months 6 Months 9 Months 12 Months 15 Months 18 Months 24 Months
Hepatitis B Pediarix Pediarix Pediatrix Vaccine Vaccine* Vaccine* Vaccine*
Kids under 8 years may need a second dose of FLU Vaccine
Screening for Autism &
Developmental Delay
Screening for Anemia
FirstDental
Appointment
Screening for Anemia
Lead Screening
Test
At every well child visit, we check your child's growth (height/length & weight), check vision and hearing, and ask important screening and development questions. We provide education about what you can expect for your child's age group and how to keep your child healthy. It's a great time to ask questions about any concerns you may have about your child's development.
Calendario de Exámenes Físicos
0-2 años
La Vacuna de DTaP (contra la Difteria,
el Tétano, y la Tosferina)
Vacuna contra
la Hepatitis A
Detección de Autismo y
Retraso del Desarrollo
Vacuna contra la Haemophilus
Influenzae (Hib) Tipo B
Vacuna contra Infección
Neumocócica
Vacuna Contra el Rotavirus (Por Boca)
Vacuna contra la Haemophilus
Influenzae (Hib) Tipo B
Vacuna contra Infección
Neumocócica
Vacuna contra el Rotavirus (Por Boca)
Vacuna contra la Haemophilus
Influenzae (Hib) Tipo B
Vacuna contra Infección
Neumocócica
Vacuna contra la Hepatitis A
Vacuna contra el Sarampión,
las Paperas y la Rubéola (MMR)©
Ponerse al día con vacunas
atrasadas.
Prueba de detección de
plomo* La vacuna Pediarix proteja contra 5 Enfermedades Prevenibles: la Difteria, el Tétano, la Tosferina, la Hepatitis B y Polio
Se recomienda la Vacuna contra la Gripe cada Año para todos los pacientes mayores de 6 meses de edad.
Vacuna contra Infección
Neumocócica
Vacuna Contra el Rotavirus (Por Boca)
Al Nacer 2 Meses 4 Meses 6 Meses 9 Meses 12 Meses 15 Meses 18 Meses 24 Meses
Vacuna La Vacuna La Vacuna La Vacuna Contra la Pediarix* Pediarix* Pediarix* Hepatitis B
Los niños menores de 8 años puedan necesitar una segunda dosis de la vacuna de la gripe.
Detección de Autismo y Retraso del Desarrollo
Prueba de Detección de
Anemia
Primera Cita Dental
Prueba de Detección de
Anemia
Prueba de Detección de
Plomo
En cada examen físico, revisamos el crecimiento de su niño/a (estatura y peso), revisamos la visión y audición, hacemos preguntas importantes de revisión y de desarrollo, y proveemos información acerca de lo que puede esperar de su niño/a según su edad y cómo mantener a su niño/a sano/a. Es un buen tiempo para hacer preguntas a su proveedor/a médico/a de cualquier preocupación pueda tener acerca del desarrollo de su niño/a.
Practices for Improving Vaccination RatesNovember 7th, 2018
Tiffany Jimenez, RN, MSNQuality Improvement & Care Innovations Director
Petaluma Health Center
About PHC/RPHC• Federally Qualified Health Center (FQHC)• Two locations in Southern Sonoma County
• Petaluma Health Center• Rohnert Park Health Center
• Family Practice with 32,000 unique patients in 2 locations• Approximately 50% of patients have Partnership• Primary care with on site Dental, OB/GYN, MH services,
Nutrition, and Integrative Medicine
Immunization Rates
UDS Childhood IZ Childhood IZs Combo 3 Adolescent IZs
Care Team Workflow
Prep• HIC Prints CAIR routing slip the day before & checks
beginning of shift
Huddle• Provider & MA review CAIR & eCW record
MA• Rooms pt with: VIS, CAIR, presumptive language –
what’s due today and what’s due next
PCP• Screens for contraindications, orders
immunizations, answers any questions, addresses concerns
MA • Reviews drawn up IZs with provider and administers
Alerts
• Pts due for vaccines (according to eCW)• Limitations
Vaccine Inventory Management• Have enough vaccine on hand• Maintain Vaccines for Children Program Compliance
• Transparency with Vaccine Inventory
Vaccine Schedule
Immunization Schedule
Communication about vaccines• How many vaccines you can give at once• Vaccines when a child is ill• Presumptive language• Making the case for flu vaccine
Well Child Check Visits
Automated Recalls for all WCC visits
Call Center calls for 0-2 yrs overdue for WCC
Data Accuracy• Commitment to making CAIR & ECW match• Understand how data exchange works
• New Patients – allow new CAIR record to be created automatically• Vaccines that didn’t transfer to CAIR
Vaccine Documentation Audits
•Pending Vaccines
Data Clean Up• Early PDSAs: CAIRs for each and every visit• Lots of resources for little gain• At the time of the visit many times it’s too late
• Data review: All CAIR patients 0-2yrs• 578 Pts• 8,000 vaccinations• 80 hours
Recalls
Population Management Time• 9-11 Months overdue for vaccines• 12-17 months overdue for vaccines• 18-23 months overdue for vaccines• 11-12 year olds: Due for HPV• QIP recalls: look at entire population by birthdate
• 3mo-2yrs: New patient visit• Patients <2 years not seen in the last 1 year
New Patient Records• New Patient visits: ALWAYS get a signed release
• When received, assigned to MA Manager on the team
• MA manager Enters into eCW
Other Challenges• Patients declining vaccines (6.5%), declining flu (15-20%)• New Patients from other countries
Patient Incentives• $25 for HPV #2• Healthy Beginnings Punch Card• Picture wall – kids up to date on vaccines
Workflows & Trainings
What’s Next• Increasing Prenatal education• Rooming Template: decreasing missed opportunities for
same day patients
Questions? Comments?
CONTACT INFORMATION
Tiffany Jimenez, RN, MSNQuality Improvement & Care Innovations Director
Petaluma Health [email protected]
