Implementing Clinical Improvement Plans to Increase Immunization Rates

In 2014, thirty-eight MaineHealth practices adopted a standardized clinical improvement plan that identified and recommended evidence-based strategies for improving immunization rates; facilitated monthly practice-level data sharing among MaineHealth organizations, leadership teams and provider champions; and established action plans, based on challenges identified during site visits or technical assistance requests.

MaineHealth practices still utilize the clinical improvement plan as a guiding framework for improving childhood immunization rates from birth to age 19. The MaineHealth Child Health program works in tandem with a pediatric practice support specialist from the MaineHealth Accountable Care Organization to provide targeted and timely technical assistance and support.

In addition to sharing evidence-based strategies, the Child Health Team facilitates peer learning across pediatric and family medicine sites. This enables to the team to highlight good work that is already being done across the system, and provide targeted support to practices in areas that remain challenging.

Taking action to improve immunization rates

Pediatric and family medicine sites across the MaineHealth system have worked to improve immunization rates through a variety of strategies implemented at the practice level.
Franklin Pediatrics, part of Franklin Community Health Network, exceeded childhood and adolescent immunization targets in FY17. One strategy that contributed to their high rates is offering vaccines on a standard schedule. While all MaineHealth providers administer vaccines in accordance with ACIP guidelines, some vaccines can be provided within an age range and still be considered on-time. Franklin Pediatrics established a single vaccine schedule in alignment with well-child visits that all providers follow. This assures clear and consistent communication with patients regarding the timing of vaccines. It also enables any MAs or nurses who float across practices to easily understand where a child is on the vaccine schedule, and catch patients up as needed.
At Southern Maine Health Care (SMHC), practices adopted a standing orders protocol for routine childhood vaccination. Standing orders are an effective way to improve access to routine vaccinations and streamline operations by effectively utilizing members of the care team, such as medical assistants and nursing staff to the fullest extent of their role. In order to implement this protocol effectively, SMHC has launched educational initiatives to train staff at all levels on what the new protocol means for them, and how to carry out their responsibilities appropriately. As SMHC continues to improve their childhood immunization rates, the MaineHealth Child Health team will identify opportunities for them to share their learnings and successes with others.
Western Maine Pediatrics is a consistently high performer in both childhood and adolescent vaccination. One way they are able to achieve and maintain high rates of vaccination is through maximizing every opportunity to vaccinate children when they are in the office. They consistently offer vaccines during both well-child and acute visits, and utilize pre-visit planning to prepare for incoming patients. Each member of the care team is actively engaged in achieving a high level of success, and has a role in making sure that no opportunity to immunize is missed.
Pen Bay Pediatrics recently trained additional nursing staff in running ImmPact’s reminder/recall reports, expanding their capacity to proactively look at their patients who are due for immunizations. Through this effort, they developed patient outreach lists, which clinical support staff use to proactively call parents to schedule a nurse visit focused on immunizations. They also use these lists as a resource when planning 'catch up' vaccine clinics, and specifically invite patients who are falling behind in the vaccine schedule to come in for an appointment.

At LincolnHealth, Waldoboro Family Medicine committed staff time and attention to data clean up to make sure that their patients had accurate immunization records in their electronic medical record and in ImmPact. When they reviewed their current patient list in Epic, and compared it to their attributed patients in ImmPact, they noticed that the two lists were substantially different. They updated the ImmPact registry with only their current patients, and removed any patient names from ImmPact if they no longer came to their practice for care.

After updating the data in ImmPact to reflect their current patients, they ran a new report to check their immunization rates for 2 year olds. They discovered that they are actually meeting several of the individual 2 year-old vaccine CDC benchmarks. Completing this project highlighted how important it is to maintain accurate data, both to reflect the good work they are already doing, as well as to inform future improvement activities in areas that are in need of the most attention.

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Map UTD on 10 by HSA Oct2018

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