fy21 lhd quarterly report - work in progress...fy21 lhd quarterly report - work in progress local...

FY21 LHD Quarterly Report - Work in Progress

LOCAL HEALTH DEPARTMENT INFO

Affiliation of Person Completing or Reviewing Report: *

Local Health Department Staff

Public Health Region Staff

Central Office-Austin Staff

PHR 1PHR 2/3PHR 4/5NPHR 6/5SPHR 7PHR 8PHR 9/10PHR 11

Region *

Amarillo CityAbilene Public Health DepartmentAndrews Health DepartmentAngelina County & Cities Health DepartmentAustin-Travis County HHS DepartmentBeaumont Public Health DepartmentBell County Public Health DistrictBrazoria CountyBrazos County Health DistrictBrownwood-Brown County Health DepartmentCameron County Health DepartmentCherokee County Health DepartmentCollin County Health Care ServicesComal County Health DepartmentCorpus Christi-Nueces County Public Health DistrictCorsicana Navarro County Public Health DistrictDallas County HHSDenton County Health DepartmentEctor County Health DepartmentEl Paso City-County Health DistrictFort Bend County HealthGalveston County Health DepartmentGarland Health DepartmentGregg County HealthHardin County Health DepartmentHays County Health DepartmentHidalgo County Health DepartmentHouston HHS DepartmentHunt Health Department (Greenville)Jasper-Newton County Public Health DistrictLaredo City Health DepartmentLubbock City Health DepartmentMarshall-Harrison County Health DistrictMedina County Health DepartmentMidland Health DepartmentMilam County Health DepartmentNortheast Texas Public Health DistrictParis-Lamar County Health DepartmentPlainview-Hale County Health DistrictPort Arthur City Health DepartmentSan Antonio Metro Health DistrictSan Patricio County Health DepartmentSouth Plains Public Health DistrictSweetwater Nolan Health DepartmentTarrant County Health DepartmentTexarkana-Bowie County Fam Health CenterVictoria City-County Health DepartmentWaco McLennan County Public Health DistrictWichita Falls-Wichita County Public Health DistrictWilliamson County & Cities Health District

Facility Name *

Amarillo CityAbilene Public Health DepartmentAndrews Health DepartmentAngelina County & Cities Health DepartmentAustin-Travis County HHS DepartmentBeaumont Public Health DepartmentBell County Public Health DistrictBrazoria CountyBrazos County Health DistrictBrownwood-Brown County Health DepartmentCameron County Health DepartmentCherokee County Health DepartmentCollin County Health Care ServicesComal County Health DepartmentCorpus Christi-Nueces County Public Health DistrictCorsicana Navarro County Public Health DistrictDallas County HHSDenton County Health DepartmentEctor County Health DepartmentEl Paso City-County Health DistrictFort Bend County HealthGalveston County Health DepartmentGarland Health DepartmentGregg County HealthHardin County Health DepartmentHays County Health DepartmentHidalgo County Health DepartmentHouston HHS DepartmentHunt Health Department (Greenville)Jasper-Newton County Public Health DistrictLaredo City Health DepartmentLubbock City Health DepartmentMarshall-Harrison County Health DistrictMedina County Health DepartmentMidland Health DepartmentMilam County Health DepartmentNortheast Texas Public Health DistrictParis-Lamar County Health DepartmentPlainview-Hale County Health DistrictPort Arthur City Health DepartmentSan Antonio Metro Health DistrictSan Patricio County Health DepartmentSouth Plains Public Health DistrictSweetwater Nolan Health DepartmentTarrant County Health DepartmentTexarkana-Bowie County Fam Health CenterVictoria City-County Health DepartmentWaco McLennan County Public Health DistrictWichita Falls-Wichita County Public Health DistrictWilliamson County & Cities Health District

County:

Your Name:

Facility Information *

1. PROGRAM & CONTRACT MANAGEMENT

Your Name:

Your Title:

Your Phone (XXX-XXX-XXXX):

Your Email:

First Quarter: September-NovemberSecond Quarter: December-FebruaryThird Quarter: March-MayFourth Quarter: June-August

Select the quarter you are reporting: *

PHR Email Address

List email address to which inbox your office would like to receive theemail notification and PDF copy of report upon submission

*NOTE: Only ONE email address can be listed, please use the email forthe staff you manages and tracks submissions of these reports.

You can always retrieve PDF Versions of reports any time by loggingdirectly into SurveyGizmo and using your Region's Log-In Information

PHR Email Address

Add Another

Click the hyperlink to access the FY21 LHD Immunization Program Contacts.Select your facility to review the Program Contacts provided in the ILAcontract packet.

Where there any changes in staff THIS quarter to the Program Contactslisted? (1.1.02 & 1.1.09)

Yes

No

Enter the necessary changes in Program Contacts for THIS quarter below:(1.1.09)

Name & Position Title

ArrivingDeparting

Select if: Date of arrival/departure

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Interim Info (Name, Phone, Email)

Date notice sent to DSHS

� YesNo

Notice sent w/in 30 days? If no, why?

Add Another

Does your facility have any contract funded staff positions vacant for morethan 90 consecutive calendar days? (1.1.10)

Yes

No

Enter the necessary changes in Program Contacts for THIS quarter below:(1.1.10)

*NOTE: Under 'Salary saving action' include comments on actionstaken to ensure salary savings from the vacancy are not lapsed (e.g.redirection of funds)

Position Title Who previously held this position

Date position became vacant

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Salary savings action*

Date notice sent to DSHS

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If no, why? Actions taken to fill vacancy

Is your LHD on track to expend at least 95% of awarded funds by August31st? (1.3.06)

Yes

No

Enter percent of grant funds expended for the current quarter below: (1.3.06)

Please explain why below: (1.3.06)

REGIONAL REVIEW DATE:

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Your Name:

Your Title:

Your Email:

REGIONAL REVIEWER:

REGIONAL REVIEW:

List any follow-up, corrective actions, or successes that need to becompleted based on THIS section. Ensure to document any technicalassistance provided. (1)

If no additional comments, enter N/A

2. FACILITY IMMUNIZATION ASSESSMENTS

CENTRAL OFFICE REVIEW DATE:

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Your Name:

Your Title:

Your Email:

CENTRAL OFFICE REVIEWER:

CENTRAL OFFICE REVIEW:



Did your facility provide education during audits of schools & childcarefacilities with high provisional delinquency, and/or exemption rates? (2.2.01)

Yes

No

Add Another

Enter the data for each education activity provided below: (2.2.01)

Facility Name Title of Training

Topics Discussed

Resources Provided


Did your facility provide feedback to the DSHS ACE (Assessment,Compliance & Evaluation) Group on trends and/or issues for school, college,and childcare vaccination requirements? (2.2.02)

*NOTE: Feedback should be submitted to the DSHS ACE Groupvia https://www.surveygizmo.com/s3/5213608/School-Feedback

Yes

No

N/A


https://www.surveygizmo.com/s3/5213608/School-Feedback


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Your Name:

Your Title:

Your Email:

REGIONAL REVIEWER:

REGIONAL REVIEW:



3. MANAGING TVFC & ASN PROVIDERS


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Your Name:

Your Title:

Your Email:





Add Another

Did your facility recruit new TVFC providers to administer vaccines toprogram-eligible populations? (3.1.01)

NOTE: The goal is to increase each LHD provider's enrollment by a minimumof 5%

Yes

No

Enter the corresponding information below: (3.1.01)

Total number of TVFC providers from the previous quarter

Total number of TVFC providers THIS quarter (including recruited)

Percent increase from PREVIOUS quarter

Enter the PINs of each recruited TVFC provider below: (3.1.01)

PIN

Add Another

Did your facility host any trainings for TVFC and ASN providers on policiesoutlined in the TVFC & ASN Provider Manual and recommended proceduresfor implementing them? (3.3.01)

Yes

No


Total number of enrolled providers that attended training

Enter the data for each TVFC/ASN training hosted below: (3.3.01)

Date of Training (MM/DD/YY)

�

Title of Trianing

Total number of attendees

Did your facility identify any TVFC or ASN providers that experiencedany vaccine loss (including wasted and expired) THIS quarter? (3.3.05)

Yes

No

Add Another

Enter the data for activities that were developed to help reduce the amountof vaccine loss for each provider below: (3.5.02)

*NOTE: Activity type examples are process improvement methods,training, etc.

TVFCASN

Type of Facility PIN Activity Type

Topics Discussed

Resources Provided

YesNo

Was a VLR submitted in EVI?

Did your facility conduct unannounced storage & handling (USH) visits andenter data from the visit into the CDC PEAR system? (3.05.02)

Yes

No


Total number of enrolled TVFC providers from the PREVIOUS quarter (A)

Total number of USH visit conducted THIS quarter (B)

Percent of USH conducted {Calculate by dividing (B) by (A) and move decimal placetwo spaces to the right}

Total number of USH visits documented in PEAR

YesNo

Were all of the USH visits conducted THIS quarter documented in PEAR?

Add Another

Enter the data for each USH visit that was conducted below: (3.5.02)

PIN Date of USH (MM/DD/YY)

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Time of USH

YesNo

Was this USH visit documented in PEAR?


Did a provider in your jurisdiction experience a vaccine loss as a result of atemperature excursion? (3.5.11)

Yes

No

Add Another

Enter the data for provider(s) that experienced vaccine loss as a result oftemperature excursions below: (3.5.09 & 3.5.11)

PIN

YesNo

Did you review the data logger reports to validate the accuracy of the submittedtemperature logs for this PIN?

Did your facility conduct annual training on the TVFC/ASN requirements andupdate training for all LHD staff funded on the LHD contract, as described inthe TVFC & ASN Program Operations Manual for Responsible Entities?(3.7.01)

Yes

No

Add Another

Enter the data for each staff member that attended training below: (3.7.01)

Position of Title of staff that attended Date of Training (MM/DD/YY)

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Title of Training

Were any vaccine borrowing forms submitted to your facility THIS quarter?(3.8.04)

Yes

No

Add Another

Enter the corresponding information for any providers that submitted avaccine borrowing form below: (3.8.04)

PIN

YesNo

Did provider adhere to all of the borrowing procedures?

If no, why?


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Your Name:

Your Title:

Your Email:

REGIONAL REVIEWER:

REGIONAL REVIEW:


If no additional comments, enter N/A:

4. EPIDEMIOLOGY & SURVEILLANCE


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Your Name:

Your Title:

Your Email:





%

Did your facility have any moms with estimated delivery dates (EDD)?(4.1.01)

Yes

No

N/A

Enter the percent of moms with an infant reported to the Peri Hep B Programbelow: (4.1.01)

If 100% of these infants were NOT reported to the Peri Hep B Program,please explain why below: (4.1.01)

If <90% of these infants was reported, what is your corrective action?:(4.1.01)

Did your facility conduct educational training for hospital and healthcareproviders within the Contractor's jurisdiction, to increase mandatoryscreening and reporting hepatitis B surface antigen (HBsAg)-positivewomen? (4.4.02)

Yes

No

N/A


Total number of educational trainings conducted


Add Another

Enter the corresponding data for the education training provided to increasemandatory screening and reporting of HBsAg-positive women below: (4.4.02)

HospitalProvider

Type of Facility Date of Training (MM/DD/YY)

�

Facility Name

Topics Discussed

Resources Provided


Were 90% of investigations of confirmed or probable reportable vaccine-preventable disease (VPD) cases completed within 30 days? (4.5.01)

Yes

No

N/A


Did your facility enter the complete vaccination history for at least 90% ofconfirmed or probable reportable vaccine-preventable disease (VPD) casesinto the National Electronic Surveillance System Based System (NBS)?(4.5.06)

Yes

No

N/A


Did your facility complete the Community Needs Assessment Report Form?(4.7.01)

Yes

No

Provide a brief summary on progress with the Community NeedsAssessment Report below: (4.7.01)


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Your Name:

Your Title:

Your Email:

REGIONAL REVIEWER:

REGIONAL REVIEW:



CENTRAL OFFICE REVIEW

ACE REVIEW DATE

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Your Name:

Your Title:

Your Email:

ACE REVIEWER:

ACE REVIEW:



6. INCREASED USE OF THE TEXAS IMMUNIZATION REGISTRY

CENTRAL OFFICE REVIEW

IDCU REVIEW DATE

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Your Name:

Your Title:

Your Email:

IDCU REVIEWER:

IDCU REVIEW:



Add Another

Did your RE conduct outreach and educational activities focused on 18-year-olds in high school and colleges/universities in your area? (6.2.02)

Yes

No

Enter the corresponding information below: (6.2.02)*NOTE: Enter ImmTrac2 ORG Code only if applicable

Date of Activity

�

Organization Name ImmTrac2 ORG Code*

Resources Provided Outcome of Outreach (i.e. overall results)


As a reminder, you are required to complete at least twelve (12) outreach andeducational activities focused on 18-year-olds in high schools,college/universities and/or institutions of higher learning by the end of the4th Quarter: (6.2.02)

I have read the reminder

If <12 or less than 100% outreach/educational activities were conducted,please explain why below: (6.2.02)

Did your RE conduct at least twelve (12) outreach and educational activitiesfocused on 18-year-olds in high school and colleges/universities in yourarea? (6.2.02)

Answer "Yes" if outreach was performed to 100% in jurisdiction

Yes

No

If <12 or less than 100% outreach/educational activities were conducted,please explain why below: (6.2.02)

Did the average percentage of active users exceed 90% according to the lastthree (3) Provider Activity Reports (PAR)? (6.3.01)

Yes

No

What was the average percentage of active users according to the last three(3) Provider Activity Reports? (6.3.01)

Did the average percentage increase by 5% based on the PREVIOUSquarter? (6.3.01)

Yes

No


What was the average percentage of active users according to the last three(3) Provider Activity Reports? (6.3.01)

Did your RE increase the total number of registered organizations? (6.5.01)

Yes

No

_

Number of registered organizations according to the August 2020 PAR

Total number of registered organizations according to the most recentPAR



Did your RE increase the number of registered organizations by 5% at theend of the 4th quarter? (6.5.01)

Yes

No


_

Number of consented clients according to the August 2020 report fromCentral Office

Total number of consented clients according to the most recent report fromCentral Office

Did the total number of clients consented increase in your jurisdiction?(6.6.01)

Yes

No



Did your RE increase the number of consented clients by 5% at the end ofthe 4th quarter? (6.6.01)

Yes

No


Did your RE review the quarterly Consent Accepted Rate Evaluation (CARE)reports for the previous three (3) months to target 75 (or 100%) oforganizations with the largest client volume and/or lowest consentacceptance? (6.6.02)

Yes

No

Provide the average consent acceptance rate according to the most recentCARE report below: (6.6.02)

*NOTE: Please ensure to select the proper Consent Rate; if you do notmove the Consent Rate button it will report 0%

ConsentRate


_

Total number of quality improvement initial visits conductedTHIS quarter

Total number of quality improvement follow-up feedbackconducted THIS quarter

Total number of completed quality improvementassessments this FISCAL year

Did your RE complete any Texas Immunization Registry organization qualityimprovement assessments? (6.6.03)

Yes

No

Provide the total number of quality improvement refusals: (6.6.03)

Please provide the following based on the Quality ImprovementAssessments conducted: (6.6.03)

Did your RE complete less than 60 quality improvement follow-up feedbackby the end of the 4th quarter? (6.6.03)

Yes

No



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Your Name:

Your Title:

Your Email:

REGIONAL REVIEWER:

REGIONAL REVIEW:



7. EDUCATION & PARTNERSHIP


�

Your Name:

Your Title:

Your Email:





Did your facility organize any events to inform and educate the public aboutvaccines and vaccine-preventable diseases? (7.1.01)

Yes

No

Add Another


Date of Event

�

Title of Event

Topics Discussed Resources Provided


Did your facility host any special initiatives, events, collaborations, orgeneral public educational events to inform the general public about theTVFC & ASN Programs and the eligibility criteria for qualifying for theprograms? (7.1.02)

Yes

No

Add Another


Date of Event

�

Title of Event



Did your facility provide any training opportunities and/or resources toassist immunization providers in communication with patients and/orparents on how to communicate the benefits of immunization? (7.2.05)

Yes

No

Add Another

Enter the corresponding information below: (7.2.05)*NOTE: Specify whether resources provided were either print orelectronic version

Date of Training

�

Title of Traning

Organization Name Provider Name (Group or Individual)

Resources Provided* Total number of attendees

Did your facility plan and implement any community educational activitiesand partnerships aimed at improving and sustaining immunization coveragelevel? (7.5.01)

Yes

No

Add Another


Date of Activity

�

Title of Activity

Organization Name Provider Name (Group or Individual)


If applicable, did your facility conduct any outreach and collaborativeactivities with American Indian Tribes? (7.5.02)

Yes

No

N/A

Add Another


Date of Activity

�

Title of Activity Organization Name

Group in attendance Topics Discussed



Add Another

If applicable, did your facility participate in at least one collaborative meetingconcerning tribal health issues, concerns, or needs with American Indiantribal members? (7.5.03)

Yes

No

N/A


Date of Meeting

�

Group in attendance




Did your facility engage in education and partnerships aimed at reducing oreliminating coverage disparities by race, ethnicity, and socioeconomicstatus? (7.5.06)

Yes

No

Add Another


Date of Activity

�

Title of Activity Group in attendance

Topics Discussed Resources Provided*



Add Another

Did your facility maintain a contact list of providers, hospitals, schools,childcare facilities, social services agencies, and community groupsinvolved in promoting immunizations and reducing vaccine-preventabledisease (VPD)? (7.5.07)

*NOTE: This information is for reporting purposes only

Yes

No

Enter NEW contact information below: (7.5.07)

Name of Organization Type of Organization

Additional Notes on this organization

Did your facility implement the DSHS Immunization Ambassador Programthroughout your area? (7.5.09)

Yes

No

For any ambassadors you have assigned, select all that apply: (7.5.09)

Schools

Post-Secondary (college, trade, etc.)

Young Children

Elderly

First Responders

Private Industry (offices or hospitals)


Did your facility distribute ASN information and educational materials atvenues and clinics that serve eligible adults? (7.7.01)

Yes

No

Add Another


Provider Name (Group or Individual) Resources Provided*

Date info was distributed

�

Did your facility distribute TVFC information and educational materials atvenues where parents of TVFC-eligible children might frequent? (7.7.02)

Yes

No

Add Another


Provider Name (Group or Individual) Resources Provided*

Date info was distributed

�

Did your facility use national immunization observances as opportunities toconduct spcific education and promotional activites to give emphasis to theimportance and benefits of vaccines? (7.7.05)

National Infant Immunization Week (NIIW), National ImmunizationAwareness Month (NIAM), National Influenza Vaccination Week (NIVW),and Texas Influenza Awareness

Yes

No

Total Number

National Infant Immunization Week (NIIW)

National Immunization Awareness Month (NIAM)

National Influenza Vaccination Week (NIVW)

Texas Influenza Awareness

Enter the total number of activities completed THIS quarter for each of thefollowing: (7.7.05)

NOTE: If none, enter 0


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Your Name:

Your Title:

Your Email:

REGIONAL REVIEWER:

REGIONAL REVIEW:



Submission Date


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Your Name:

Your Title:

Your Email:





DSHS Contracts Management Section tracks the submission dates of all requiredreports as specified in the Contractors Guide to ensure contractualcompliance. Overdue reports are considered to be non-compliant with contractstandards.Enter report completion date (MM/DD/YYYY) *

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fy21 lhd quarterly report - work in progress...fy21 lhd quarterly report - work in progress local...

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