General Internal Medicine – Access Health Columbus

Vaccine Improvement Project

December 7, 2012 – Nazhat Taj-Schaal, MD John J. Davis, RN

3

What was the problem?

Variable rates for vaccinations (TDaP, Pneumo) among providers.

How was the improvement project identified?

Technical assistance from Access Health Columbus (Krista Stock) on a project charter.

1) EFINE

5

What was the key measure?

Immunization Rates for several Providers

2) EASURE

6/1/12 TDAP

Grever 36.3%

Jonaus 22.2%

Li 16.8%

6/1/12 Pneumovax

Grever 38.3%

Jonaus 35.1%

Li 41.2%

6

What root causes were identified?

3) NALYZE

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Increase the TDAP vaccination rate in patients aged 19+

10% in 3 months

25% in 5 months

Increase the Pneumovax vaccination rate in pts age 65+

10% in 3 months

25% in 5 months

Improve documentation rate of historical immunizations.

Educate and train clinic staff and physicians.

Improve the process of educating patients.

4) MPROVE

“Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.”

William A. Foster

9

What intervention was tried?

Introduce patients to vaccine importance with registration stamp.

Provide patient education materials in exam rooms.

Train MAs to ask patients about TDaP, Pneumo. MAs to enter historical vaccines if possible. MAs to pend vaccines.

Providers to sign pended orders.

MAs to administer vaccines.

4) MPROVE (continued)

New Workflow

10

What were the results?

10% & 25% Goals were met for TDaP

4) MPROVE (continued)

10%

25%

10%

25%

10%

25%

36.0%

39.4%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

55.0%

6/1 6/28 8/6 9/4 10/4 11/1

TD

aP

%

Monthly TDaP Rates vs Goals

Grever

Grever Goal

Jonaus

Jonaus Goal

Li

Li Goal

Others (avg change)

Others Range:

-10.8 to + 20.9

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What were the results?

10% & 25% Goals were met for Pneumovax

4) MPROVE (continued)

10%

25%

10%

25% 10%

25%

60.5%

62.3%

35.0%

40.0%

45.0%

50.0%

55.0%

60.0%

65.0%

6/1 6/28 8/6 9/4 10/4 11/1

Pn

eu

mo

%

Monthly Pneumo Rates vs Goals

Grever

Grever Goal

Jonaus

Jonaus Goal

Li

Li Goal

Others (avg change)

Others Range:

-17.8 to + 12.3

12

How was the process monitored?

Monthly Reports out of Epic/IHIS

Impromptu “huddles” with floor staff

Monthly meetings to discuss progress

5) ONTROL

Address Issues

Celebrate Success

13

Move from Stamp to Rooming dot phrase

Add Shingles Vaccine

Expand to all of General Internal Medicine

Track monthly progress for Gen Med & NCQA

Apply performance data to NCQA 2011 Standard 6 for submission as a PCMH

Next Steps

14 14

TEAM MEMBERS

Neeraj Tayal, MD - Division Director

Gail Grever, MD - Morehouse Lead Physician

Nazhat Taj-Schaal, MD – Core Team Physician

John Davis, PCMH RN – Core Team Member

Krista Stock, MHA – AHC Project Leader – THANK YOU!!

Sarah Jonaus, MD – Morehouse Physician

Guibin Li, MD – Morehouse Physician

Charlotte Boyer – Clinic Manager

Charlene McMahon – Clinic Nurse

Maxine Jefferson - MA

Stacy Muck- MA

Nicole Rittenhouse – MA

Registration & Pharmacy