San Diego-Influenza Coverage Extension (SD-ICE)

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DESCRIPTION (provided by applicant): Despite the availability of an effective vaccine, influenza vaccine coverage levels remain far below Health People 2010 goals. The vast majority of annual influenza vaccinations are provided during the months of October-December. This is due to the availability of vaccine, provider practices and public expectations. The expansion of the groups recommended for annual vaccination means that current provider capabilities will be challenged. If recommendations and vaccine availability are expanded to include the entire population, provider and public health capacity will be severely tested. Since the seasonal peak in influenza cases is most common in February, expanding the season into the month of February is a viable strategy. We propose to work with a diverse sample of medical providers to improve annual influenza coverage by promoting use of evidence based interventions shown to improve immunization coverage expansion (ICE). The primary interventions anticipated include: patient and provider reminder/recall systems (including those incorporated in electronic medical record systems and the County's web-based immunization registry), standing orders, and assessment and feedback for providers. Many of the interventions build upon existing capabilities of providers and our County Immunization Branch. The primary goal will be to extend use of these interventions through February. To accomplish this expansion, we will investigate barriers to ICE, assess readiness and capacity for change, and prepare "tool kits" to facilitate practice changes. To allow better comparisons, after initial assessment we plan to allocate stratified or matched practice sites into two levels of intervention; intensive and information only. To assess the changes in coverage, patterns of intervention adoption and other changes in provider practices we will conduct follow-up assessments in all practices. Information will be collected from practices using a combination of qualitative and quantitative surveys. Primary outcomes include change in influenza vaccine coverage rate and reduction of missed opportunities to administer influenza vaccine. Cost analysis will assess incremental costs incurred to extend the vaccination season. Summative evaluation will include assessment of how practices overcome barriers, select and implement interventions as well as prospects for sustainability of an extended season.