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CMS has a variety of efforts underway to promote adult immunization. These include the National Influenza and Pneumococcal Vaccination Campaign led by Dr. Randolph Farris, CMS Dallas Regional Office Administrator, CMS's "breakthrough" initiatives targeting immunizations in nursing homes and dialysis facilities, and quality improvement efforts led by Quality Improvement Organizations (QIOs). QIOs work with consumers, physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get the right care at the right time, particularly among underserved populations. Breakthrough Initiatives CMS is launching a series of "breakthrough" projects focusing on specific areas where large quality gaps exist and stakeholders have identified specific steps to improve performance. CMS collaborates with various stakeholders on these initiatives and coordinates internally across key components of the agency, including coverage, payment, and public information, to leverage greater change. The delivery of immunizations in nursing homes and end stage renal dialysis facilities has been identified as an area where rapid improvement is possible and is the focus of two breakthrough projects described below. Nursing Home Immunization: CMS identified increasing influenza and pneumococcal immunizations in nursing homes as a "breakthrough" initiative in 2005. Nursing home residents are a priority population for receiving the influenza and pneumococcal vaccines, yet immunization rates for this population remain far below the Healthy People 2010 goal of 90%. The objectives for this initiative are to increase the annual nursing home resident influenza vaccination rate from 66% to 90% by 2010 and to increase the lifetime nursing home resident pneumococcal vaccination rate from 38% to 90% by 2010. Dialysis Immunization: CMS identified increasing influenza and pneumococcal immunizations in end stage renal disease (ESRD) facilities as an immunization "breakthrough" initiative in 2005. Dialysis patients have long been recognized as vulnerable and underserved populations that would benefit from immunizations, which will result in reducing the risk of hospitalization and death from these infections. Dialysis patients with ESRD are under immunized. The objectives for this initiative are to increase the annual ESRD patient influenza vaccination rate to 90% by 2010 and to increase the lifetime ESRD patient pneumococcal vaccination rate to 90% by 2010. Quality Improvement Efforts Under the direction of CMS, the Quality Improvement Organization (QIO) program consists of a national network of fifty-three QIOs responsible for each U.S. state, territory, and the District of Columbia. QIOs work with consumers, physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get the right care at the right time, particularly among underserved populations. QIOs conduct projects focused on improving the quality and health of all Medicare beneficiaries. These projects include efforts to improve diabetes care, and the delivery of mammography and adult immunizations (influenza and pneumococcal). The adult immunization projects focus on increasing influenza and pneumococcal rates for Medicare beneficiaries, and improving pneumonia treatment. Descriptions of these projects are available on the Medicare Quality Improvement Center (MedQIC) website. MedQIC is a national knowledge forum for healthcare and quality improvement professionals. It provides easy access to quality improvement resources and a community of professionals sharing knowledge and experiences to accelerate healthcare quality improvement across the nation. QIOs work with various providers on these projects: - Physician Office: The efforts to increase immunization rates in the physician office setting include developing office protocols to remind and encourage adults to receive routine vaccinations, targeting outreach efforts to patients with the greatest risk, and sharing information about the importance of routine immunizations with patients.
- Hospitals: Influenza and pneumococcal immunizations have been shown to reduce deaths. Since not all patients seek routine office care, the only care often received is in the hospital. Therefore, it is imperative that this opportunity for assessment, education, and immunization is not missed. Prevention steps are initiated when measures include assessing for and immunizing all eligible patients for influenza and pneumococcal pneumonia. This can be achieved through several strategies, which include adoption of an immunization standing orders program and aggressive healthcare workers vaccination programs.
- Home Health Care: Efforts to increase immunization rates in the home health setting include incorporating influenza and pneumococcal immunizations into an agency"s comprehensive patient assessment, including offering these vaccinations (or aligning themselves to a vaccination source, i.e., physician practice sites, departments of health), as well as providing follow-up activities to ensure the patient has received vaccination.
- Nursing Home: A comprehensive, concerted effort is essential to improve influenza and pneumococcal vaccination delivery in nursing homes.
QIOs also work with providers to improve pneumonia treatment, which includes timely and consistent antibiotic administration, blood culture collection, oxygenation assessment, influenza and pneumococcal immunization, and smoking cessation counseling. CMS works with a number of partners on these initiatives, including: - CDC: CDC is the authority on the epidemiology of influenza and pneumonia. A wealth of information may be obtained through its National Immunization Program. They are also the most reliable source of information on vaccine safety and availability.
- National Coalition for Adult Immunization: This unique coalition includes CMS, CDC, all vaccine manufacturers, and advocacy groups.
- National Partnership for Immunization/National Foundation for Infectious Diseases (NFID): The Partnership is sponsored, in part, by NFID and covers all childhood and adults immunizations
Page Last Modified: 05/14/2008 8:04:24 AM
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