Historically, hospitals have been destinations for acute medical care. Hospitals can have influence through their roles as respected organizations and large employers within their communities. Guided by growing evidence that much of one's health can be attributed to nonmedical determinants such as social, behavioral, and environmental factors, some hospitals are taking a broad population health stance. They can use their leadership expertise to act as catalysts, working with community organizations and public health departments to improve the health of their communities.
SPONSORED BY: Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., has paid for and provided editorial input on this material.
Geisinger Health System, based in Danville, Pennsylvania, is representative of this shift. The system is committed to innovative, patient-centered care approaches. Geisinger serves more than 3 million residents throughout 45 counties in central, southcentral and northeast Pennsylvania and in southern New Jersey. In 1996, Geisinger implemented an Electronic Health Record (EHR) system.
In January 2017, the health system announced its newest population health initiative, dubbed Springboard Health. The program focuses on improving the health of the Scranton community by coordinating and collaborating with local stakeholders to help manage and alleviate chronic medical conditions and eliminate preventable cancers, and look to address the socioeconomic health of the community.
"We want to transform health care at its core by focusing on preventive care, behavioral health, and economic growth," said David Feinberg, MD, MBA, president and CEO of Geisinger Health System.
Geisinger's approach to vaccination is indicative of the organization's commitment to preventive care, population health management, and patient-centered care. "We believe strongly that successful vaccination programs are the most important way to help protect our community from many communicable diseases," said Lisa Esolen, MD, FIDSA Medical Director, Infection Prevention Medical Director, Occupational Health Assistant Chief, Quality & Patient Safety, Geisinger Health System. "Indeed, vaccinations have had a significant impact in our society over the past 100 years. Accordingly, it has long been a priority for our health system, as for all quality health systems, to organize and coordinate effective vaccination programs."
Adult vaccination coverage remains low for most routinely recommended vaccines and well below Healthy People 2020 targets. For example, in 2012, just 64.2% of American adults between 19 and 49 years of age were up to date on their tetanus vaccination, according to the Centers for Disease Control and Prevention (CDC). These findings highlight the importance of emphasizing efforts to boost vaccination rates among patient populations. At Geisinger, these efforts began with leadership. In 2016, Geisinger's strategies to boost vaccination rates helped the system meet Healthy People 2020 goals for all adult and adolescent vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP).
Empower vaccine champions
Leadership support is an essential component of the Geisinger approach to vaccination. At the onset of the system's vaccination improvement initiative, leaders established a multidisciplinary vaccine committee. The committee was tasked with assessing the system's vaccination processes and rates, identifying potential roadblocks that could hinder efforts to improve vaccination rates and creating the support to achieve the goals of the initiative. The vaccine committee at the system is jointly sponsored by Amy Howell, MD, Geisinger's Community of Practice Service Line (CPSL) Bundle Leader, and Michael Ashton, MD, Geisinger's director of performance improvement.
"We set goals for vaccination rates that initially seemed out of reach, but a team approach and constant diligence to improving our processes has brought great success," said Dr. Howell.
Another key element of the system's approach is appointing and empowering a vaccine champion at each clinical site. Having a local, designated vaccine champion at each clinical site helps build support for the initiative and allows for the standardization of vaccine processes. These champions are tasked with identifying barriers to vaccination, monitoring vaccine errors, managing inventory, serving as vaccine advocates, and supporting system wide strategies to increase vaccination rates.
"Our nurse vaccine champions do a tremendous job in coordinating our vaccination efforts at each site," said Dr. Ashton. "Our vaccine distribution and storage is more efficient, and our staff and patients are better informed because of the work they do."
The system's vaccine policies and changes regarding vaccination are regularly updated in the EHR. To ensure vaccine champions are up to date on vaccine label change s, and proper vaccination practices, vaccine champions from across the system come together biannually for a meeting prepared by the vaccine committee. Champions are tasked with communicating key takeaways from this meeting to colleagues at their respective sites.
The system recognizes the top-performing offices in regards to vaccination rates with framed certificates and asks champions from these offices to share best practices regarding vaccination.
Leverage technology to promote and monitor vaccination
Geisinger uses optimized health IT to enable providers to proactively identify patients missing recommended vaccinations. This use of technology has been standardized and replicated across the system.
Additionally, each month a report is generated detailing clinic or provider vaccination rates for all ACIP-recommended vaccinations and highlighting those who met their goals.
At Geisinger, the Pennsylvania state vaccination registry has played an important role in developing comprehensive patient vaccination records. Geisinger's EHR system has been updated to automatically populate patient files with data from the state registry.
Before, during, and after the patient visit
By using anticipatory reports and predicative analytics, Geisinger's efforts to promote vaccination begin well before a patient enters a care location. Anticipatory reports regarding scheduled patient visits are disseminated among providers each morning, so members of the care team can see which patients might be missing a recommended vaccination. This helps facilitate a culture in which every patient visit becomes an opportunity to assess vaccination status.
Geisinger also promotes vaccination through patient engagement efforts including text messaging, phone calls, mobile apps, and mail. The care gaps team at Geisinger works to identify patients who may be missing a vaccine by analyzing care records. When a patient who is not up to date on their vaccinations is identified, a member from the care gaps team reaches out to him or her through the patient's preferred mode of contact. After the team member informs the patient of the missed vaccine, the patient is transferred to an appointment scheduling line to plan his or her next visit.
During patient visits at Geisinger facilities, clinical staff receive alerts via the EHR to alert them when a patient has yet to receive a recommended vaccination. Disease and vaccine facts are included in certain alerts to assist the clinical staff during patient interactions. By establishing system wide standing orders and empowering the clinical staff to complete them, efficiency improves and missed opportunities are decreased.
Standing orders carried out by nurses or other qualified health care professionals can be an effective means for increasing vaccination rates and reducing missed opportunities for vaccination, which helps improve the quality of care for patients. Geisinger empowers its clinical staff to implement standing orders in many ways, including:
- Fostering an environment of trust between leadership and employees
- Emphasizing the importance of the nurse's role in the care team and giving these key frontline care providers a voice in decision-making processes that influence clinical care
- Promoting the shared goal of helping to keep patients healthy
- Posting the clinic's monthly vaccination rates so team members can view them
- Providing vaccine and technical training to clinical staff
- Providing staff with clearly defined processes and procedures for every standing order
- Communicating system expectations of clinical staff to work at the top of their license
After the visit, the patient is given a summary detailing vaccinations administered during the appointment. Patients with access to the patient portal can also view their vaccination records. If the patient received a vaccine that is a part of a series, providers will schedule a follow-up vaccination appointment before the patient leaves the office.
A call to action
While adult vaccination rates have been historically low, hospitals and health systems are striving to find new ways to intervene. Low adult vaccination rates should no longer be accepted as the status quo. It's time for hospitals and health systems to take advantage of the resources available to improve vaccination rates among their patient populations.
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