# Presentation: 253728

## Racial and Ethnic Adult Disparities in Immunization Initiative (READII)

- Tamara J. Kicera
- READII Project Coordinator
- Immunization Services Division
- National Immunization Program
- Centers for Disease Control and Prevention

## Soliciting Public Input

- Difference between help with Implementation vs. Decision-Making
- READII projects were largely about engaging partners to implement intervention strategies known to be effective

## Overview

- Background on READII project
- Preliminary findings, lessons learned
- Next steps
- Rochester’s Experience: Key message – *starting/funding something new isn’t always necessary*

## We’ve Been Busy!

- Project Genesis – Spring 2002
- HHS Support – July 31st announcement
- Partners engaged: CMS, HRSA, AoA, AHRQ
- Funds awarded; Demonstration sites began to identify stakeholders, Develop Community Plans

**Notes:**
>Drs. Walt Orenstein & Lance Rodewald met with Deputy Secretary Claude Allen and others at HHS to propose this initiative to address the on-going influenza & pneumococcal vaccination disparities among African American & Hispanic eldery; This was not  “hard-sell” given that eliminating such disparities was & remains a high priority for HHS, & the data were clear.
>Once each of your demonstration sites was identified; Deputy Secretary & other HHS officials participated in a press event in DC on July 31st to announce READII.
>We went about enlisting the collaboration/cooperation of sister Federal agencies, some of whom we had experience working with, others of whom were new partners for us.
>Many of you will recall that with a VERY short turn-around time, proposals were developed & funds were awarded at the end of FY2002 in hopes that projects might get up & running that fall...

## Getting started...

- State/local health departments had to obligate funds quickly
- Programs had little/no adult infrastructure in place
- Smallpox activities began; Immunization/Health Department personnel asked to respond
- 2002-2003 Influenza season was upon us

**Notes:**
>By December 31st of that year, & because of many constraints imposed by state/local health dept. personnel systems in hiring staff, & other bureaucratic & logistic issues around setting activities in motion, this resulted in a number of contracts being put into place by pretty much all of the grantees.
>Since historically, most all of our emphases – at the Federal/State/Local levels – were on childhood vaccination efforts, systems/activities reflected those partners & community stakeholders – NOT those in the adult health or aging services arenas.
>Since it was critical to have immunization health dept. staff “at the table” for these efforts, a number of READII start-up activities had to be put on hold, or moved forward more slowly than originally anticipated.
>Flu vaccination activities, campaigns, events – for the most part – were already in place or underway based on previous years’ efforts, although there were some nothing-short-of heroic efforts being made by many of you to begin to incorporate a READII focus into those first-season activities.

## What’s happening...

- Sites and Agencies have formed new, important partnerships; Engaged their communities
- Infrastructure needs/gaps are better understood
- Evidence-based interventions are underway
- Evaluation efforts are planned to look at both outcome and process measures
- Formative research is generating ideas for targeted health education messages to patients and providers, including media campaigns
- READII activities have been widely publicized

**Notes:**
>The March mid-course review allowed for an exchange of ideas from our grantees & from the invited panelists; we have been particularly happy to be learning so much about the Aging Services Network – stakeholders & activities previously unfamiliar to our grantees; CDC’s continued long-standing relationships with CMS (reimbursement increase/standing orders project and by way of an IAA, the Medicare Beneficiary Survey); HRSA’s Health Disparity Collaboratives; & AHRQ’s National Healthcare Disparities Report (to be presented tomorrow).
>Feasibility/sustainability issues are being better described; we’ve heard a lot from our grantees about the tremendous effort working with providers has proven to be; Social & economic forces also affect our efforts (For example, in Milwaukee ....  no clinic venues in targeted ZIP codes).
>The Guide to Community Preventive Services has served as a model for evidence-based interventions, as has research done by Dr. Kristin Nichol  and others in the adult immunization field. Provider focused efforts, shown to be effective, are among the strategies each of your sites has emphasized.
>Focus group results and provider interviews – conducted by NIP/OC, some READII sites & other partner agencies – have generated ideas for further study; These findings led to NIP/OC’s production of a Provider Tool Kit (Julie’s picture on next slide).

## Provider Tool Kit

**CDC Director Julie L. Gerberding holds up the READII Provider Tool Kit at a press conference.**

**PHOTO CREDIT: Evan Vucci--AP**

**Notes:**
>Here you see CDC Director, Dr. Julie Gerberding, with a copy of the Provider Tool Kit that was developed and distributed this past flu season, not only to READII sites, but also to other sites around the country.

## What’s happening... (cont.)

- Sites and Agencies have formed new, important partnerships; Engaged their communities
- Infrastructure needs/gaps are better understood
- Evidence-based interventions are underway
- Evaluation efforts are planned to look at both outcome and process measures
- Formative research is generating ideas for targeted media campaigns, health education messages to patients and providers
- READII activities have been widely publicized

**Notes:**
Again, thanks to the support of HHS and our partners, and in addition to countless newspaper articles, TV spots, press events/conferences, 2 National satellite broadcasts (seen by thousands of public health professionals across the country) have high-lighted the work of our READII projects, one of which will be shown tomorrow during the HHS session, and another more recently aired by the UNC/Chapel Hill which featured Chicago’s efforts.  This has all generated a tremendous amount of interest in READII activities and, we hope, the project’s outcomes.

## What are we learning?

- Every year presents new challenges!
- Duplicating childhood successes for adults may need new methods, interventions, partnerships
- Providers’/Health Professionals’ attitudes about immunizing adults requires additional study/efforts
- Change of this magnitude takes time

**Notes:**
Last year smallpox, followed by SARS, followed by Monkeypox!; This year an unusually early flu season, publicized pediatric deaths & a resultant flu vaccine shortage. 

## Mid-Course Review Meeting – March 9-10, 2004 - Goals

- To review and discuss successes and challenges thus far in the project with each other;
- To allow discussion of issues and challenges with CDC, partners and invited panelists; and
- To share site-specific project information with senior officials from HHS and other partners.

**Notes:**
>To afford an opportunity for key READII staff from each of the five sites to review and discuss with each other, with CDC and with other partners their successes and challenges thus far in the project;

> To allow discussion of issues and challenges among grantees, CDC and invited panelists; and

To share site-specific project information with senior officials from HHS and other partners.

Introductions

How session will proceed

Agenda

## What’s Next?

- Programmatic activities end December 31, 2004; Evaluation activities begin in earnest January 2005
- 2003-2004 flu season experience is presenting opportunities...
- Sites’ experiences are/will be valuable to future efforts – both programmatic and research efforts
- Dissemination of findings; Replication?

**Notes:**
>Extended from 2 years initially to a include a THIRD flu season; Process/Outcome evaluation efforts have begun but at the close of the project, will involve sites, partners (i.e., CMS/Abt), CDC/NIP staff & AED – we’ve begun discussions to ascertain the resources that will be required and the time-line expected to complete formal evaluation activities of the READII project.
>A LOT of discussion/planning/ going-on; not just at Federal agencies (CDC, FDA) but among vaccine manufacturers, the insurance industry & (public & private) health providers.
>New partners (Aging Services Network) are on board and many programs see the need to address adult/disparity issues in an evidence-based, cost-effective & efficient manner.
>It probably goes without saying that, upon completing and evaluating READII efforts, we plan to share as widely as possible the results/findings.  And to the extent that resources might be identified, we would hope that successful interventions/models could be replicated in many more sites across the country.

## READII ROCHESTER

- Community Action Plan
- Christine Long, M.P.H.
- The Center for Rochester’s Health
- A collaboration of the
- University of Rochester and the
- Monroe County Department
- of Public Health

## Outline

- Community Action Plan components
- Community Advisory Board
- Community Based Organizations
- Communications
- Targeted Projects
- Vaccine Providers
- Actions and Accomplishments
- Assessment

**Notes:**
I’ll quickly review the community outreach aspect of READII Rochester... intervention in primary care requires a separate presentation. 
Evaluation of community action plan will be from Medicare survey conducted this spring

## READII RochesterCommunity Action Plan

- Primary Care
- Practice Intervention

## Community Advisory Board Members

- Urban League of Rochester
- Ibero American Action League
- Economic development groups
- Senior Organizations
- Coalition of African American Churches
- Influenza vaccine providers
- Health care providers from Primary Care Sites
- Insurers, Medical Society, Primary Care Network
- Health Department immunization unit

## READII RochesterCommunity Action Plan Goal

-   Messages endorsed by African American community:
- Adult vaccines are important and needed
- Racial and ethnic disparities exist
- Direction on where and how to get vaccines

- READII RochesterCommunity Action Plan Goal

## Community Advisory Board

- Approved all intervention plans
- Made specific recommendations
- Use existing organizations to spread message on adult vaccines
- One to one, or small group format is best
- Be patient
-  Volunteered their organizations
-  Volunteered as speakers (churches,
-      media)

## Community Based Organizations

-    Outreach and education to own constituents
-    e.g.: foster grandparents, case
-    management clients, Head Start
- READII team provided:
-    Low literacy cards and brochures;
-    Training for CBO staff on culturally
-    competent delivery of vaccine information

## Community Based Organizations

- 10 CBOs reported on activities
- Improvement needed:
- Engage Hispanic American Community
- Engage more CBOs from other parts of city

## Communications

- Summer campaign:
*   **Any time of year is the right time to talk to your doctor about vaccines*
- 	  Television and newspaper articles
- Fall campaign:
*Protect your loved ones, protect yourself*
- 	  Television and newspaper articles
- 	  Paid radio spots and transit ads

## Lessons from the Community Action Plan

- Interpersonal approach worked best
- CBOs
- Church outreach
- Senior housing
- African Americans in Rochester did not  respond to national media-created flu vaccine emergency
- Need to better evaluate media treatment of flu news and non-traditional communication strategies

## Lessons continued

- Success of Community Advisory Board linked to specific tasks, easily incorporated into usual activities
- Trusted members of community giving information about vaccines
- Low pressure education on vaccines

## Questions?