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- 2. B. NARRATIVE SECTION Need/Problem Statement Vaccine preventable disease outbreaks have been on the rise throughout the United States. These outbreaks are largely attributed to declining vaccination rates. According to the CDC, Washington State has some of the lowest vaccination rates in the country, and is showing no signs of improving. The following are some key facts that exemplify this problem: Childhood vaccination rates remain well below the Healthy People 2020 goals for all required vaccines. In 2014, only 67.4% of children aged 1935 months were complete for their childhood vaccinations. This low rate can lead to preventable disease outbreaks such as whooping cough and measles. In 2014, there were 33 cases of Measles, up from only four in 2013. The number of kindergarteners out of compliance for required vaccinations has risen steadily since the late 1990s. Only 57% of children and 41.5% of adults receive the flu shot. Only 44.1% of seniors received the Zoster vaccine. Whatcom County is located in the northwesternmost part of the state, sharing a border with British Columbia, Canada. Whatcom County is home to over 200,000 residents, with around 15% of persons in poverty, and a population density of 95.5 people per square mile. The racial and ethnic makeup of the county, according to the 2010 Census data, is largely White (85.4%), with Hispanics comprising 7.8% of the population. Although little data exists on vaccination rates by county in Washington State, the data that does exist for Whatcom County is concerning. Less than half of 1935 montholds completed the 4:3:1:3:1:4 (4 DTaP, 3 polio, 1 MMR, 3 Hib, 3 Hep B, 1 Varicella and 4 PCV) series, which is below many of Washington’s other counties that report vaccination
- 4. Activities: A) Identify and recruit “Champions” doctors and nurses who are involved in the community and are concerned about low vaccination rates. B) Schedule monthly facetoface meetings with coalition: Discuss best ways to reach out and engage providers Identify potential barriers to implementation of program Determine best methods to get clinics on board Objective 1b: By November, 2016, all 15 clinics that offer vaccines as part of their services and use EHRs will be informed about the importance and feasibility of implementing a vaccine reminder system in their clinic. Activities: A) The program coordinator will: Coordinate site visits Handle logistics Create educational materials for physician education visits at each clinic Objective 1c: By January, 2016, 75% of all clinics that offer vaccines as part of their services and use EHRs will agree to update their system. Activities: A) Conduct followup meetings with clinic office managers to answer questions and discuss next steps to update clinic systems. B) Collect a signed letter of agreement by participating clinics. Goal 2: Update EHRs with EzVac and train clinicians on how to use and understand immunization features of EHRs. Objective 2a: By February, 2017, 90% of clinicians will have attended 15 minute training explaining how to use the EzVac system facilitated by health educator. Activities: Offer three training times during lunch hour for clinicians at their respective office sites.
- 8. C. BUDGET Description Cost Purpose Coalition of volunteers for programs $1,268.85 This coalition comprises of two physicians, two nurses, and one IT expert. The coalition will meet monthly for one hour 11 months with the project coordinator. The cost is calculated by the volunteer rate of $23.07/hour. Project Coordinator $18,000 This cost has been calculated based on a $40,000 annual salary at .45 FTE. Duties include compiling a list of all clinics and clinicians who offer vaccines, contacting clinic managers, performing training sessions, running coalition meetings, ensuring project elements are being implemented, and scheduling and performing followup meetings with clinics. The project coordinator will also gather baseline vaccine offerings and vaccine rates in the EHRs from clinics to evaluate the program after 1 year. Support Technician, Information Technology $23,053.9 8 This rate has been calculated accounting for hiring an IT support technician at $23.05/hour. It was reported that implementing EzVac into EHRs requires 80 hours. An additional 25 hours have been included in this cost to review the implementation manual. The cost has been split between the HLED 432 Grant (732 hours) and the Immunization Action Coalition Grant (268 hours). EzVac Manual $1,500 The EzVac manual is available for free online, a courtesy of Columbia Presbyterian Network, the original creators of EzVac. This manual is estimated to cost $1,500.00. Boardroom for coalition meetings $660 Whatcom County Health Department has donated a boardroom for our monthly meetings. Rates are $60 for half of a day rental, and we will have 11 meetings. Presentation Supplies $213.79 Supplies include paper and pens for testing materials, ink to print testing materials, as well as a laminated summary of the presentation that includes key features of the EzVac components that will be given to all clinicians for future reference.
- 9. Lunch for class attendees $1,650 Several classes will be offered at each clinic in boardrooms and lunchrooms. We will be providing sandwiches and fresh fruit to clinicians. Clinicians who will receive the training include the following positions: MD, DOs, ARNP, RN, MA, and anyone else who uses EHRs and schedules routine vaccinations during the patient visit. Evaluation Not Included Process evaluation costs are included in the project coordinator’s salary. Impact evaluation will be completed one year after the grant period and will be funded and conducted by the Whatcom County Department of Health. This involves a quasiexperimental design, comparing vaccination offering and rates of clinics with EzVac and those without EzVac. These numbers are easily obtained off of the EHRs. Comparisons will also be made of the vaccination offering and rates before and after EzVac implementation.
- 10. Cash Required Other Received Funding In-Kind Contributions Total Budget Revenue Foundations Whatcom County Department of Health $660.00 HLED 432 Foundation $50,000.00 Columbia Presbyterian Network $1,500.00 Immunization Action Coalition Grant $8,500.00 Volunteer Service Coalition of volunteers for programs $1,268.85 Total Revenue $50,000.00 $8,500.00 $3,428.85 $61,928.85 Expenses Personnel Program Coordinator (Salary: $40,000 per year * 0.45 FTE) $18,000.00 Information Technology Specialist ($23.05 per hour * 1000hours) $16,872.60 $6,181.82 Coalition Members $1,268.85 Taxes and benefits for Staff (25%) $8,718.15 $1,545.46 Personnel Total $43,590.75 $7,727.28 $1,268.85 $52,586.88 Program Materials EzVac Manual $1,500.00 Boardroom for coalition meetings $660.00 Presentation Supplies $213.79 Lunch for class attendees (33 classes @ $50/class) $1,650.00 Program Materials Total $1,863.79 $0.00 $2,160.00 $4,023.79 Program Expenses $45,454.54 $7,727.28 $3,428.85 Indirect Costs (10%) $4,545.45 $772.73 Total Expenses $50,000.00 $8,500.00 $3,428.85 $61,928.85
- 11. D. TIMELINE 1 2 3 4 5 6 7 8 9 10 11 12 Sept. Oct. Nov Dec Jan Feb Mar Apr May Jun Jul Aug EzVac coalition meetings Program Coordinator X X X X X x X X X X X Meet with with clinic managers to discuss EzVac system in EHR and gain participation in program, perform follow-ups to go over any questions, collect signed letters of agreement Program Coordinator X X X X Conduct EzVac trainings for staff, provide lunch. Program Coordinator X X X X Install EzVac Software in EHRs of all participating clinics Information Technology Specialist X X X X X Process Evaluation - Ensure that all project components are being conducted on time and with fidelity. Conduct follow ups after EzVac installation to ensure use. Program Coordinator X X X X X X X X X X X X Organization Name: Whatcom County Department of Health Project Name: EzVac Activities Identified in Logic Model/Narrative Lead Staff Responsible Time Line (in months)
- 12. E. LOGIC MODEL Situation: Child and adult immunizations are below HP2020 standards. A significant factor in the low rates is that clinicians are not offering necessary vaccines. Lack of vaccine offering is due largely to the fact that clinicians are often unaware of patients’ immunization status. Implementing EzVac into existing EHRs addresses these barriers in order to increase vaccination rates Inputs Outputs Outcomes Impact Activities Participation Short Medium Long Staff: Information Technology (IT) specialist to integrate EHR with existing city and national immunization registries Health Educator to instruct clinicians on how to use EzVac Project coordinator to oversee, and coordinate project logistics Technology: Reminder notation system in EHR (EzVac) Money: Staff Materials Build partnerships with clinics with EHRs Educate clinicians of value of EzVac program Update EHR systems with EzVac Train clinicians on how to use immunization features of EHR Clinicians: MDs, DOs, NDs, ARNPs, RNs, MAs Health Educators IT Specialist Clinicians experience increased awareness of patient’s immunization status Clinicians report increased skills in assessing patient’s immunization needs Clinicians report increased confidence in recommending vaccines Clinicians increase offering immunizations Increase vaccine uptake among patients Reduce morbidity and mortality of vaccine preventable diseases Reduce medical costs spent on treating vaccine preventable diseases Assumptions External Factors People are not getting vaccinated because they are not being offered vaccine Physician participation with system Meets physicians needs and safeguards against process failures Antivaccination movements (documentary, media) Efficacy of vaccines (such as seasonal influenza)
- 14. Carol Hawk HLED 432 Foundation May 15, 2016 Dear Ms. Hawk: This letter is to inform the HLED 432 Foundation that Bellingham Family Health Clinic is in full support of the EzVac project. We believe this system change an important and comprehensive way to support busy clinicians to be more aware of vaccination status of their patients, and to be better equipped to offer necessary vaccines to their patients. We believe this is the best way to prevent missed vaccination opportunities, and subsequently, reduce the spread of vaccine preventable diseases, a health issue on the rise in our nation. This grant project aligns with our mission at Bellingham Family Health clinic, to support wellbeing of all Bellingham residents, and prevent unnecessary harm. The Bellingham Family Health Clinic is excited to partner with the EzVac project. Our support for the program includes but is not limited to: Providing a site to pilot test the program Providing our conference room for training clinicians Integrating the EzVac Software in to our Electronic Health Care System Providing access to EzVac for evaluation Collaborating with project coordinators as to best ways to engage other clinics Publishing our collaboration and sending it to other clinics in Whatcom County to raise awareness and garner support for the project Please contact us at 3609999999 if you have any questions regarding our partnership with the EzVac program. We are confident that this innovative project will support our clinicians to better serve our clientele and create a healthier Whatcom County. Bonnie Sprague, ARNP 3609999999 Bonnie.Sprague@BellinghamFHC.com