KEYWORDS:
nursing homes, long term care facilities, immunization

BACKGROUND:
Immunization rates for patients in LTCFs continue to be well below optimal levels (national average: 64% for influenza and 28% for pneumococcal) and the rates for staff are even lower. In 2000, MassPRO began participation in a CDC/CMS pilot project whose aim is to increase the implementation of SOs for influenza and pneumococcal immunizations in LTCFs.

OBJECTIVE(S):
With no uniform intervention strategies required of the participating Quality Improvement Organizations (QIOs), a key objective was to develop and test a statewide quality improvement model for a effective immunization program in LTCFs for patients and staff that focuses on systems change.

METHOD(S):
The project began with a pilot project involving 22 LTCFs. After completing the evaluation of the pilot, a seven-step process was used for all 482 LTCF in the state:
¨ Plan the Roll Out with Partners
¨ Conduct an Informational Campaign
¨ Disseminate Workbook and Kit
¨ Conduct Regional Workshops
¨ Encourage Partners to Provide Ongoing Support
¨ Develop and Implement Plans for Action
¨ Evaluate System Changes

RESULT(S):
Results include: Workbooks sent to 482 facilities; 332 individuals from 186 facilities registered to attend a workshop and 215 individuals from 138 facilities attended; 155 Plans for Action submitted. Planned system changes include introducing tracking forms, and revising immunization polices and procedures, including use of SO. Facilities also requested large quantities of educational materials. Presentation will include results from a survey on system changes that were implemented, barriers to implementation and an assessment of the intervention process based on level of interaction with project staff.

CONCLUSIONS(S):
Simplifying decision-making with easy to access tools, and providing on-going support from stakeholder organizations, and monitoring implementation are keys to successful implimantion of system changes in LTCFs.

LEARNING OBJECTIVES:
· Understand the intervention process
· Understand the key steps included in the workbook