KEYWORDS:
healthcare disparities, adult immunizations, African Americans, American Indian/Alaska Natives, Asian American/Pacific Islanders, Hispanics, and low-income (Medicare/Medicaid)

BACKGROUND:
Quality Improvement Organizations (QIOs) are funded by The Centers for Medicare & Medicaid Services (CMS) to ensure and improve the quality of care for persons receiving Medicare. In 1999, QIOs in the United States were required by to create quality improvement projects targeting underserved populations receiving Medicare. Adult immunization was one of three outpatient clinical indicators selected.

OBJECTIVE:
All QIOs were to learn about the target populations in their state and implement projects that addressed identified barriers to care. This paper will present a description of efforts to address adult immunization in the context of the Medicare QIO work.

METHOD:
The Underserved Populations QIO Support Center generated rates for all states, all clinical conditions, and populations using the available national data. QIOs selected a population and clinical condition that had at least a 7% disparity in care between the general population and the target population. They developed appropriate interventions and implemented projects improve the quality of healthcare for the targeted populations and reducing the disparity.

RESULT:
QIOs in 12 states selected Adult Immunization as a topic for their 1999-2002 projects targeting underserved populations. Seven states conducted projects targeting PPV and flu vaccines for African Americans. Three targeted low-income (Medicare/Medicaid) beneficiaries. One QIO had a disparity in flu shots for Hispanics and targeted that population.

CONCLUSION:
Although adult vaccination rates in general are low, rates for underserved populations are even lower. Lessons learned about how to develop interventions targeting underserved populations are valuable in assuring success in changing behavior and improving adult immunization rates for those who are most at risk - the underserved elderly.

LEARNING OBJECTIVES:
This session will educate the audience about the CMS national effort to reduce disparities in adult immunization rates for elderly underserved populations. The audience will leave with an understanding of this effort, the states that targeted adult immunization disparities, and the need to continue this effort. They will walk away with lessons learned from this national effort.