BACKGROUND:
Since 2002, the Chicago Department of Public Health (CDPH) has participated in the Racial and Ethnic Adult Disparities in Immunization Initiative (READII) to increase immunization coverage among African-American and Hispanic seniors (65 years or older). CDPH partnered with the Illinois Foundation for Quality Health Care (IFQHC), the Medicare Quality Improvement Organization (QIO), to implement an office-based quality improvement initiative modeled after the CDC's “AFIX” approach (Assessment, Feedback, Incentive, and eXchange).

OBJECTIVE:
To implement a quality improvement initiative in 30 clinics serving African American or Hispanic seniors.

METHOD:
CDPH staff used the CDC's Adult Clinic Assessment Software Application (ACASA) to determine clinic-level pre and post-intervention influenza and pneumococcal coverage levels. The IFQHC staff conducted in-office training sessions using a curriculum that included introduction of evidence-based interventions (e.g., standing orders, provider or patient reminders), a resource toolkit, and incentives (continuing education, attendance certificates and free vaccine). In 2004, a survey was conducted to assess adoption of recommended strategies and to identify barriers to adoption of strategies and post-intervention assessments were conducted in a sample of clinics.

RESULT:
Of the 30 participating clinics, 30 (100%) had pre-intervention assessments conducted, 21 (70%) received in-office training and 9 (30%) attended either of two Group Learning Sessions. Of the 30 clinics, 97% responded to the survey. 59% adopted 2 or more strategies and 100% adopted 1 strategy. 8 clinics had post-intervention assessments conducted. When compared to pre-intervention coverage, post-intervention influenza vaccination coverage levels increased in practices serving African American (16% to 27%) and Hispanic (27% to 67%) communities.

CONCLUSION:
Combining CDC's AFIX approach with the state QIO's quality improvement curriculum was an efficient way to implement a quality improvement initiative. Preliminary post-intervention results suggest that clinic level immunization coverage levels increased from 2002-2003.

LEARNING OBJECTIVES:
Identify provider education interventions that work in implementing standards of adult immunization practices.