Learning Objectives for this Presentation:
By the end of the presentation participants will be able to describe:
1. racial and ethnic disparities in adult influenza and pneumococcal immunization coverage in Chicago
2. provider activities and practices promoted by the Chicago READII
3. provider activities and practices that may have increased clinic–level immunizations levels for African American and Hispanic senior citizens in READII communities.


Background:
. African Americans and Hispanic senior citizens (≥ 65 years) have significantly lower influenza and pneumococcal immunization levels than white seniors. Chicago's READII project was a 2.5 year CDC sponsored- demonstration project that focused on increasing adult immunization coverage among African American and Hispanic seniors residing in 14 of 77 communities. Part of the initiative was to increase use of effective office-based strategies in clinics serving these seniors

Objectives:
To examine clinic practices associated with change and stability in coverage levels in clinics participating in the READII project.


Methods:
At the clinic level, independent audits were conducted to assess coverage levels among eligible patients pre and post intervention. Structured telephone interviews were conducted with READII clinics to assess the degree of implementation of program components

Results:
All 31 participating clinics had pre and post intervention assessments conducted. Influenza vaccination coverage levels increased significantly from 22% to 51% (p<0.01). Post intervention coverage levels per clinic ranged from 9% to 100%. Similarly, there was variation in implementation of recommended strategies for improving coverage levels. For example, about two-thirds of the clinics employed structural changes such as standing orders, while there was greater variability in use of flowsheets (31%), and other techniques (i.e., posters, flyers, progress note reminders, and others).

Conclusions:
While the READII project helped some clinics to recognize and implement system changes to increase vaccination levels, more research needs to be done on how to better support consistent implementation of these changes.