Learning Objectives for this Presentation:
By the end of the presentation, participants will be able to:
1. Describe a model using external resources to improve quality in Community Health Centers (CHC) and urban clinics
2. List three evidence based strategies to eliminate racial disparities in vaccine rates
3. List advantages of a centrally coordinated and administered program to support vaccine administration in primary care
4. Describe future activities needed to continue progress on racial disparities in immunization.



Background:
Despite progress in increasing rates of pneumococcal vaccination among seniors, significant racial disparities persist in the U.S. and our community. (African-Americans = 42%, Whites = 75%).


Setting:
Eight urban CHCs and hospital clinics in Rochester, NY


Population:
CHC and hospital clinic patients > 65 years in Rochester, NY


Project Description:
Because pneumococcal polysaccharide vaccine (PPV) is most frequently administered in doctors' offices, the authors recruited eight urban CHCs and hospital clinics to participate in a program to reduce disparities in immunization. Centrally supervised outreach workers used evidence based methods – Tracking, Reminder/Recall and Outreach (TRO) – to improve vaccination rates for 4299 patients, regardless of race.
In 2003 and 2004, they tracked vaccination status for all patients > 65 years, reminded physicians of needed vaccines by flagging patient records, reminded patients who needed vaccines, and performed outreach by telephone and personal visits to those who remained unvaccinated after missed opportunities.



Results/Lessons Learned:
At the end of the program PPV rates were 79% for African-Americans and for Whites, and 78% for both Hispanic seniors and those of other races/ethnicity.
Health disparities can be eliminated using proven strategies to improve quality of care. TRO should be extended to improve vaccine rates in adults < age 65 with high-risk conditions. Health disparities can be eliminated only if we commit to a comprehensive, coherent system of providing preventive health services to all people.