Arizona Long Term Care System (ALTCS) Clinical Quality Performance Indicators for Influenza Immunizations/Pneumococcal Vaccinations October 15, 2002 Produced By: Office of Medical Management Executive Summary This is the sixth annual assessment of influenza immunizations and pneumococcal vaccinations. This report analyzes Arizona Long Term Care System (ALTCS) Contractor performance in the following areas: · Influenza immunizations for those Elderly and/or Physically Disabled (E/PD) ALTCS members residing in rural or urban counties.1 · Influenza immunizations for ALTCS E/PD members residing in nursing facility (NF) or Home and Community Based (HCB) settings during the measurement period. · Pneumococcal vaccinations for ALTCS E/PD members residing in rural or urban counties.1 · Pneumococcal vaccinations for ALTCS E/PD members residing in NF or in HCB settings during the measurement period. Results of this study were based on measurements of a select group of members who were continuously enrolled from September 1, 2001, through April 30, 2002. The results did not include members who were not eligible to receive Medicare, those who received acute care services only, those who enrolled into ALTCS after December 1, 2001, or those who expired during the measurement period. Results for the current measurement period are reported as relative changes from the previous measurement period, where applicable. The report also indicates whether this change is statistically significant, that is, whether the change is probably true and not merely due to chance. The following is a summary of the results of the study: Influenza Immunizations Home and Community Based (HCB) settings Results: · 61 percent of members in the urban HCB population and 69 percent of members in the rural HCB population received influenza immunizations. · 64 percent of the individuals residing in HCB settings received influenza immunizations during the measurement period, a 27 percent relative improvement. This change was statistically significant. · All seven Contractors attained rates above the Arizona Care Cost Containment System (AHCCCS) Minimum Performance Standard (MPS) of 46 percent. Nursing Facility (NF) settings Results: · 86 percent of members in the urban NF population and 88 percent of members in the rural NF population received influenza immunizations. · 86 percent of members residing in NFs received influenza immunizations during the measurement period, a four percent relative increase. This change was statistically significant. · Six Contractors attained rates above the MPS of eighty-two percent. 1 Maricopa and Pima are considered urban counties and all other counties are considered rural counties (see appendix A “Definitions”). - ii - Pneumococcal Vaccinations Home and Community Based (HCB) settings Results: · 58 percent of members in the urban HCB population and 59 percent of members in the rural HCB population received pneumococcal vaccinations. · 58 percent of members in HCB setting acknowledged receipt of pneumococcal vaccinations. Although not comparable, the rate during the previous measurement period was 44 percent.2 · Six Contractors attained rates above the MPS of 48 percent. Nursing Facility (NF) settings Results: · 84 percent of members in the urban NF population and 76 percent of members in the rural NF population received pneumococcal vaccinations. · 82 percent of NF members reported receiving pneumococcal vaccinations. Although not comparable, the rate during the previous measurement period was 70 percent. 2 · Five Contractors attained rates above the MPS of 72 percent. The ALTCS Contractors have implemented many varied interventions to improve rates for these indicators, including more frequent education programs for providers, members, and member families. This has influenced, and will continue to influence, perception concerning immunizations and vaccinations. Presentations of “best practices” regarding successful interventions will be shared among all Contractors. Under their contracts with AHCCCS, ALTCS Contractors are required to improve their rates for Performance Indicators and achieve specific goals for each Indicator. AHCCCS will provide individual results to Contractors and will require Correction Action Plans, as necessary, based on the findings of this report. Contractors that fail to show improvement may be subject to sanctions. AHCCCS recognizes the dedication of the ALTCS Contractors in preventive quality improvement efforts, which have resulted in gaining achievements in rates for influenza immunizations and pneumococcal vaccinations for ALTCS E/PD members. 2 A change was made in the methodology for pneumococcal reporting from the 2001 report. For 2002, a pneumococcal vaccination received at anytime in a person’s lifetime was accepted. In 2001, only pneumococcal vaccinations received during the previous five years were accepted. - iii - Percent of Members Who Receive influenza immunization Figure 1 AHCCCS ALTCS E/PD Home and Community Based INFLUENZA IMMUNIZATION TREND for the Measurement Periods: September 1, 1999, to April 30, 2002 80% 70% 60% 64% 63% 59% 51% 50% 40% 30% 20% 10% 1999 2000 2001 2002 All Program Contractors Note: The national influenza vaccine shortage in 2001 contributed to the drop in rate and was identified by CDC statistical analysis. 12 Percent of Members Who Receive influenza immunization Figure 2 AHCCCS ALTCS E/PD Nursing Facility INFLUENZA IMMUNIZATION TREND for the Measurement Periods: September 1, 1997, to April 30, 2002 100% 90% 87% 88% 86% 85% 86% 83% 80% 70% 60% 50% 1997 1998 1999 2000 2001 2002 All Program Contractors Note: The national influenza vaccine shortage in 2001 contributed to the drop in rate and was identified by CDC statistical analysis. 12