PCIRN

RESEARCH THEMES

VACCINE COVERAGE

The objective of the vaccine coverage theme, housed at Public Health Ontario, is to develop methodologies for assessing pandemic vaccine coverage, including isolated communities and cohorts of concern such as health care workers and age cohorts. The specific aims of the theme are to:

• Identify the barriers that prevent public health authorities from entering individual-level data into their information systems at the point of vaccine delivery in various healthcare settings.
• Clarify the data requirements of immunization planners for vaccine coverage;
• Identify and evaluate approaches to collecting immunization data in the various healthcare settings where vaccines are delivered (e.g., public health mass vaccination clinics, physician offices, institutions); and
• Develop efficient approaches for point-of-care electronic data collection by evaluating innovative technologies.

Current projects:

Integrating the Barcode Scanning of Vaccines into Immunization Settings

In response to the need for improved quality of vaccine inventory and client immunization records, barcodes containing a unique identifier and lot number will be placed on all vaccine vials in Canada. To facilitate future adoption, we are conducting a two-phase feasibility study to examine the integration of barcode scanning into immunization staff workflow in vaccination settings. Phase I was conducted during the 2010/11 seasonal influenza vaccination campaign, involving 21 Ontario public health units and comparing barcode scanning to conventional methods of recording vaccine clinic inventory data (global trade identification number [GTIN], lot number and expiry date). Our study demonstrated good readability of barcodes and favorable staff perceptions of the method. However, scanning individual vials for high-volume clinics was time-consuming, and modifying the process to scan secondary packaging instead in such settings will facilitate the adoption of this method.

Based on Phase I, we have developed a User’s Toolkit to assist immunization staff who are implementing barcode scanning in the vaccination settings for the first time. This document will be further enhanced after Phase II, during which we explore barcode scanning of vaccine data into client immunization records, in physicians’ offices and general public health clinics.

.Click here to access the User's Toolkit.

Incorporating Scannable Forms into Immunization Data Collection Processes: A Feasibility Study 

Individual-level data retained electronically are ideal for obtaining the highest quality influenza immunization information. Several jurisdictions across Canada employ systems based on this model, but in areas where electronic data entry at the point of vaccination is not feasible, manual entry of client data into electronic immunization information systems (IISs) following each immunization clinic is time-consuming. A straightforward alternative is the use of scannable client forms, completed at the point of vaccination and submitted to a central site for scanning and processing. Using scanning hardware and software, these forms can be designed to incorporate the same demographic and clinical fields that are contained within IISs. Information is recorded on paper at the point of vaccination, scanned, and directly exported into an existing database or registry. We anticipate that this approach will be more efficient, and lead to higher quality data, than manual data entry. In Fall 2011 we will be conducting a pilot study in which we will implement scannable forms as tools for immunization data capture in two Ontario settings: public health mass immunization clinics and a long-term care facility. We will be evaluating the feasibility of incorporating scannable forms into immunization data collection processes based on data quality, time, and usability.

 

Investigation of Methods to Measure Vaccine Coverage Workers in Hospital Institutions

Annual influenza vaccination is recommended for health care workers as a means to reduce transmission of influenza in health care settings. It is difficult to make comparisons of influenza immunization coverage between institutions, as sources of information vary and this impacts the quality and accuracy of the rates reported. Such information is important for evaluating the success of vaccination programs and assessing whether vaccination coverage targets are met. As a first step to address this issue, this project aims to describe healthcare organizations’ ability to measure coverage and identify factors that are associated with complete coverage measurement. Further, we hope to identify potential ideal solutions that can be implemented across institutions to address barriers with existing methods.

 

Ethnic Disparities in Influenza Immunizations in Canada

 

Much research has been conducted in the U.S. describing ethnic disparities in influenza vaccine coverage. However, there has been a paucity of Canadian data on this subject. Given the differences in vaccine access and ethnic populations, data from the U.S. are likely not generalizable to the Canadian population. To assess the presence of ethnic disparities in influenza vaccine coverage across 12 ethnic groups, we conducted a study using data from the Canadian Community Health Survey. Results from this study will be helpful for highlighting gaps in coverage which can guide health promotional activities and policies directed at improving immunizations in under-served groups.

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Development and Application of an Evaluation Framework for Immunization Information Systems

 

As public health authorities across the country consider the transition from hybrid to fully electronic immunization information systems, existing electronic systems serve as valuable examples. Evaluations of these systems can thus provide important information, serving to strengthen the systems themselves as well as to guide other organizations in the process of designing and implementing augmented approaches to data collection. Informed by a range of resources, we have developed an evaluation framework and piloted it in a comprehensive assessment of two electronic influenza immunization data collection systems. Specific attributes examined include: simplicity, flexibility, data quality, timeliness, acceptability, stability, and security.

Completed projects:

Perceptions of Influenza Immunization Information Systems within Canada’s Public Health Community

 

In advance of the second wave of 2009 H1N1 vaccination campaign, we conducted a study to understand the perceived value of individual-level data and immunization information systems (IISs) for influenza control, identify ideal system functions, and explore barriers to implementation. Semi-structured interviews were conducted with key informants engaged in vaccine delivery and/or pandemic planning in regional, provincial/territorial and federal jurisdictions across Canada. Key informants were recruited using a combination of convenience and snowball sampling methodologies. Qualitative analysis was used to extract themes from interview content. Patient management, assessment of vaccine coverage, and evaluation of safety and effectiveness were identified as public health priorities that would be achieved in a more timely manner with greater accuracy through the use of an IIS. Features described as ideal included system flexibility, rapid data entry, and universality. Financial and human resource constraints as well as coordination between immunization providers were expressed as barriers to implementation.

 

Pan-Canadian Study of Immunization Data Collection During the H1N1 Vaccination Campaign

 

As part of the 2009 novel influenza A (H1N1) vaccination campaign, electronic and hybrid (combination of paper and electronic) data collection systems were used to collect patient-level H1N1 immunization data. We visited immunization clinics in 38 organizations across 9 provinces and territories in Canada between October 28th and December 18th, 2009, in order to observe and evaluate the data collection processes employed.

Description of data collection methods: Clinic processes – particularly tasks related to data collection and management – were observed at each study site. Field notes were analyzed in order to understand the data collection mechanisms that comprised each information system as a whole. Observed systems included standalone databases, immunization registries, and electronic health records. Organizations incorporated components such as magnetic card reader technology, telephone registration, specialized immunization interfaces, and pre-populated fields into data collection approaches in order to increase accuracy and efficiency.

Comparison of data collection methods by time: The objective of this component of the study was to measure the time spent by staff on tasks related to data collection in order to compare the efficiencies between electronic and hybrid systems. We measured the time spent by staff on patient registration, medical history collection, vaccine record keeping, preparation of vaccine proof, and post vaccination data entry. The total average time spent per record for data collection was 117 seconds using a completely electronic system, 143 seconds using a hybrid system with electronic patient registration, and 172 seconds using a hybrid system with paper-based patient registration. Across the systems, the majority of time on average was spent on patient registration (44 seconds), whereas medical history collection took 26 seconds, and record keeping took 23 seconds. Electronic patient registration and record keeping had significantly shorter data collection times when compared to paper-based methods. Overall, electronic systems were more efficient than hybrid systems for collecting influenza immunization data. 

Comparison of data collection methods by user perception: A convenience sample of staff at clinics we attended completed a questionnaire in which they indicated their level of agreement with seven statements regarding the usability of the data collection system employed at their vaccination clinic. Questions included overall ease of use, effectiveness of the method utilized, efficiency at completing tasks, comfort using the method, ability to recover from mistakes, ease of learning the method and overall satisfaction with the method. Approximately half the respondents had a year or less of experience with immunization-related tasks during seasonal influenza campaigns. Over 90% of all frontline staff found their data collection method easy to use, perceived it to be effective in helping them complete their tasks, felt quick and comfortable using the method, and found the method easy to learn, regardless of whether a hybrid or electronic system was used.

Economic Evaluation of Immunization Data Collection Systems

Data collection systems can differ considerably based on factors including efficiency, human resource requirements, and financial investment in system infrastructure. Although cost has been identified as one of the primary perceived barriers to implementing an electronic system to collect client-level immunization data, there are currently no related Canadian economic evaluations. Such information would be invaluable to healthcare decision-makers as well as public health authorities involved with future mass vaccination campaigns. Therefore, this study’s objective was to estimate the short and long-term costs associated with implementing a fully electronic influenza immunization system vs. paper-based methods. We found that five-year cost projections for electronic systems were comparable or less expensive than for hybrid systems, for all public health unit population sizes.

Individual-Level Immunization Data Collection in Non-Public Health Settings

Across non-public health (PH) settings in Canada, seasonal influenza immunization data collection appears to be much less uniform than within PH, due to the lack of reporting standards. For these settings, including physician offices and hospitals, it is not well understood which data collection methods are employed, which data elements are collected and if/how the data can be shared among settings. This makes it difficult to ascertain accurate coverage rates at levels ranging from provinces/territories to more granular geography. Therefore, we conducted an environmental scan to understand the current context of immunization data collection in non-PH settings across Canada. Our findings confirm that in many cases, provincial/territorial standards mandating the systematic collection and central reporting of immunization data from physicians’ offices, hospitals, pharmacies, and private clinics are either absent or not enforced. It therefore remains nearly impossible to ascertain whether vaccine coverage estimates are truly representative, particularly where vaccine is primarily delivered by community-based providers; without accurate and timely coverage data, it is immensely challenging to understand the nature of infection spread and mount a coordinated response.

 

 

 

 

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