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HSR&D 2004 National Meeting Abstracts

1064. Facilitation of Interventions to Improve Vaccination Rates: SCI QUERI
Marcia W Legro, PhD, VA Puget Sound Healthcare System, C Wallace, VA Puget Sound Healthcare System, B Goldstein, VA Puget Sound Healthcare System

Objectives: To describe facilitation - a method to implement best practice.

Methods: Two-year project at 23 VA SCI centers to deliver respiratory vaccines. Four evidence-based interventions directed at patient/practitioner attitudes and behaviors, and modifying systems. Mailed patient reminders and educational materials Computerized clinical reminders (CCR) Practitioner education Standing orders Study personnel facilitated use of interventions and simultaneously gathered evaluative data. Based on work at Royal College of Nursing, UK.

Results: Patient reminders/educational materials: 1st year, facilitators prepared and mailed letters with cooperation of center staff; 2nd year, center staff followed pattern from year before, completed work on their own at 20/23 centers. Practitioner education: e-mails to interested staff, phone conferencess across centers to problem-solve, SCI Newsletter articles, and national leadership messages on monthly calls. CCR: Email questionnaires indicated CCR was installed at 23/23 facilities, but further staff contact uncovered many barriers to CCR use. Facilitators sought solutions to problems identified by center personnel. Documenting vaccinations in CCR templates became major goal because of information gathered by facilitators. Standing orders (protocols, procedures) for nurses: in place at 20/23 facilities. Phone interviews suggest actual knowledge of standing orders among personnel at SCI centers is variable.

Conclusions: Facilitation provided information, assistance and problem-solving. Data collection/analysis evaluated status of interventions at SCI centers. With this information, mid-course corrections improved use of interventions.

Impact: Interventions must be adapted to local circumstances; otherwise, interventions will not be adopted and maintained.