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Service Delivery Innovation Profile

Annual Drive-Through Clinic Enhances Access to Influenza and Pneumococcal Vaccinations for Seniors


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Snapshot

Summary

A medical center in central Florida offers free influenza and pneumococcal vaccines to seniors during a 3-day "drive-through" program offered each fall in the hospital's parking deck. The initiative has significantly increased access to vaccinations among the elderly, with the annual number of immunizations provided increasing from 130 in 1999 (before the drive-through program began) to more than 1,700 in 2008.

Evidence Rating (What is this?)

Suggestive: The evidence consists of trend data on the number of vaccinations administered.
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Developing Organizations

Lakeland Regional Medical Center
Lakeland, FLend do

Use By Other Organizations

The Sarasota County Health Department in Sarasota, FL, offers several drive-through clinics at area churches, libraries, and other locations. Patients pay $25 to $35 for the flu vaccine and $45 for the pneumonia vaccine.

Date First Implemented

1999
The clinic was initially set up in the hospital's library in 1999 and moved to the more convenient parking facility in 2002.begin ppxml

Patient Population

The program is open to adults age 55 and older who are participants in the hospital's Senior Care Club.Age > Aged adult (80 + years); Vulnerable Populations > Frail elderly; Age > Middle-aged adult (45-64 years); Senior adult (65-79 years)end pp

Problem Addressed

Influenza and pneumonia are common, costly, and deadly conditions, particularly for elderly Americans. Although vaccinations can substantially reduce the risk, severity, and costs of both conditions, many older Americans fail to get immunized. These low vaccination rates are due to a variety of reasons, including lack of knowledge about the benefits and difficulties in getting an immunization.
  • Common, deadly conditions: Each year in the United States, between 5 to 20 percent of the population gets the flu, with more than 200,000 people being hospitalized and 41,000 people dying from flu-related complications.1 Influenza and pneumonia together represent the eighth leading cause of death among all Americans and the sixth leading cause of death among Americans over the age of 65.2 An estimated 63 percent of flu-related hospitalizations and 90 percent of flu-related deaths involve people age 65 and older.3 The number of flu-related deaths is expected to increase as the nation's 65 and older population doubles by the year 2030.
  • Costly conditions: In 2005, influenza and pneumonia cost the U.S. economy $40.2 billion—$6 billion in indirect costs and $34.2 billion in direct costs.2
  • The benefits of vaccination: A national study that spanned two influenza seasons found that immunizations significantly reduce the risk of hospitalization (by 19 percent for cardiac disease, roughly 20 percent for cerebrovascular disease, and approximately 30 percent for pneumonia or influenza) and death (by nearly 50 percent).4 Another study found that influenza vaccinations yield net medical care cost savings (due to fewer respiratory or cardiovascular hospitalizations) of $71 per person vaccinated, or roughly $809 per year of life saved.5 As a result, U.S. Centers for Disease Control and Prevention (CDC) guidelines recommend that adults age 50 and older get an influenza vaccine annually and that those age 65 and older receive a pneumococcal vaccination at least once.
  • Low vaccination rates: Despite the significant benefits of vaccinations, one-third of Americans age 65 and older do not get their influenza shots each year, and more than one-third have never been vaccinated against pneumococcal disease.3 Rates are lowest among older, vulnerable people who most need the vaccines most, including African Americans, Hispanics, and those with chronic illnesses such as diabetes, heart disease, and kidney disease. To address these low rates, CDC's Healthy People 2010 program has set a goal of having 90 percent of older adults vaccinated against pneumonia and influenza according to CDC guidelines by 2010.
  • Reasons for underuse: Seniors often do not get immunized because they do not understand the benefits of doing so, and/or because of the significant effort required to obtain an immunization, including scheduling an appointment, negotiating transportation to the clinic site, and reaching the site from the parking lot, which can be challenging for those who use a walker or wheelchair. Lakeland Regional Medical Center, for example, used to hold a vaccine clinic in the medical center's library, but found that few seniors used it due to the difficulty of getting to the clinic location.

What They Did

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Description of the Innovative Activity

Lakeland Regional Medical Center developed a free, drive-through vaccination program that makes it easy for seniors to receive influenza and pneumococcal vaccines. For 3 days in late September or early October (right after the flu vaccine becomes available), nurses set up stations in the center's covered parking deck and administer vaccines to seniors while still in their cars or in a nearby seating area. Key elements of the program are described below:
  • Marketing to the community: Once assured of the delivery of influenza vaccines (which usually occurs in late September or early October), the medical center announces its free, drive-through vaccination program. Seniors who have enrolled in the center's Senior Club Program receive an announcement about the program in the mail. Interested seniors are asked to call the hospital at a designated number to leave their name and number, and hospital staff then call them back to schedule their drive-through immunization during the 3-day program.
  • Program preparations: Before each 3-day program, the hospital prepares signs, a total of six stations, five for influenza vaccines and one for the pneumonia vaccine, and assigns nurses and nursing students to work at each station. The center's emergency department is notified about the program in the event there is an adverse reaction to the shot. The security team cordons off the drive-through area.
  • Program operations: Seniors drive up to the vaccine station during established hours—8 a.m. to 4 p.m. each day. The clinic can handle approximately 70 patients every hour throughout the day. Each person typically waits in line in his or her car for about 3 or 4 minutes before a nurse approaches the driver and/or passenger, briefly reviews his or her health and medical history, and has them sign consent forms for the vaccination(s). The nurse or a nursing student administers any needed vaccines either in the car or in a nearby seating area depending upon the patient's preference. The nurse makes sure there are no adverse reactions and provides vaccine recipients with a confirmation card to show their primary care providers that indicates they have been immunized. Seniors who bring their pets dogs to the drive-through receive biscuits.

Context of the Innovation

The nonprofit Lakeland Regional Medical Center is a 851-bed facility that offers primary and specialty medical services to Polk County residents. Approximately 17.2 percent of the county's population is age 65 and older, and the center anticipates substantial growth in its senior patient base over the next decade. The drive-through immunization program is part of the center's Senior Club Program, which provides health care information, educational resources, and free health screenings—including immunizations. The drive-through program was developed in 2002 as a replacement for the center's library-based vaccination program. As noted earlier, uptake in this program was slow because seniors often found it difficult to drive to the medical center, find a parking place, and walk to the library (which was particularly challenging for the mobility impaired). Recognizing the difficulties facing seniors, the nursing staff began researching alternatives and discovered that drive-through programs had been used in other parts of Florida. The nurses proposed holding a drive-through vaccine clinic in the center's new parking deck, which has a circular traffic pattern and adequate space to host the program.

Did It Work?

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Results

The drive-through vaccine program has significantly increased access to influenza and pneumococcal vaccinations among the elderly, with the number of immunizations increasing from 130 before the program began, to more than 1,700 in 2008.
  • More seniors immunized: When the medical center offered vaccines in its library, the response from seniors was relatively muted. In 1999, for example, the library-based program administered 130 vaccinations. The drive-through program has substantially increased access to vaccinations for area seniors. In 2008, for example, the drive-through clinic administered more than 1,700 immunizations, including 1,535 influenza and 207 pneumococcal vaccines.
  • Many unlikely to be immunized if program not available: Many of these seniors likely would not have been immunized in the absence of the program, which increased seniors' awareness of the importance of vaccinations and made it very easy to receive them.

Evidence Rating (What is this?)

Suggestive: The evidence consists of trend data on the number of vaccinations administered.

How They Did It

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Planning and Development Process

Key elements in the planning and development process include the following:
  • Enlisting medical staff and leadership support: Senior nursing staff approached and won support for the program from medical center leadership.
  • Developing staffing models: Program leaders developed staffing models to handle roughly 500 vaccines per day. Leaders decided to staff each clinic with six experienced nurses who were reassigned for the 3-day event (with arrangements made for others to cover these nurses' regular duties on these days). The plan also called for the nurses to be supported by volunteer nursing students who would likely to be attracted to the chance to gain experience working with healthy seniors.
  • Developing logistical plans: Program leaders worked with hospital engineering staff to prepare the necessary signage to direct seniors to the right area within the parking deck, and with security staff to develop plans for directing traffic.

Resources Used and Skills Needed

  • Staffing: Each clinic has six nurses and six volunteer nursing students. In addition, engineering department staff, environmental services staff, and security officers assist in making signs, directing drivers to the vaccine area, and setting up tables and trash containers. There is a 1-hour orientation for all volunteer and center staff who participate. 
  • Costs: Each influenza vaccine costs the center $9.75, while each pneumonia vaccine costs $46.92. Other costs (for which estimates are not available) include marketing and setting up for and staffing each 3-day clinic.
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Funding Sources

Lakeland Regional Medical Center
Although Medicare covers influenza and pneumococcal vaccines, the hospital chooses to self-fund the program rather than complete the required paperwork to receive reimbursement.end fs

Tools and Other Resources

A 60-second podcast about this program is available through the Agency for Healthcare Research and Quality "Healthcare 411" news series at http://www.healthcare411.ahrq.gov/radiocast.aspx?id=996

Information on CDC recommendations for vaccinations for adults/seniors is available at http://www.immunize.org/catg.d/p4030.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.).

Information on CDC recommendations for the prevention of pneumococcal disease is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00047135.htm.

Information on the prevention and control of influenza can be found in the Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices, 2008, available at http://www.cdc.gov/mmwr/pdf/rr/rr5707.pdf.

Adoption Considerations

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Getting Started with This Innovation

  • Assess whether "drive-through" model works for patients and center: The drive-through approach works best for seniors who have access to cars. Medical centers that serve a large population of seniors who rely on public transportation may be better off holding vaccine clinics in licensed long-term care facilities or independent senior housing developments. In addition, the drive-through approach will only work for organizations that have adequate facilities to host the clinic, including a driveway or parking garage with lanes or space that can be blocked to daily use for several days without disrupting regular and emergency traffic. In addition, because flu vaccines should be administered in late September or early October, the vaccine site should be appropriate for the weather, offering adequate protection to workers and seniors from hot or cold weather, direct sunlight, rain, or other inclement conditions.
  • Design publicity to reach target population: Identify media outlets and other vehicles for notifying the target population about the vaccination program.
  • Set up systems to allow appointment scheduling: To prevent potential logjams, set up a dedicated phone line and assign an administrative staff person to attempt to schedule immunizations whenever possible.

Sustaining This Innovation

  • Anticipate vaccine delivery delays: Do not schedule the event until the center is absolutely assured of vaccine delivery. Historically, there have been vaccine shortages and delays that could undermine patient confidence in the program if the schedule is set prematurely.
  • Stick with the campaign schedule: Offer the program at the same time each year to build community awareness and retain repeat customers. This type of consistency also makes it easier to plan staffing and to replace vaccine program workers during the drive-through clinics.
  • Consider additional sites cautiously: Lakeland has thus far resisted the idea of offering the drive-through clinic in other locations. The current space works best because the medical center depends on its onsite team of nurses, engineers, and security personnel to staff the clinic, and on the clinic's proximity to the emergency department in the event of an adverse reaction.

Use By Other Organizations

The Sarasota County Health Department in Sarasota, FL, offers several drive-through clinics at area churches, libraries, and other locations. Patients pay $25 to $35 for the flu vaccine and $45 for the pneumonia vaccine.

Additional Considerations

  • Provide written confirmation cards: Provide a confirmation card that patients can give to their primary care providers to show they have been immunized against the flu or pneumonia, thus allowing the provision of the service to be entered into their medical records.

More Information

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Contact the Innovator

Mary Jane Seymour, MS, RNC
Manager, Advanced Practice Nursing
Lakeland Regional Medical Center
1324 Lakeland Hills Blvd.
Lakeland, FL 33805
Phone: (863) 413-5977
Fax: (863) 284-1978
E-mail: maryjane.seymour@lrmc.com

Innovator Disclosures

Ms. Seymour has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.

Footnotes

1 Dushoff J, Plotkin J, Viboud C, et al. Mortality due to influenza in the United States—an annualized regression approach using multiple-cause mortality data. Am J Epidemiol. 2006;163(2):181-7; doi:10.1093/aje/kwj024. [PubMed] Available at: http://aje.oxfordjournals.org/cgi/content/full/163/2/181
2 American Lung Association. Influenza Fact Sheet. September 2007. New York City. Available at: http://www.lungusa.org/lung-disease/influenza/in-depth-resources/influenza-fact-sheet.html
3 Aldrich N, Keyser C. CDC Says Immunizations Reduce Deaths From Influenza and Pneumococcal Disease Among Older Adults. U.S. Centers for Disease Prevention and Control. 2008. Atlanta. Available at: http://www.healthbenefitsabcs.com/DocumentsPublic/file/Media
/CDC%20Backgrounder%20Adult%20Immunization%203-17-04.pdf
4 Nichol KL, Nordin J, Mullooly J. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med. 2003;348(14):1322-32. [PubMed]
5 Nichol KL, Nordin J, Mullooly J. Influence of clinical outcome and outcome period definitions on estimates of absolute clinical and economic benefits of influenza vaccination in community dwelling elderly persons. Vaccine. 2006;24(10):1562-8. [PubMed]
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Original publication: November 25, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: May 07, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: April 02, 2012.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.