Becker's Hospital Review

34 Executive Briefing Sponsored by: T he US healthcare system is moving from volume- based care to one focused on value, forcing providers to shift their focus to efficiency and quality instead of patient quantity. As a result, health organizations are developing new systems to address issues resulting from this paradigm shift. These trends are evidenced in the concerns of CEOs. In a May 2017 survey of 20 health system CEOs conducted by consulting firm Deloitte, respondents cited the move toward population health management, a component of value-based care, as one of the top-of-mind concerns. One CEO survey participant described the shift toward population health- and value-based care as "a concern, but also a huge opportunity for our country to provide better healthcare." Population health management can be defined as efforts made to prevent illness and improve healthcare outcomes among a defined set of people by monitoring and identifying individuals within the group. Vaccination is a core component of any preventive services package. In 2011, the CDC identified vaccines as one of the 10 public health achievements of the 20th century. Improving vaccination rates is an important area of focus. The persistence of vaccination myths The popularization of the Internet at the beginning of the 21st century has offered an unprecedented opportunity for antivaccination activists to disseminate their messages to a wider audience. For example, individuals who are opposed to vaccination are very active in news forums, resulting in a minority of users generating a disproportionate amount of antivaccination content. The Internet enables scientific abstracts and articles to be shared outside of the scientific community, often without presenting the details of the scientific information or context, which can lead to misinterpretation. Studies examining vaccination-related content on websites or social media platforms have shown that the quality of information was highly variable, with a substantial amount of inaccurate information. Vaccination experts have indicated they are concerned that as the vaccination debate on the Internet intensifies, "many parents may shift from vaccine hesitancy to vaccine resistance, and from vaccine resistance to outright opposition." Parental concerns about vaccine safety and efficacy are resulting in many families choosing to decline required school vaccinations for their children by obtaining religious- or philosophical-based exemptions. In 2016, exemptions based on philosophical beliefs were permitted by 18 states. These findings indicate that new foci of antivaccine activities are being established in major metropolitan areas, rendering select cities vulnerable for certain vaccine-preventable diseases. In fact, approximately 72 percent of children aged 19 to 35 months were fully vaccinated in accordance with guidelines issued by the Advisory Committee on Immunization Practices, according to the National Immunization 2015 survey. According to the American Academy of Pediatrics (AAP), the single most important factor in getting parents to accept vaccines remains the one-on-one contact with an informed, caring, and concerned pediatrician. In a study reported in Pediatrics, parents of more than 7000 children 19 to 35 months of age were surveyed to determine what influence their primary care providers had on their decisions to vaccinate. Nearly 80 percent of parents stated that their decision to vaccinate was positively influenced by their primary care provider. As pediatricians encounter parental resistance to vaccination, parental concerns must be addressed. La Crosse, Wisconsin- based Gundersen Health System has developed an approach to address parental concerns in order to increase vaccination rates. Rajiv Naik, MD, an Onalaska-Wisconsin-based pediatrician with Gundersen, recently spoke with Becker's Hospital Review about how Gundersen leveraged the electronic health record (EHR) to help providers address vaccination myths and vaccinate more adolescent patients. "Regarding healthcare for children, immunizing them is the most important thing we can do," Dr. Naik said. To improve vaccination rates among its pediatric patient population, Gundersen initiated an EHR-based solution based on the Plan-Do-Study-Act (PDSA) model created by the Institute for Healthcare Improvement (IHI). Over a 3-year period that started in March 2015, Gundersen tracked how the initiative How Gundersen Health System debunked vaccine myths and boosted adolescent vaccination rates with an EHR-based solution SPONSORED BY: Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., has paid for and provided editorial input on this material.

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