Becker's Hospital Review

81 Executive Briefing For more than a century, Merck has been inventing for life, bringing forward medicines and vaccines for many of the world's most challenging diseases. Today, Merck continues be at the forefront of research to deliver inno- vative health solutions and advance the prevention and treatment of diseases that threaten people and animals around the world. and 23.6% of men between 50 and 75 years of age reported being screened for colon cancer. An example of an underutilized preventive care option for America's adult patient population is the influenza vaccine. The flu shot can reduce the likelihood of contracting influenza by 50 to 60%, according to the CDC. The possible preventive care benefits being underutilized are significant when considering the lack of adherence among the general population. The detriment associated with the underutilization of these services on the health of Americans is exacerbated by the nation's aging population, as these patients tend to suffer from more complex chronic health conditions. The number of Americans ages 65 and older is projected to rise sharply in the coming decades, according to a 2015 report from the Population Reference Bureau. By the end of 2014, there were 46 million Americans ages 65 years and older accounting for 15% of the overall population. For the 2014–2015 flu season, influenza vaccine coverage for adults was 43.6%, according to the CDC. While coverage for the same season was higher (66.7%) for adults ages 65 and old- er, there remains substantial room for improvement among this vulnerable population. In a 2013 study published in PLOS One, researchers examined influenza vaccination surveillance data compiled from 2005 to 2011. Analysis revealed that between 71% and 85% of seasonal flurelated deaths occur among adults older than 65 years of age. Vaccine landscape Despite the efforts of providers and health agencies to pro- mote adult vaccinations, adherence rates remain low. As stated earlier the influenza vaccination coverage for the 2014–2015 flu season was just 43.6%, falling well short of the HHS Healthy Peo- ple 2020 goal of 70%. Additionally, while rates of pediatric vaccination adherence re- main relatively high — largely because of mandates issued by schools requiring vaccination — segments of the American pop- ulation remain susceptible to renascent outbreaks due to poor vaccine adherence. According to a 2014 CDC survey of vaccination coverage among adult, the prevalence of illness attributable to vac- cine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. The survey also noted that coverage for all vaccines for adults remained low, and missed opportunities to vaccinate adults continued. Although having health insurance coverage and a usual place for healthcare are associated with higher vaccina- tion coverage, these factors alone do not assure optimal adult vaccination coverage. "Vaccines really are central to preventive care," says Melanie Mouzoon, MD, managing physician for vaccination practices at Woman's Hospital of Texas, Kelsey-Seybold Clinic in Kingwood. Dr. Mouzoon added that while other preventive care initiatives can certainly be effective in improving the health of patients, most of these strategies are really designed to simply catch po- tential health issues in their early stages. An achievable strategy While tertiary prevention strategies, such as disease manage- ment, can be quite complex and multi-faceted, vaccine inter- vention is typically different. As detailed in a 2015 article pub- lished in Mayo Clinic Proceedings, vaccinations typically occur in a single care setting, are one-time or relatively infrequent events, and do not require significant initiative from the patient like a change in diet or a commitment to an exercise routine. For patients achieving immunity, vaccination can help reduce disease transmission, disease burden, and the need for disease specific intervention. Quality initiatives designed to boost vaccination rates have been implemented in multiple healthcare settings with great success. One example from Boston Children's Hospital is doc- umented in a 2014 quality report published in the journal Pedi- atrics. Boston Children's was able to boost its vaccination rate for patients aged 24 months to 95% by using a database and a patient tracking registry to systemically identify under-immu- nized patients. The hospital also conducted patient outreach initiatives and used care coordination to notify providers of up- coming appointments with suggested vaccines. A call to action As hospitals and health systems navigate value-based health- care and strive to achieve the tenets of the Quadruple Aim, leaders must emphasize the implementation of preventive strat- egies to achieve population health management. Vaccines are evidence-based treatments that may help improve the health of patient populations and help healthcare organizations as they strive to improve quality of care. n Vaccines are evidence-based treatments that may help improve the health of patient populations and help healthcare organizations as they strive to improve quality of care. USDHHS=United States Department of Health and Human Services.

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