P3W: Pertussis Prevention for Pregnant Women

Summary

Impact Statement: 
Pregnant women face economic barriers to receipt of pertussis vaccines, increasing risks for infant transmission of the disease. Using PDSA and rapid cycle improvement, the health department partnered with a prenatal care provider to increase Tdap coverage from 1% to 49% of pregnant women whose pregnancies were greater than 20 weeks gestation.
Summary: 

Collier County Health Department (CCHD) sought to ensure that all pregnant women received the tetanus, diphtheria, and pertussis (Tdap) vaccine before delivery to protect their infants against pertussis, as recommended by the Advisory Committee on Immunization Practices on October 24, 2012.

Discussions with providers at the Women's Health Foundation (WHF) indicate almost 100% of their clients remain unvaccinated against pertussis and that these women lack resources to pay for the vaccine. WHF did not have resources to purchase the vaccine and did not think they could manage and administer vaccines with current staffing levels even if vaccine costs were covered. Currently, neither hospital with an obstetrics unit provides the vaccine to women after delivery. Finally, Medicaid does not cover administration of adult vaccines.

CCHD thought a partnership with WHF was a natural choice and should be a priority because WHF delivers approximately 40% of babies in Collier County and serves indigent women who lack other resources to obtain the vaccine. WHF collected financial information and applications for the Merck Vaccine Patient Assistance Program (VPAP) and referred clients to CCHD. CCHD processed the applications and administered the Tdap vaccine to women at more than 20 weeks of gestation. Approximately 60% of WHF clients were eligible for the Merck VPAP, and CCHD financed the remaining 40%. The combination of local government funding and vaccine assistance allows the program to remain sustainable. Seven months after program inception, 139 out of 421 (33%) registered pregnant women have received Tdap through this initiative.

Women registered at the end of this 7-month period will not be medically ready for the vaccine until they reach 27–32 weeks of gestation.

Organization that conducted the QI initiative: 
CCHD
Citation: 

Levine, L. Public Health Quality Improvement Exchange. P3W: Pertussis Prevention for Pregnant Women. Tue, 03/04/2014 - 09:59. Available at https://www.phqix.org/content/p3w-pertussis-prevention-pregnant-women. Accessed August 15, 2018.

Submission Status: 
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Comments

prusso's picture
Submitted by prusso on

This is a terrific example of a public health - health care collaboration. Working in QI projects outside the health department walls with partners from a different organization is another level of challenge that you clearly mastered!

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LowrieWard's picture
Submitted by LowrieWard on

I agree with Pamela, this project seems to be not only a great example of LHD clinical QI initiatives, but it also appears to be a great way to think about QI while working with partners.

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Submitted by denniec on

Great partnership with the community. Good engagement with an outside partner.

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Submitted by lauralevine on

Thank you for the strong vote of confidence this has been a great project for us in Collier County

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Submitted by sfenton on

This initiative provides a great model for implementing an similar project in our county and has set my immunization project wheels turning. There are a number of possibilities for internal and external partnerships that are very exciting. Thank you so much for posting this project; can't wait to discuss it with my infectious disease team and the maternal child health division.

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Submitted by kvogelson on

Great information here! We implemented a pertussis QI project focusing on decreasing exposure via reducing days between onset and reporting in collaboration with a medical provider. Through that process we found getting pregnant women vaccinated is an issue. I plan to use some of your framework to work toward getting a higher vaccination rate among pregnant women in our area. Thank you so much for your information.

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Grace Gorenflo's picture
Submitted by Grace Gorenflo on

In addition to being a great example of public/private collaboration, you've also provided a tremendous example of a cogent flow chart with a process that spans 3 different agencies. Thanks for sharing your work!

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Link to the resource where this submission is also published: 
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