Low resident and staff vaccination rates put the most vulnerable at risk.

COVID-19 vaccination is the most effective way to prevent infection among people with Medicare, a population that is at high risk of dying from complications caused by the virus. In the summer of 2021, nearly 200 nursing homes in the seven-state region served by Alliant Health Solutions (Alliant), a Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network-Quality Improvement Organization (QIN-QIO), vaccinated their residents and staff against COVID-19 at rates well below their state averages.

One-on-one support and consistent, multi-faceted communication helped nursing homes make progress.

To assist nursing homes in their efforts to improve vaccination rates, Alliant used direct, one-on-one outreach strategies. The Alliant team developed a script incorporating the principles of behavioral science for its Quality Advisors to follow when conducting their outreach. This not only ensured consistent messaging and support to each nursing home, it helped Quality Advisors better understand motivational interviewing, an intervention strategy used to encourage behavior change.

During their initial phone calls, Quality Advisors discussed each facility’s vaccine rates and provided an opportunity for staff to share their challenges and barriers. Following these calls, the Quality Advisors came together to discuss their findings and identify common barriers that helped inform the interventions they recommended. They also performed a root cause analysis and created an improvement plan based on the Plan-Do-Study-Act template. Quality Advisors then followed up with nursing homes to walk through the barriers, review their improvement plans and share specific interventions.

In total, the Alliant team recommended at least 44 different intervention strategies to help nursing homes address the barriers they identified. The strategies most often used by the nursing homes were motivational interviewing and general education materials provided by Alliant. Examples of these materials include a “Using Motivational Interviewing to Increase COVID-19 Vaccinations” handout and an “Attention Visitors” poster outlining core principles visitors should follow while in a facility. Follow up from the Alliant team to determine if and how the intervention strategies were being used ensured the facilities’ success.  

In addition to one-on-one support, Alliant communicated consistently across multiple channels, offering tools and resources to help nursing homes build awareness of the importance of vaccination and increase staff receptiveness to getting vaccinated. Group calls and office hours featuring Alliant’s medical director, infection preventionist, and National Healthcare Safety Network (NHSN) expert were conducted weekly, along with emails highlighting provider success stories and links to upcoming educational events. Alliant also created a dedicated website featuring downloadable and printable resources.

While the primary goal of Alliant’s support was to help nursing homes improve their resident and staff vaccination rates, an additional goal was to help nursing homes improve their reporting of these rates to the Centers for Disease Control and Prevention’s NHSN database. Alliant implemented a multipronged strategy that included one-on-one assistance, a “Do Not Report Zeros” one-pager, promoting the one-pager in partner and association newsletters, direct outreach to nursing home corporations, and hosting  “Shop Talk” monthly office hours with Alliant’s NHSN experts.

An example from the field

Through its direct outreach, Alliant learned that a nursing home corporation with 20 facilities lacked access to the vaccine and did not consistently offer vaccine clinics. They also struggled with NHSN data reporting and integrity. Working with corporate leadership, Alliant helped initiate several interventions. These included:

Identifying a corporate nurse to assist each facility with vaccine clinics, tracking, and education
Notifying participating facilities of the corporate requirement to participate in weekly QIN-QIO vaccine educational events
Leading an NHSN educational session focused on entry and validation of vaccine data

At baseline, the facilities had a resident vaccination rate of 56.5 percent and a staff vaccination rate of 47.3 percent, respectively. As of April 1, 2022, the facilities increased their average resident vaccination to 81.3 percent, a 24 percent improvement. The average staff vaccination rate increased to 95.8 percent, a 48 percent improvement.

Outcomes from Alliant’s efforts

Alliant’s approach to helping nursing homes increase COVID-19 vaccinations among residents and staff led to notable improvements in vaccination rates in their seven-state region. Alliant suggests the one-on-one support delivered to nursing homes, rather than specific interventions, was the key factor driving the improved rates.

Among facilities with below-average resident vaccination rates that received assistance from QIN-QIOs, Alliant had the highest proportion of nursing homes achieving greater than five percentage points above improvement compared to the average resident vaccination rate in their state.

Similarly, among facilities with below-average staff vaccination rates that received assistance from QIN-QIOs, Alliant had the third-highest proportion of nursing homes achieving greater than five percentage points above improvement compared to the average nursing home staff vaccination rate in their state.

This material was prepared by The Bizzell Group (Bizzell), the Data Validation and Administrative (DVA) contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. 12SOW/Bizzell/DVA-1143-07/18/2023