Q&A with Donna Thorson, Shannon Finegood and Linda Griskell at Comagine Health 

COVID-19 vaccine access and uptake has been identified as a challenge for nursing homes. What was your vision and plan to improve vaccine access and uptake?

 At Comagine Health, we are aiming to increase access to, uptake of and confidence in the COVID-19 vaccine, including the booster, among long-term and post-acute care residents and staff.

We developed an integrated approach reflective of the complex and variable nature of vaccine access and uptake challenges. We offered 1:1 technical assistance, facilitated group training sessions, created and disseminated relevant resources like the COVID-19 Vaccination Access Quick Guide, the COVID-19 Vaccine Booster Guide and Immunization Information System (IIS) Resources, and hosted weekly troubleshooting sessions to allow for peer-to-peer learning.

What kind of technical assistance did you provide to improve vaccine access and uptake?

A key message to facility leaders is that residents and staff who are willing to receive a booster should not have to wait weeks for the next opportunity, and anything we can do to increase frequency of clinics is critical. This is particularly true for short-stay residents who are there for only a few days and have less opportunity to receive a vaccine before discharge.

Comagine Health improvement advisors, in partnership with facility leadership, help staff find solutions to access issues by developing an action plan, which may include:

• Identifying alternative vaccine providers, such as local pharmacies, hospitals, home health agencies, EMT services, urgent care, nursing schools, medical students and the health department, and collaborating with the state agency
• Bringing those alternative vaccine providers to the facility to avoid transport of residents
• Recommending more frequent hosting of onsite clinics to capture short-stay patients
• Enrolling the facility as a “vaccine provider” 

We connect facilities to local health departments and to CDC resources to find a verified provider to partner with nursing homes to provide onsite vaccines. We help facilities find alternative solutions such as nearby hospitals, EMT services, other providers in the area who provide COVID-19 vaccines and boosters who are willing to travel to the facility with more frequency. These partners are administering the vaccine and reporting numbers to the state immunization information systems (IIS) and scheduling the next clinic. 

To increase vaccine confidence and uptake, advisors address misinformation and health literacy barriers by:

• Developing a script that facilities can use upon patient intake and discharge to improve vaccine confidence and encourage boosters
  • This script was then vetted by Comagine Health’s Patient and Family Advisory Council (PFAC) to ensure its utility
• Providing training on the motivational interviewing approach to improve communication style among staff and elicit motivation for change

What additional interventions were part of your comprehensive strategy?

We knew we needed a multipronged approach to education and information dissemination because of our audience’s time constraints, particularly when it comes to outside training. We opted for three levels of advisor assistance and multiple methods of resource distribution and event promotion targeting resident and staff vaccination rates:

• Our improvement advisors reach out individually to offer direct technical assistance to facilities struggling with access and uptake.
• We host a weekly webinar series that features best practices and resources that are actionable for facility leaders and staff to increase vaccination access and clinics.
• We host weekly open office hours sessions where facility staff are encouraged to ask questions and hear and learn from a small group of peers.
• We promote both events and disseminate accompanying resources focused on vaccine uptake, clinic access and current CDC guidance via our newsletter every week. We also use targeted e-blasts and social media posts to increase engagement and attendance, particularly when we have procured a well-known expert in the field.

What topics have you covered in your webinar sessions?

We provide group training on several topics, including vaccination access, CDC updates, motivational interviewing, communication to help with vaccine hesitancy, safety protocols for visitors and staff, timely and accurate NHSN reporting and system updates, infection prevention, and building vaccine confidence. This gives us another opportunity to share best practices and resources from local and national sources.

What lessons have you learned so far?

• Reporting errors resulting from high staff turnover continue to be an issue for facilities. Developing an NHSN expert on staff has been extremely beneficial, both to facility staff and Comagine Health.
• More recently, through in-depth conversations with nursing home leadership, it has come to our attention that leadership and staff could benefit from additional education on balancing the resident’s right to refuse vaccination and ensuring the resident is accurately and thoroughly informed about the vaccine to make an educated decision. We are currently working with partners to develop content for support in response to this concern.
• There is no one-size-fits-all solution for increasing vaccine clinics and boosters. At Comagine Health, we’ve found the most effective approach is one that combines general outreach with individual action plans tailored to the facilities’ unique needs. If we remain flexible, resourceful and able to actively listen to each administrator, we can help long-term and post-acute care centers succeed in improving vaccine access and uptake

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-1135-07/18/2023