The Telligen QI Connect™ team, as a Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network-Quality Improvement Organization (QIN-QIO), partners with nursing homes in Colorado, Illinois, Iowa and Oklahoma to support their quality improvement efforts. Throughout the COVID-19 pandemic, Telligen has equipped vaccine champions within nursing homes with tools and education so they can confidently discuss the COVID-19 vaccine with their peers.

Challenge

According to the Centers for Disease Control and Prevention (CDC), “There are many social, geographic, political, economic and environmental factors that create challenges to vaccination access and acceptance, and that often affect racial and ethnic minority groups. Some of these factors include education, income and wealth gaps; job access and working conditions; racism and other forms of discrimination; gaps in healthcare access; transportation and neighborhood conditions; and lack of trust as a result of past medical racism and experimentation.” Because of these and other challenges, many nursing home staff members and residents have been hesitant to get vaccinated against COVID-19, despite their increased risk and exposure.

Action

The champion model is “increasingly being adopted to improve uptake of guideline-based care in long-term care (LTC).” Specifically, Telligen implements the champion model in areas of care that have proven resistant to improvement, such as low vaccination confidence among nursing home staff and residents.

Telligen helps nursing homes identify and foster vaccine champions who serve as messengers for supporting change and include:

• Representatives for each group within the nursing home (e.g., a certified nursing assistant champion, a registered nurse champion, a leadership champion, a resident champion, etc.). Champions are most effective when they are equal to their peers or colleagues and have comparable social or work status.
• Individuals who are deemed influential, well-respected, and trustworthy by their peers. Champions have a greater platform for spreading resources and information if they lean on their existing relationships and good standing with their peers.
• Staff members who are equipped with the necessary knowledge and tools to have meaningful conversations with their peers and can model and reinforce the desired behavior.

Telligen hosted a COVID-19 in LTC Office Hours focusing on “Let’s Try Something New: Promoting COVID-19 Vaccine Confidence Now.” The presentation featured Dr. Leslie Eber who discussed 15 key strategies, including empathetic listening for vaccine champions.  A flyer on “Conversation Tips to Increase COVID-19 Vaccine Confidence” that contains bite-sized resources was developed and shared with the vaccine champions during 1:1 technical assistance sessions.

Additionally, motivational interviewing (MI) was taught to the vaccine champions as a useful tool for addressing hesitancy. MI is an evidence-based and culturally sensitive approach to help people manage mixed feelings and move toward healthy behavior change that is consistent with their values and needs. MI-focused resources, such as the CDC’s website on “Talking with Patients about COVID-19 Vaccination: An Introduction to Motivational Interviewing for Healthcare Professionals,” were used during vaccine champion trainings.

To guide conversations about vaccination with their peers, Telligen encouraged vaccine champions to use the OARS Model which includes Open-ended questions, Affirming statements, Reflective listening and Summarizing.

Results

As of April 2022, Telligen has provided 1:1 assistance to 282 nursing homes to increase COVID-19 vaccine rates. This includes support for 118 nursing homes to train MI coaches and develop vaccine champions. This approach helped Telligen to achieve 27% higher vaccination rate among nursing homes that have received 1:1 assistance compared to those that have not.  

While we have seen improvements in vaccination rates, we know our work is not done. We are continuing to work on additional MI training materials to support nursing home vaccine champions. Stay tuned!

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-1134-07/18/2023