All right, I think we will go ahead and get started. Thank you all for joining us this afternoon. I'm Melissa Ferrari. I'm Vice President of Membership and Operations at the American College of Preventive Medicine. And thank you for joining our session on Advancing Immunizations. And I'm going to put a subtitle on at least the first portion of that, which is An Enhancing Member Engagement. That's a little bonus presentation. I think you'll walk away with after the first 30 minutes. It's my pleasure to introduce Donna Grande, CEO of the American College of Preventive Medicine, and Jane Barwis, President and CEO of BRG Communications. As many of you know Donna from being part of this community, Donna is an executive leader with a long history of developing innovative programs and applying evidence-based principles and cutting-edge strategies to improve people, processes, and health conditions. Jane is the founder of BRG Communications, which was named PR Week's Best Boutique Agency for 2023. She is a leader in developing communications programs, large and small, for medical associations and societies, nonprofits, and Fortune 500 companies, all with a mission of promoting safety, health, and wellness. Together, as you'll see through their presentation and learn a lot more about the partnership, Donna and Jane are going to lead you through the ACPM We Are Vaccine Confident campaign. It's a dynamic, innovative campaign that helped ACPM tap into our greatest resource, our members. We used our members to promote the safety and efficacy of vaccinations when it was needed most. So, with that, I'll turn it over to Donna. Great. Thank you, Melissa, and it's such a pleasure to be here, and thank you to each and every one of you for carving out your time today to be here with us. So, I'm going to ask you to go on a little journey with us back to 2020, the infamous year in which we all had lockdown, and it was the heat of the pandemic. We had a lot of scientific advancements in 2020 with the mRNA vaccine, however, we had a lot of apprehension with the physician population who were a little hesitant about getting their patients vaccinated with this new tool that had come to market in their mind so quickly, but yet people were dying, and specifically marginalized populations were dying at accelerated rates. So, we at Preventive Medicine said we couldn't sit still. We needed to do something to do what we could do and what we do best to amplify and to actually get in front of this pandemic. So, why ACPM? Well, ACPM has a very long history in prevention. We are one of the ABMS boarded specialties since 1954. We've been around for quite a while. We have approximately 2,000 members in our specialty, in our membership society, and our members focus on disease prevention and health promotion, and they're grounded in evidence-based science. Our members also establish the U.S. Preventive Services Task Force, which establishes the clinical guidelines for preventive services, and in the heat of a pandemic, you want your public health leaders to be the ones that are going to communicate, advocate, and encourage people to take good preventive measures, and so many of our members are public health leaders at the state and local and federal public health agencies, and they've been leaders for years. And so, we had just come off the communications calendar on our power prevention campaign, and that was pretty much stalled, but we said we have to do something. We can't come out power prevention because here we are in the middle of a pandemic, and it's really about treating and getting people the tools they need so they don't get this disease. So, as I shared with you the landscape, I'm going to take you on a little bit of the journey of where we were in 2020, and again, what we did since that point in time. As I mentioned earlier, the mRNA vaccine launched, and we knew that physicians were apprehensive, and we needed to come together with a campaign, but I needed to secure funding. So, I reached out to members of our prevention alliance and sought funding to say we need to do some research, see what our members say, and if our members are as confident as I believe they're going to be confident in the science, we need to rally, and we need to do something about this. So, we selected a firm, Jane Barwis, as Melissa introduced, that shared our values, shared a perspective of being evidence-based, and together we launched and developed a framework and then a campaign. And we launched a soft launch based on the data of our members, that over 98 percent of them said they were confident in the vaccine, absolutely confident in the science, and that was something that we could play to and play to our strengths. And with the campaign, and you'll hear more about it in a moment, it also enabled us to then apply for and secure over $3 million of CDC funding to amplify and to take the campaign to the next level. So Jane? So, as Donna said, having the right partner in this was really critical because time was moving very quickly, and ACPM really needed a team that could come and be a true extension to their team. We had to get things off the ground quickly, and fortunately we were able to bring to the table our deep experience working with medical societies, building evidence-based campaigns, and our true passion for reaching unique audiences with critical health messages. We were able to bring all that to bear for ACPM. Donna set the scene. We all remember it, unfortunately. But she set the scene, and the time was right to find credible voices to help create a dialogue and reinforce the efficacy of vaccines. So as we set out to build the campaign, we really had two objectives. Obviously, we had to address the critical need to build confidence in the COVID-19 vaccine, but we also wanted to develop a campaign that would have legs and would be evergreen because there was a bigger conversation that we wanted to be a part of, which is the ongoing need for all vaccines and the ongoing importance for all vaccines. So we were able to do this, and it became even more evident and more important as we came out of the pandemic, and the rates of routine vaccines had plummeted. So the campaign positioned us nicely to be able to address both needs. Donna already mentioned 98 percent of the membership was confident in the vaccines, and when you look at the fact that they are the experts, the campaign almost presented itself. We are vaccine confident. You can be too. Our goal in this was not to tell people to go get a vaccine. Well, of course, we all know that's what we wanted to happen. But our goal was to help build confidence, give people a place where they can start dialogue and have conversations and get questions answered. And we wanted to build that confidence in vaccines even beyond our profession. So starting with our profession, but then going beyond. And we were going to do that by, again, tapping the expert voices, arming them with evidence-based messaging and letting them go deep into the communities that they serve. And one of the things you'll notice is that we didn't put a ACPM brand on it, and that's kind of part and parcel for where we are with CMSS, is that we had an opportunity to really ensure that anyone could pick up this campaign, any physician practice, any clinician, any nurse, nurses, anyone could actually say, if they're confident in this campaign, confident in this vaccine, they could actually take the assets and move it forward. So it was important also that we look at how we can engage some of our members. And thankfully, the president of ACPM at the time was an academic physician and the dean of the School of Public Health and Tropical Medicine at Tulane. And so through this beautiful quick PSA, we were able to utilize the talent that we had in-house, not pay for an extra spokesperson, but actually build on what ACPM is all about. Thank you. The PSA actually was picked up quite a bit, and we engaged a PSA distribution firm to circulate it quite widely, and so we'll share a little bit more about the metrics in a moment. But telling the story is really important. As Jane mentioned, how do we build on the assets that we have as our membership, and how do we actually give them the tools they need to amplify the message more broadly? And so many of us know that women – data shows that women are the key healthcare decision makers in a family, and people listen to their physician, and they also listen to physicians that look and sound and are like them. So we tapped into the diversity of preventive medicine. Two-thirds of all resident applicants into the field self-select that they are nonwhite. And so diversity is already built into the fabric of the DNA of a preventive medicine physician, but we really truly tapped into our board members and our fellows and our president and committee leaders that could actually be spokespeople for this campaign and meet the physician and the patient population where they were. So we had a great story to tell, but it was time to tell it, and we needed a very well-rounded campaign to be able to do that. The news cycle was obviously ripe. I mean, there was nothing else on the news, practically. I'm sorry for anybody trying to get any news coverage outside of COVID. But instead of just going heavy national and local news with our story, which we did, we also prepped all of our spokespeople to be commentators on the issues. Because as you remember, that landscape continuously changed. Every day there was a new story or a new issue or a new fact that needed to be validated or needed to be challenged, and we trained our spokespeople to be that resource for the media. We also used a lot of digital tools. We leveraged some paid or controlled content, and that was mainly just to make sure that we were going wide and we were hitting people consistently in various forms, various channels. And then we developed some strategic digital assets to support the campaign, but I think as everything Donna and I are saying, the most important thing and what set this campaign apart is we really engaged the members. We started by doing a member rally. So we launched the whole campaign. The member rally was all about them getting to know about the campaign, getting the messaging, and building true energy and excitement around what we were going to accomplish and actually giving the members this outlet, you know, an opportunity to really do something, because we all felt so helpless during those times. And then after that, we launched an ambassador network, which is a more select group of the membership that we would use as key spokespeople in communities. And we also drove thought leadership through the very diverse membership. So we found very unique opportunities to tell the important stories into a wide variety of media. We did develop a microsite, which is kind of common with a lot of campaigns. I'm sure you all have done it, where you have a microsite. It houses all the campaign materials, so it's readily accessible. But we took it a step further, because we wanted this microsite to be more than that. We wanted it to be an information hub, a resource hub. And so we added a feature, which was Ask the Doctor, and people could go there and ask their questions about the COVID-19 vaccine, express their concerns, ask the tough questions. And they got, within a 24-hour period, they would get a response from an ACPM physician. So it was real hand-to-hand direct communication. And it became so successful and gained so much traction that media started going to it as a resource whenever issues would pop up. They would go and check our resources just to see if questions had been asked or if the physicians had been answering those questions. We also went heavy on social media, because let's face it, everybody was sitting at home in front of their computers. So social media was the name of the game. But we kept it relevant throughout the year. Instead of just doing some fun social right at the beginning launch of the campaign to catch attention, we tied it through the year, and we used timing hooks all throughout the year. So we kept it relevant and in people's daily thoughts. We kept a very consistent, steady pace of that social media outreach. We also developed a member toolkit, and this was for all the members, whether they were an ambassador or not. And the key with this toolkit is, number one, it was very robust. So it had everything in it from template op-eds to presentation slides to infographics to other social media content. But the key is that it could all be customized. So it could be customized to that member and to the community that they serve. So they got the base messaging, they had the nice design things, they had all the words and the messaging. But then we gave instruction of how they could customize it. And each of the assets and each of the data points was all based on science. So our members had done vaccine science, we worked with our colleagues at CDC. We wanted to make sure that everything we posted and everything we had and everything we included in all of the content was absolutely most accurate at the point of time. So we had this evergreen element, but yet we also had this ever-changing element of ensuring that all the facts and the data points were all correct. So as I mentioned, the campaign positioned us to be able to be well-positioned to get CDC funding to take this program and amplify it, as Jane mentioned, to really build out this ambassador program that gave us the capacity and the bandwidth that Jane's firm brought to our small 14-person ACPM staff, focused on advocacy, membership, all of the grants that we run and manage. It gave us the bandwidth to actually run more of a PR campaign with the funding from CDC. So this will tell you a little bit about the story. This is a video that shows us that this public health tool is not only safe, but it's effective. It is the greatest tool that we have. ♪ For centuries, infectious diseases have threatened our way of life. With the widespread use of vaccines, we've been able to control or eradicate most of them. We are vaccine-confident and you can be too. ♪ We're doing our part to protect our community and to decrease and slow the transmission of this variant while we increase vaccination rates across the community. Moderna vaccines are very good at preventing disease, symptomatic disease, related to the Delta or the Delta Plus variant. ♪ ♪ So as we've mentioned, the messenger really makes the difference. Dr. Chris Purnell was at the start of this video and she has actually been catapulted up into being on the main Rolodex, as you will, for MSNBC and CNN to comment on a whole host of issues pertaining to public health. But it was really about the diversity of our membership. Oh, I keep hitting the wrong thing. The diversity of our membership that really is our strength, as you've heard, and it's the common theme here. Because preventive medicine physicians work in very, very diverse settings. We have a whole host of physicians in the military. And so they can access and communicate directly with military medicine and those that are actually in that whole circle, Army Wife Network as one. They are also well-positioned across their communities, working either in health departments or in community-based organizations or in qualified health centers. And they really are those physicians that are truly in the evidence-based application at the population health level. And so they were really the strong assets for this campaign. So those of you sitting here, you all have memberships. And, you know, I hear this a lot from different clients. An ambassador program sounds great. Engaging your members sounds great. But how the heck do you make it actually happen? And so I really thought through everything, the road we've been on the last two years. And there are really five key learnings that I think can apply universally, whether it's a vaccine program or any kind of program. Number one, you really need to be clear about the commitment and the expectations. So when you engage a member and talk to them about being an ambassador, don't be afraid to say, yes, this is going to take some of your time. It will take approximately whatever your program will dictate. And here's what's expected. It's okay to put expectations because it just enables them to make a decision and feel confident in the commitment they make when they sign up. Second one, meet them where they are. This was a big one for us. The membership is very diverse, as Don has pointed out. And we had to talk to each of the members and say, you know, what are you comfortable doing? You know, we weren't going to turn somebody who was terrified of public speaking into a top-notch presenter or, you know, put them on CNN or somebody who's never touched social media and asked them to push out content. So we really had to talk with them and work with them one-on-one to figure out where they were comfortable and make sure we had the diversity of tools to answer all those needs. Providing consistent training, it is not a one-and-done. You can't just launch it and leave it. We've done numerous trainings throughout the last two years, and not only have we trained them, we have started getting them to train each other. So train the trainer programs, and it's peppered throughout ACPM's curriculum throughout the year. The other one is ensuring the tools are adaptable. I've mentioned that a few times. One set of tools that speak to what ACPM wants to deliver is fantastic, and it's fantastic for ACPM to push out. But each of the members has unique circumstances in their communities or the environments that they work in, and so the tools need to be adaptable, and you need to be able to tell them how to adapt them. And then lastly, leverage an influencer mentality. And by that, I just mean we started with 20 ambassadors in 15 key markets that were high-risk areas. Those 20 ambassadors, we did a lot of hand-holding. We did a lot of training. The team got on the phone and asked them a million questions, found out where they speak, what are they members of, what are they comfortable doing, what are they not comfortable doing, what have they done in the past, and we customized tailored plans for each of those 20 ambassadors. And then we worked with them to make sure those plans were being delivered on. Again, it's very much a push and then stand back and see what they can do, make sure you're giving them the resources. But the beauty of this was we then captured the testimonials, we captured the stories, we captured the successes, and the genuine passion of those ambassadors started to spread. It started to go peer-to-peer. And over the course of the next two sessions, 22 and 23, we upped our ambassadors to now today we have 100 active ambassadors for ACPM. And it was actually at our annual conference when we showcased the campaign. We also showcased the work of the ambassadors, and then we had a QR code, and about 50 more individuals in the audience, members, said, I want to be an ambassador. I want to be a part of this and use my voice and learn everything that my peers have learned and on. Be careful what you ask for. So obviously over the last two years, I could fill a whole deck and a long presentation full of all the different touch points and the amazing things that the ambassadors have done. But this is just to show again and reinforce again, you really have to have a wide set of tools and a wide set of opportunities so people can find their comfort zone. We've done everything from having them lead trainings on pediatric vaccines to participating in television placements to speaking at community events or patient events. It's gone across the board. And some of the ambassadors, they simply do it right from their office, and they are just consistently pushing out social content. It's all valuable. The greatest thing about this, though, is, again, seeing the energy and the enthusiasm that comes from them. They've really developed a true sense of ownership and a sense of pride in what they were able to contribute during the pandemic and beyond. And the really cool thing also is that they view all of the training as added skill base, and it's a value add for their membership. I mean, over the course of two years, they've been media trained. They've been taught how to navigate various social channels that maybe they weren't even on at the beginning. They've been given speaking points, presentation points. So they really feel like they've built up their own skill base as well. So it's a value add to the membership. So not only are they vaccine confident, but they're also confident in their own abilities, which is a really cool aspect of the campaign. And so we have had a number of different outcomes and a number of different metrics that we've been looking at. Really more than anything, you know, you have your traditional media metrics that you want to report on as far as the number of placements and the different impressions on social media. But really the ambassador aspects that Jane was mentioning as well, really looking at the aspects of the rallies, the events, the PR, the public relations efforts that were at their own local community, what they embarked on in Baltimore with Army Wife Network. I mean, a whole host of different aspects of outreach that they all demonstrated and that they all were able to be a part of this larger campaign. And building that confidence gave us an ability to also think more strategically about how now can we even more, you know, how can we build on this momentum and how can we build upon the work further? And I'll share that in a moment. This campaign across the board has gotten a lot of recognition. And the main reason we put this in here is just to show that it's being noticed. It's across from associations to PR industry and marketing industry institutes. The campaign is being recognized because it was so holistic and because I truly believe because of that member engagement piece. And I think, you know, so you're probably saying, well, what's next for the ambassadors, right? So this was a campaign. I had mentioned our power prevention campaign that was stalled with the pandemic. We pivoted. We moved into this vaccine confident campaign. We actually secured funding to get the initial assets built, partner up with Jane to really look at getting the $3 million for CDC COVID-19 money, which ends in the end of December. And so we needed to also build on what our members needed most and what the consistent message has been across the membership society, and that is how do we actually build awareness and how do we look at building the awareness of what preventive medicine is, what our members do, and why it's important. And so all of the work with the vaccine confident campaign established foundational principles, the tools and assets we needed, the relationships with the members, their confidence in being spokespeople and ambassadors. And then what we really needed then was the same type of assets built around what is preventive medicine. And, again, working with Jane and her team, we were able to build, and our visibility task force that we put together, it was a built-in focus group to be able to get feedback on our messaging, on the audiences, the whole nine yards. And it was just really a wonderful opportunity to build in this whole campaign around this is preventive medicine, you know, building on the sense of pride that Jane commented on, on the ownership of the vaccine campaign, but now how can they own this is preventive medicine campaign. We launched this in March of this past year at our annual conference in New Orleans, and I'll share in a moment the big reveal, you know, our video that we launched as part of the campaign that really got our members even more excited and the residents even more excited that they selected preventive medicine as their field of choice. Today, our nation's health faces new and existing challenges with more opportunities. the lab, the halls of government, and beyond. Preventive medicine, which is critical here, and community health and its positions are working every day to improve the lives of individuals, communities, and entire populations. So, I want to thank again BRG Communications, our incredible partner on this campaign, and of course all of our members in preventive medicine to really take it to the next level and to really help ensure that populations were vaccinated. As you probably see in the data, the marginalized populations, vaccine level and the vaccine uptake increased exponentially with the influx of campaign dollars, not just with ACPM, but all the different associations and organizations across this country that really rallied around ensuring that everyone was vaccinated. So thank you. Thank you, Donna and Jane. So, I think we have maybe just a couple of minutes for some questions and then we're going to hand it over to the second half of our presentation from our other group. Having been in membership-based associations for almost 30 years, we all know members who are engaged are members who stay. So, Donna, I'll ask you, how did you incentivize members to be part of this campaign? Well, there was a number of, thank you, great question, Melissa and BRG. You know, incentivizing members, how do you get people to engage, take up, carve out additional time out of their day? By volunteering on this campaign, they got points towards their becoming a fellow of the college. We have a point system, number one. They would get professional training on how to meet and talk with and be interviewed by the media. And also, really looking at establishing their own professional platform, right? They became confident, as Jane was mentioning, in social media that they may not have ever done before. And so, the skills, the tools, the knowledge that they gained, the ability to use their voice to influence the population behavior, that's what they do. That's why they signed up for preventive medicine. And so, we really gave them that, as well as recognition by their peers. They love the opportunity to have, especially the younger physicians, to be noted by their senior physicians in the audience, like, good job, you really did a great interview. I mean, it was really remarkable. I want to make sure we have time for at least one question from the audience, but I want to toss one out to you, Jane, real fast, because you've worked on a number of healthcare-focused campaigns. What would you say are the biggest challenges that you faced in this campaign, and how did you solve them? Honestly, I mean, I'm sure you can all guess, but I mean, it was the pandemic. Nobody knew what was happening from one day to the next, so, you know, traditionally, we do our research, we do our consensus building, we build this amazing campaign, we launch and everything just goes smoothly as planned. With this, we never knew what we were going to face every morning we woke up, so we had to be very agile, and that's where the teamwork really mattered. I mean, there were many phone calls at late hours or early mornings where it's like, okay, we've got to shift or we have to pivot, because we wanted to stay relevant, and we wanted to do work that really made a difference and really mattered, so I think that was the biggest difference against other campaigns. Thank you. Any questions from the audience? I mean, obviously, one organization isn't going to stop misinformation in media. If that were the case, it wouldn't exist, right? But what we were able to do, especially on the hub, on the information hub, the microsite, we could feed some questions. So when there was questionable information being put out there, we would make sure we had an opportunity for one of the ACPM physicians to jump on there and clarify. We also did a lot of media training with our spokespeople on bridging away from inaccurate information. So when an interviewer would start steering down a course that was not accurate but popular, our spokespeople were trained to bridge back to what actually is evidence-based and true. So those are just a few of the ways that we helped to try to contribute to shifting that dialogue. Yeah, and I think to add on to that, and I know our time is limited, so I'll just quickly weigh in also. Earlier in my career, I ran the vaccine campaigns for the CDC, and there were a lot of anti-vaxxers at the time. And so having some of that in the back pocket really helped to know what kind of angles might be thrown out into the mix, but no one could ever have imagined the misinformation that was actually so prevalent in the marketplace and how it's only continued to expand, enhance, and just it's wildfires that are burning. And so our members are very active and involved in the Trust Coalition for Health and Science and really looking at how we can continue to amplify correct factual evidence. And they always came back, as Jane mentioned, to their single overriding communication objective, which is getting back on task about, and this vaccine, the science is sound and we are confident. Thank you both. And I'm going to hand it over to Karen for, I think you're supposed to stand. Hello, everybody. We're getting, we're winding down. Thanks for coming. I'm Karen Collishaw. I'm the CEO at the American Thoracic Society. And we are fortunate today to have Sarah Imhoff from CMSS, who is in charge of the CDC grant at CMSS that a number of specialty societies participate in, and I'm fortunate enough to have one of my members here, Dr. Laura Feimster from the University of Washington, and she is the chair of our Quality Improvement and Implementation Committee and is on our expert steering group for our particular part of this grant. And so she's going to talk, Laura will talk a little bit about the program more generally, and then Laura will talk about how it's unrolling and unveiling at the ATS. So with that, I'll turn it over to you guys. Do we have the slides for? Thank you, Karen. I think we need to go to the deck that's marked three. Yep, that's fine. So speaking of anti-vaxxers, did you all, I saw an interview with Kennedy the other night on TV. Oh, my gosh. He's running for president. Anyway. Thank you, Karen. Take it away. Okay. No problem. Okay. Hi, everyone. I'm Sarah Imhoff. I'm senior program director with CMSS, and I'm going to talk about the Specialty Societies Advancing Adult Immunization Project. Oops, wrong button. Okay. So I'll just give a high-level project overview here. This is a five-year cooperative agreement between CDC and CMSS, and the goal of this project is to promote adult immunization for high-risk patients in specialty care settings. And part of sort of what is underlying the need for this project is that a lot of patients with chronic illness are less likely to get vaccinated than other patients, and yet they may need it more. And CDC believed that there was really a missed opportunity to be addressing vaccination in the specialty care setting where patients with chronic illness, in particular, may be more likely, more frequently to go. So this is sort of historically been in the domain of primary care to address immunization, but specialty care physicians are often the physicians that the patients with chronic illness are seeing the most often. And so I think the particular data point that I've heard CDC mention when they've talked about this project is the patients in 2019 and 2020 flu season, only half of patients with chronic illness got their flu vaccine, but these are the patients that can least afford to get the flu. So that's sort of what the kind of the rationale was for the project. This is something that we're implementing in partnership with seven of our member societies, ACE, ACC, ACOM, AGS, ASCO, ASN, and ATS. And this project really operates on two tracks. There's a lot of activities, but they essentially boil down to these two tracks. One is a very boots on the ground sort of strategy to work within specialty practices in health systems across the country to test interventions, to adopt the CDC's standards for adult immunization practice. And when we talk about the standards for adult immunization practice, we're talking about sort of the four elements of this domain, I always have to look at the assessing for immunization status, recommending the needed vaccines, administering vaccines or referring if you're not administering in practice, and documentation within the EHR of the patient's vaccine status. So we've got this one track where we're doing developing and testing these strategies within the health systems. And then the second track is with our seven partner specialty societies, aligning their educational offerings as well as policy positions, statements, guidelines to CDC's SAIP. And I'm going to talk about that first portion, that first track first, the health system track. So you can see here on the slide the logos of all the health systems that have signed on to participate. This was a pretty major undertaking for our partner societies to go out and recruit these health systems. They're very busy, as you might know these days. So essentially, the recruitment was one of the major things that we've been doing over the first two years of the project. It just concluded in September. And we, in total, brought on 45 health systems across the seven specialty societies. And among the things that we were looking for are some diversity in terms of geography, obviously, specialty, because they're coming in through the different specialty societies, and practices and health systems that focus on high-risk patient populations. And as I mentioned, the recruitment just ended in September 2023, and we're now at the point where the health systems that have come on this year are actually starting to design and implement and test interventions. And most of our health systems, from which we've started to get some reports on how they're doing in their quality improvement work, are in either their first or their second quality improvement cycle. So we're still pretty early on, but we have enough that we're able to kind of glean from this that we can kind of see where are they focusing these QI interventions. And you'll see on the, I guess it's the right-hand side of the slide, not in any particular order, we've identified 10 categories of interventions that they're focused on. So clinical workflow, vaccine assessment, patient education, administrative staff education, as well as clinician education, vaccine hesitancy, and data exchange with the immunization information systems at the state or the regional level, patient referrals, vaccine recommendations, and major area of focus being EHR modifications. So we're starting to see where they're focusing kind of at the outset of this project. Right now they're focused on COVID and flu, and then next year we'll start to expand some to some additional vaccines. And then CMSS has gone out and contracted with SoftDev, which is a data management analytics firm, and they've created a central data platform that all of the health systems are reporting into so that as we've got these, you know, on the left-hand side, we've got all of these like 45 health systems, and they're different practice sites, and there are different phases of QI cycles focused on different things. We've got a standard set of metrics and data so that we can kind of do some sense making of what's actually happening at the practice level, what seems to be working, because all of that information informs our seven partner societies who are looking at this to say what works in my specialty that we can use to spread to our other participating health systems that we can share out to our members. And then they're sharing that up with us at CMSS so that we can scan across and say what's replicable, what's applicable to other CMSS members that we can share out to everyone, not just the participants in the project, but all members about how do you really in the specialty care setting address immunization. And this slide just gives a couple of, you know, just examples of some of the current QI interventions. One of the major earlier areas of focus as they're in their first and second QI cycles is just making sure they have accurate data in the EHR, which I think a lot of them are discovering they don't about a patient's vaccine. So one health system, for example, is validating their vaccine data in their EHR by crosswalking it with the state IAS, and I know they've had multiple conversations with that state IAS trying to figure out where are the discrepancies. They're documenting what are the barriers to documenting vaccine status accurately in the EHR. Another area of focus for a lot of them early on is education and just making sure that clinicians and their staff and their teams are all on board with this, that they understand why this is important to do for their patient populations. They're also developing what they know are some needed educational materials and very much what we just heard in the last presentation to address some of the vaccine hesitancy that patients are feeling, and we also have some that are starting to work on clinical protocols. Just one example is one health system is adding immunization assessment and documentation to their standard rooming protocols, and then some are also looking out for other partnerships. So we've got a health system that's collaborating with their state Medicaid agency to identify the patients who have the lower vaccination rates so that they can really kind of target their efforts towards those patient groups. So you know, as I mentioned, we're sort of still early on. We're just starting to collect data. I think we've had maybe one or two health systems actually start to report into this data platform. So there's a lot still to learn, but just sort of anecdotally what we've been hearing from our specialty societies, we are learning quite a bit already, and I kind of grouped these into a couple of buckets. One is around the specialist role in adult immunization. What we're hearing is that the specialists, they understand the value of vaccinations for their patient populations. This isn't really something they need to be persuaded about. That's a given, and they generally view vaccination as part of their role. Now they may not see actually administering all of the vaccines as part of their role. They may see themselves primarily as referring for one or more of the vaccines, but they do think it's part of their role in general to at least be having those conversations with patients about the importance of vaccines. And then I don't think this would probably surprise many in this room to hear about some of the barriers or just the time constraints to have these conversations with patients. Particularly if you have patients who are vaccine hesitant, those can be longer conversations. Kind of coming into this with a lack of standardized processes and protocols because this hasn't really been integrated into specialty care has been a challenge, but that's what the project is, you know, here to address. Lack of reimbursement for vaccine coding or not understanding what the reimbursement is that's available has been a barrier. And then logistics related to actually administering the vaccines of those that are exploring administering vaccines that they haven't in the past. So you have to think about the ordering and the where are you going to store things. So the other track that I mentioned at the beginning, I said we're operating on two tracks. One is the health system work to develop the strategies. The other is the society's aligning their educational materials and their guidelines and policy statements. I'm going to focus on the educational materials just with the rest of my time here because there's just a really like impressive wealth of materials in different formats covering different topics, very specific, intended to address some of the gaps and the challenges we just heard about that the societies are putting out. I just put snapshots of a few of these up here, but CMSS released a statement, gosh, it was last week in support of vaccination for the fall, this fall winter season. And in the statement are links out to each of the seven societies resource pages where you can access a lot of these materials and we'll have a learning management system that will be launching before the end of the year and we'll have, we'll be able to link out through that. But there's just a lot of great information that's available that the societies are putting out. And CMSS is also putting out some materials to, we've got some that are in development I'm going to talk about in a second. Some of what we're developing, we're adapting from what our societies have already put together, but we're making it more generalizable across different specialties. And then some are new things we're hearing, new resources we're developing based on what we're learning are the barriers that need to be addressed in the project. And all of this is going to be available through the learning management system, not just to the project participants, but to all CMSS members. So just very quickly, one of the resources we're developing, it will be out before the end of the year, is a vaccine coding toolkit, so this will provide really practical information about how to get reimbursement for vaccine counseling, hopefully will be helpful to clinicians and their teams. And this is adapted actually from a resource that was first developed by ACE, so we appreciate that. Another one that we're really excited about is it'll be a series of e-learning modules on conversational receptiveness. And some of you may have, if you were at the last annual meeting, you may have recalled a keynote by Julia Minson of Harvard University. She's done years of research about how do you have difficult conversations, not just in the clinical setting, but just in general. And this is going to be the first set of really practical, actionable tools that is coming out of this research that she's done, and it's going to be geared toward helping clinicians to have difficult conversations with patients. We think it's particularly applicable to this project, but it really could apply to any difficult conversations that clinicians need to have with patients. And that's going to be 10- to 15-minute learning modules with self-checks, and that'll be hopefully out in early 2024, that's the goal. And then finally, the last thing I'll mention is we have a data mapping workgroup of a subset of the health systems that are participating in the project, and they are really kind of figuring out what are the challenges in terms of, like, how do you really do this within your EHR? What are the codes and the tools that I need to use? What are the data queries? So they are coming up with some vendor-specific solutions. So if, you know, you're another health system on Epic or Cerner or whatever, here, even if you're not participating in the project, here are some things like a shortcut or a cheat sheet to really accurately be able to, you know, assess patients' vaccination status and accurately document within the EHR. So that's sort of the high level. We're very lucky to have Dr. Laura Feimster here. So I think I'm going to – Laura, I'm going to turn it over to you. She's on the Implementation Committee for one of our societies. Hi. Thank you. If we can pull up the next slide set, I'll just say I appreciate the opportunity to come and talk with you today about the activities. ATS is very excited to get to be part of this exciting initiative. And as Karen said, I'm the chair of the Quality Improvement and Implementation Committee. So as part of that, I'm part of that vaccine expert subpanel. I don't have any commercial interests. And so I'm going to spend a little time in the beginning talking about the overall activities of ATS and then specifically talk about activities that are three vanguard health systems. And Sarah said there is two prongs to this initiative. And so the first three goals of the ATS focus areas really are about that dissemination of learning to our experts, updating our policy statements, building a culture where we're pulmonary and critical care physicians squarely in our realm is vaccination for our patients. But often we have relied on primary care in the past. So we're doing a lot of work in the ground, doing focus groups with our members. And as Sarah said, we do all feel that responsibility. And so learning tools on how to bring that into our clinics. And then we're partnering with eight health systems to develop these interventions at a local level. We are led by our senior director, Amy Stern, and manager, Anna Horvath. And our expert panel is co-chaired by doctors Tina Harchett and Justin Ortiz. I'm just show this slide to show you that we've developed a number of subcommittees to address each prong of these activities. And I'll highlight Donna Appel, who's the patient advisory roundtable representative. And so we've worked very hard to not only bring our member voices in, but also the patient voice as well, which is so important to these efforts. So these are the eight health systems. Those in blue are our vanguard health systems that we have been able to partner with that I'll give you a little more detail about. So UCSF in California, led by George Hsu, University of Arizona, working with Cy Parthasarathy there, and the West Virginia University with Rob Stansbury. And then the five additional health systems that have come on in this second round of recruitment. So overall, ATS is really proud that we've been able to partner with a diverse group across the country, different regional medical centers, but also a nice mix of both academic and community partners, our community care hospitals. And at each individual level, we are using a quality improvement process, but embedding it into the implementation frameworks as well. So this is, you know, with each health system, they're evaluating their clinical context to begin with, figuring out the strategies that they can implement there that are most suited. You'll see the three health systems I'm going to tell you about have been in different stages as to how much activity has been going on in their hospitals already to increase vaccination rates. They're developing implementation plans and evaluating those, and then iterating through those QI cycles that Sarah talked about. And actually, those next couple of slides I'm going to summarize just briefly in one and say that in addition to understanding which interventions are most effective, we are very focused on understanding other implementation outcomes, such as reach into the clinics, the adoption by various providers and clinics of the interventions that are being there, the fidelity to those interventions, and also what makes them sustainable over long term. And so by collecting these outcomes, we are able to understand how best to scale these to other health systems, how they might need to be adapted in others, and then contributing to that larger project with all the other health systems as well. So the Vanguard health systems, I'm going to give you a few examples from each of these. And I think that they're nice examples because they're very different health systems that are in very different places. And as Sarah said, we're really at the beginning of their journeys. So West Virginia University Hospitals, this is an academic tertiary care referrals center that serves largely an older rural population of patients, many of whom exhibit vaccine hesitancy. And this is baseline data leading up into going into the QI initiative there. Overall, at least 77% of their patients had at least one COVID vaccination. However, the number that were fully vaccinated was much lower. And only about 50% had received a flu vaccine in the past season. And so in the health system, they had not done a lot of initiatives as the others had before this. And so they really had to start from the ground up. Rob has been working with Nicole Stout, an implementation scientist there. And so they spent a lot of time developing process maps of what is the patient journey through the pulmonary clinic, which staff people do they interact with, which clinicians do they interact with, and where are the points that they can increase vaccination rates. They're mapping those into implementation strategies and conducting focus groups. They have incorporated, they're working to incorporate into their EHR a dot phrase into the EPIC system so they can improve the data, as Sarah was talking about to begin with, of understanding where their patients are at with their vaccination status and how they can better order, recommend, document referrals, all of those things. And they're spending a lot of time talking to patients and developing questionnaires about how to best message to them among those who are vaccine hesitant. And so that is all work that is ongoing at their system. This is just an example of the data that they're now able to pull out of their EHR with their new dot phrase where you can see they had 256 patients come to the pulmonary clinic in August, 191 of whom were fully vaccinated, I'm sorry, 191 of whom actually needed at least one vaccine. So they are now being able to identify the patients more easily that they can then act upon. So UCSF is a very different health system, as many of you know. This is a vertically integrated urban safety net delivery system. They have more than 100,000 low income, publicly insured, uninsured, or undocumented patients. And they have a number of FQH clinics. When they look at their patient population with chronic lung conditions, you can again see lower than we would like vaccination rates for things like flu among people who are most at risk, pneumococcal vaccination, as well as COVID vaccination. Some work to be done. So UCSF has had a number of initiatives ongoing in the primary care clinics for quite some time. So they've had funding from a number of different agencies such as Stop COVID-19 California and an NIH Community Engagement Alliance project where they've done a lot of the groundwork about tailoring language for their patient populations and doing education and outreach. They've researched the barriers and facilitators for vaccine hesitancy and had a lot of advocacy work. And their primary care center of excellence there has developed a way to speak respectfully to patients who might be vaccine hesitant in a culturally appropriate way about how to address the conversation. And so this is the HERE platform that they're then taking into the pulmonary clinics where they talk about first asking open ended questions, expressing gratitude that they have shared their thoughts, asked about pros and cons from the patient's perspective, and then responded in an empathetic way and also asking permission to share information with them. And so this is just an example of their plans for their process, Matt. They're starting obviously finishing up phase one where they did a deep dive in the chest clinic where they got stakeholder interviews, talked to both patients and clinicians. They figured out where the workflow issues were and are working to standardize protocols where they can bring in this HERE process and train their clinicians on using that. And so they are early in that process but iterating through and we're excited to see those results. And then lastly, I know we're running short on time, so lastly at the University of Arizona. And Arizona is a state where there are significant disparities not only in vaccination rates but also in COVID-19 outcomes. And that is particularly true of the traditionally marginalized populations. And so they have lower rates of vaccination among Hispanic and black patients and in rural versus urban communities. And that's true both for COVID-19 as well as for the flu. In fact, in their chest clinics as of May 9th, 2023, they still couldn't administer the COVID vaccine in the clinic to many of their patients. And so only 35% of their patients were fully vaccinated that were coming to chest clinic against COVID. And since then, they have implemented being able to at least administer the vaccine and have increased that by 37%. Meanwhile, they have been doing a lot of work on establishing vaccine discussions as routine practice with their pulmonary physicians. So the team at UAZ has been doing presentations to the pulmonary faculty, the fellows, the advanced practice providers, talking about the role of immunization in the pulmonary practice. And they've collaborated with their own SEAL program to disseminate culturally appropriate information. And they've made this really cool interactive vaccine booth that's present in their pulmonary clinic that has materials both in English and Spanish that talks to patients directly about how to talk to their providers about the vaccine, where to get reliable information, and teaches them about their lung disease at the same time. And with those strategies of having vaccination available as well as working on these strategies, you can see on the bottom is their baseline data where there was no COVID vaccinations that were given in the chest clinic to a trend up at the top where the blue is the COVID vaccinations and that positive trend that they are seeing in the last several months. So already some encouraging preliminary data from all their efforts there. And then they're exploring adapting something from primary care just as UCSF is where they have an alert system for flu vaccines in the primary care clinic that they are now going to replicate in the pulmonary clinic and expand to the COVID vaccinations and flu vaccinations so that they can accurately document vaccine status as well as order vaccinations for those that need them. So this is just a summary that you can see each system. That was a whirlwind. But the interventions are tailored to the population and the clinic. Often they can build on system-wide initiatives that are already there with complementary projects. Other times they're moving from the ground up. We are working hard with CMSS and CDC to have standardized measures with attention within ATS to the implementation outcomes so that we can scale these up to other health systems as well. These were academic centers that I presented information from, but as I said, our newer members of our health systems are also a large number of community hospitals as well. So we think that will add additional data. So thank you to this group and many more for all the work that they're doing towards this. Thank you. Thank you, guys. Thank you so much. Thank you, guys. Thank you so much. I think we have like four more minutes until it starts if anybody has any questions. Yeah, that's great. I mean, I can speak from our theory. We did our best. This is what I would say, is that we worked from the members that we had and did outreach through the members and then else out from there, too. And so the three vanguard systems, the leaders there were well-established members of ATS who were willing to take this on and apply and had very solid applications moving forward. And then we did outreach from there to as many people as we could by word of mouth and things like that, looking specifically to get as much diversity as we could in those health systems. And I'll just add, that was a criteria across all of the societies that were doing the recruitment and is one of the things that I think CDC has found most valuable about this project is the outreach to divert, the reach to diverse populations of patients and vulnerable populations of patients. Good question. I have a follow-up question, but I'll see if others have it. Anybody else have a question? All right, keep going, Donna. Yeah. versus who was funding outwards or whether they were the same centers because oftentimes they may not connect at the national level so we might be able to do that for them. Yeah you should definitely talk about that. Yeah I would think CMSS knows right. I mean you could compare notes as to who you're working with. Yeah. Great. Good. Great. Good. Well thank you all for sticking through till the last plenary. Yeah yeah. And thank you both. Thank you.

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