A 118-bed nursing home located in suburban Illinois was referred by the Centers for Medicare & Medicaid Services (CMS) to Telligen, a CMS Quality Innovation Network-Quality Improvement Organization (QIN-QIO), for assistance with improving its resident COVID-19 booster rate. Using resources provided through virtual one-on-one assistance and Telligen’s “Vax Hub” web page, the facility saw a net increase in its resident COVID-19 booster rate of 55.1 percent from the time the nursing home was referred to the QIN-QIO in December 2022 and the last report to the National Healthcare Safety Network (NHSN) in March 2023.

Overcoming Vaccine Fatigue and Boosting Vaccine Confidence

The facility, whose resident population is primarily under age 60 and has a diagnosis of mental illness and traumatic brain injury, was struggling with vaccine fatigue and vaccine confidence. Though this fatigue was mostly impacting staff, it was also affecting residents and their families. Reasons for not wanting to receive the bivalent booster included already having received the primary series and booster, concerns that the bivalent booster was not preventing COVID-19 infections, and families not wanting their loved ones to receive another vaccination because of their age.

To help the facility overcome vaccine fatigue, Telligen shared one-on-one its Motivational Interviewing – Fishbowl Series. The on-demand series features three, 30-minute sessions focused on building trust and establishing relationships, using Open Questions, Affirmations, Reflective Listening and Summarizing techniques and moving to understanding and action. The QIN-QIO also shared, via one-on-one emails, resources from the Centers for Disease Control and Prevention (CDC) including, Talking with Patients About COVID-19 Vaccination and Vaccine Recipient Education. To help the nursing home address concerns about the safety and efficacy of the bivalent booster, Telligen provided, via one-on-one email, its Frequently Asked Questions about the COVID-19 Bivalent Booster, its Bivalent Booster Myths and Facts, and its Conversation Tips to Increase COVID-19 Vaccine Confidence. These resources were downloaded nearly 100 times by nursing homes in Telligen’s region between December 11, 2022, and March 22, 2023.

Offering Vaccination Resources On-Demand

In addition to providing resources that addressed the facility’s specific needs, Telligen also directed the nursing home to its Vax Hub web page. Launched in January 2023, Vax Hub provides on-demand tools, resources and learning modules related to the COVID-19 vaccine and bivalent booster, including the CMS Quality Improvement Voices audio series. Nearly all learning modules available on Vax Hub are 30 minutes in length or less. Those of particular interest to the nursing home featured here and others in Telligen’s region include the weekly learning series, Give Your Nursing Home a Boost and Ask an Expert.

The Give Your Nursing Home a Boost series is targeted toward nursing home leadership, directors of nursing and frontline staff. It features subject matter experts discussing vaccine-related topics including how to improve COVID-19 booster rates and use of therapeutics by residents and staff and how to make a strong vaccine recommendation. The Ask an Expert series is targeted toward nursing home infection preventionists with the goal of helping build their skillset. Recent featured experts include:

• A pharmacist discussing bivalent versus monovalent COVID-19 vaccines (15 total views)
• An emergency response expert discussing emergency preparedness planning, including the role of vaccination programs, as part of a six-part series (Average of 11 views per part)
• An infection preventionist discussing COVID-19 and sepsis (16 total views)

All nursing homes in the region served by Telligen that were referred to the QIN-QIO for assistance between October 16, 2022, and April 2, 2023, saw a 11.7 percent net increase in resident COVID-19 bivalent booster rates as compared to nursing homes in the region that were not referred to the QIN-QIO for assistance. In addition, the percentage of residents who are up to date in nursing homes in the region that were referred to the QIN-QIO for assistance increased by 18 percent, compared to residents who are up to date in nursing homes not referred to the QIN-QIO, which increased by only two percent.

Telligen’s Regional Nursing Home Resident COVID-19 Bivalent Booster Rates Including Referrals from October 16, 2022 – April 2, 2023

The graph compares bivalent vaccination rates of CMS-referred facilities (orange) with never-referred facilities (blue) and only includes referrals made between October 16, 2022, and April 2, 2023. Never-referred facilities did not meet initial criteria for booster referral because CMS focused on facilities with significantly lower rates.

As featured on the Quality In Action blog series.