Last Updated: December 2015

Author: Planning & Health Care Quality Unit, Vermont Department of Health

Since 2008, the overall proportion of females who are up to date on a core set of clinical preventive services has declined though the most recent data shows a slight increase from 37% in 2012 to 38% in 2014.

Females were considered as meeting the core set of clinical preventive services if they reported getting a flu shot in the last year, ever getting a pneumococcal vaccine, a mammogram in the last two years, and either a colonoscopy or sigmoidoscopy in the last 10 years or Fecal Occult Blood Test in the last year. As noted by Healthy People 2020, this indicator is particularly useful for assessing program effectiveness, “because it is an all-or-none measure, it cannot increase unless multiple component activities (screenings and vaccinations) are delivered to the same individual.”

In Vermont, the overall decline in the core set is driven by small declines in flu vaccines and colorectal cancer screening. Flu vaccines dropped from 65% in 2012 to 62% in 2014. Similarly, fewer Vermont females 65 and older reported meeting the guidelines for colorectal cancer screening than in previous years (79% in 2012 compared to 76% in 2014). Mammograms remain steady and a higher proportion of females reported ever having the pneumococcal vaccine. These mixed trends in screening behavior will influence which strategies are effective for individual screenings or vaccines as well as the overall outcomes.

For more information about trends in vaccination and screening behavior, see the 2014 Behavioral Risk Factor Surveillance System Annual Report.

This indicator is part of Healthy Vermonters 2020 (the State Health Assessment) that documents the health status of Vermonters at the start of the decade and the population health indicators and goals that will guide the work of public health through 2020. Click here for more information.

As noted on the Healthy People 2020 website, “National experts agree on a set of recommended clinical preventive services for adults aged 65 or older that can help detect many chronic diseases, delay their onset, or identify them early in more treatable stages. [This indicator is] a promising tool for assessing prevention program effectiveness... The “up-to-date” measure can help improve program transparency, accountability and decision making by driving the coordination of prevention activities across disease-based “silos” in both the clinical and public health settings.”

• Primary care providers
• Vermont Department of Health Immunization Program
• Vermont Department of Health Comprehensive Cancer Control Program
• Vermonters Taking Action Against Cancer (VTAAC)

Currently, strategies for cancer screenings are distinct from immunization-related strategies.

Immunization: Primary strategies to increase vaccination include:

• Strong provider recommendations
• Patient awareness of the need for the vaccine
• Limit out of pocket costs

In addition, the availability of immunizations at pharmacies has increased access for some of the age 65 and older population. For more information, please see our Immunization Scorecard.

Cancer: The following evidence-based strategies have been shown by the Community Guide (the Community Preventive Services Task Force of the Centers for Disease Control and Prevention) to measurably impact population-level colorectal cancer screening rates:

• Reminder letters sent by providers reminding patients of being due/overdue for cancer screening
• Videos and printed materials distributed through community settings or healthcare settings.
• One-on-one education sessions to help people overcome barriers to screening
• Reducing barriers to screening by keeping flexible clinic hours, working in non-healthcare settings and offering on-site translation, transportation, patient navigators, and other administrative services.
• Giving providers feedback on their screening rates and overall performance.
• Informing providers when a patient is due or overdue for services

For more information, please see our Cancer Scorecard.

Given that declining rates of colorectal cancer screening are driving the decline in the core set of services, the Vermont Department of Health will focus efforts toward females 65 and older as aligned with the State Cancer Plan.

• Providing cancer screening education and a quality improvement process for Vermont primary care providers.
• Working with private and public insurance companies to provide primary care providers with information regarding patients that are due or overdue for specific cancer screenings.
• Coordination with the American Cancer Society to support an annual colorectal cancer summit for Vermont primary care providers.
• Public media promotion to communicate the importance of colorectal cancer screening during March (colorectal cancer awareness month)

It is important to note that since screening is lowest among adults ages 50 to 60, much of the programs efforts will target that population and those 65 and older more broadly.

Data is updated as it becomes available and timing may vary by data source. For more information about this indicator, click here.

Due to BRFSS weighting methodology changes beginning in 2011, comparisons between data collected in 2011 and later and that from 2010 and earlier should be made with caution. Differences between data from 2011 forward and earlier years may be due to methodological changes, rather than changes in opinion or behavior.