Improving Influenza and Pneumococcal Vaccination Rates in Ambulatory Specialty Practices.
Bottom Line: Rheumatology rates rose from 50% in February 2009 to 87% in January 2015.Conclusions. Integrated routine workflow and performance data sharing can effectively engage specialists and staff in vaccine adherence improvement.Influenza vaccination may require other approaches to achieve the rates seen with pneumococcal vaccine.
Affiliation: Department of Medicine Quality Program.
Background. Influenza and pneumococcal vaccinations are recommended for elderly and high-risk patients; however, rates of adherence are low. We sought to implement influenza and pneumococcal vaccine initiatives in 4 different ambulatory specialty practices, using 3 unique approaches. Methods. Four specialties with high-risk patient populations were selected for intervention: allergy (asthma), infectious disease (ID) (human immunodeficiency virus), pulmonary (chronic lung disease), and rheumatology (immunocompromised). Allergy and ID focused on influenza vaccination, and pulmonary and rheumatology focused on pneumococcal vaccination. We used 3 strategies for quality improvement: physician reminders, patient letters, and a nurse-driven model. Physicians were provided their performance data on a monthly basis and presented trended data on a quarterly basis at staff meetings. Results. All 4 specialties developed processes for improving vaccination rates with all showing some increase. Higher rates were achieved with pneumococcal vaccine than influenza. Pneumococcal vaccine rates showed steady improvement from year to year while influenza vaccine rates remained relatively constant. Allergy's influenza rate was 59% in 2011 and 64% in the 2014 flu season. Infectious disease influenza rates moved from 74% in the 2011 flu season to 86% for the 2014 season. Pneumococcal vaccine in pulmonary patients' rate was 52% at the start of intervention in February 2009 and 79% as of January 2015. Rheumatology rates rose from 50% in February 2009 to 87% in January 2015. Conclusions. Integrated routine workflow and performance data sharing can effectively engage specialists and staff in vaccine adherence improvement. Influenza vaccination may require other approaches to achieve the rates seen with pneumococcal vaccine.
No MeSH data available.
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Mentions: During the QI initiative, we saw improvements in both pneumococcal and influenza vaccination rates (Figures 3 and 4). Pneumococcal vaccine rates in pulmonary patients moved from 52% at the start of intervention in February 2009 to 79% as of January 2015. Rheumatology's rate rose from 50% in February 2009 to 87% in January 2015. Allergy influenza rates went from 59% in 2011 to 64% in the 2014 flu season. ID influenza rates saw improvement from 74% in the 2011 flu season to 86% for the 2014 season. For pneumococcal vaccination in Rheumatology, we have previously shown that our intervention had an impact on our vaccination rates through an interrupted time-series analysis [7, 8]. In the Pulmonary practice, there was a small increase in the vaccination rates present before the start of the QI intervention. However, the rate of change (slope) of the pneumococcal vaccination rate appeared to increase more sharply after the patient reminder letter intervention in mid-2011 and then plateaued approximately 80% approximately 2 years later.Figure 3.
No MeSH data available.