Increasing pneumococcal vaccination for immunosuppressed patients: A cluster quality improvement trial

Desai, Sonali; Lü, Bing; Szent-Gyorgyi, Lara E.; Bogdanova, Anna; Turchin, Alexander; Weinblatt, Michael E.; Coblyn, Jonathan S.; Greenberg, Jack J.; Kachalia, Allen; Solomon, Daniel H.

doi:10.1002/art.37716

Cited by 55 publications

(57 citation statements)

References 61 publications

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“…We had hoped that this intensive, multi-level (doctor, system, and patient) intervention would be more effective than previous interventions consisting of paper or electronic alerts. (15) (19)…”

Section: Discussionmentioning

confidence: 99%

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A Multifaceted Intervention to Improve Influenza, Pneumococcal, and Herpes Zoster Vaccination among Patients with Rheumatoid Arthritis

Baker

Brown²,

Lee³

et al. 2016

J Rheumatol

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Objective Vaccination rates for influenza, pneumococcus, and zoster in rheumatoid arthritis patients have remained low. Simple electronic or paper reminders have produced only small increases in vaccination rates. We sought to identify a more effective approach to improve vaccination rates. Methods We conducted a system-level intervention at an academic rheumatology clinic that included electronic reminders with linked order sets, physician auditing and feedback, patient outreach, and optional printed prescriptions for zoster vaccination at an outside pharmacy. Results We targeted 1255 eligible patients with rheumatoid arthritis. There was no change in patients’ self-reported influenza vaccination rates, although the baseline self-reported rate was already high and much higher than that documented in the electronic health record. Pneumococcal vaccination rates increased from 28.7% to 45.8%; in regression analysis, the rate of change in pneumococcal vaccination increased by 9.4% per year above baseline trends (95% CI = 3.9% - 15.5%; p = 0.002). The rate of zoster vaccination increased from 2.5% to 4.5% (p = 0.01) overall and from 3.0% to 6.6% among patients not receiving biologic therapy that preclude zoster vaccination. Conclusion Although the intervention improved pneumococcal and zoster vaccination rates, the improvement in pneumococcal vaccination rate was less than expected, and the zoster vaccination rate remained low even for ideal candidates. Likely barriers include lack of familiarity and difficulty using electronic reminders and order sets, uncertainty about the value and safety of recommended vaccines, and uncertainty about patients’ insurance coverage and prior vaccination history. Future interventions should include strategies to address these.

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Section: Discussionmentioning

confidence: 99%

“…The PVX rate, already high, still increased significantly (from 68% to 80%) in the intervention group but remained stable for physicians who were not selected for the intervention. (19)…”

Section: Introductionmentioning

confidence: 99%

A Multifaceted Intervention to Improve Influenza, Pneumococcal, and Herpes Zoster Vaccination among Patients with Rheumatoid Arthritis

Baker

Brown²,

Lee³

et al. 2016

J Rheumatol

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“…However, a quality improvement project in adult rheumatology practices used a point-of-care paper reminder form to significantly increase the rate of pneumococcal vaccination in immunosuppressed patients. 18 An additional project used a 1-page vaccine questionnaire in clinic for patients to fill out to improve influenza and pneumococcal vaccination rates in immunosuppressed patients with inflammatory bowel disease. 19 There are no known articles describing pneumococcal vaccination rates in the pediatric rheumatology population, although preliminary data from our center revealed 25.3% of patients with childhood-onset SLE in a small cohort received the PPSV23.…”

Section: Discussionmentioning

confidence: 99%

Improving Pneumococcal Vaccination in Pediatric Rheumatology Patients

et al. 2015

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BACKGROUND AND OBJECTIVE: Many pediatric rheumatology patients are at increased risk of pneumococcal disease secondary to a deficient immune system and/or immunosuppressive medications. The goal of this study was to improve pneumococcal vaccination rates in this high-risk population.METHODS: Eligible patients included children at least 2 years old and adults with systemic lupus erythematosus and/or currently on immunosuppressive medication. Interventions included a presentation to rheumatology providers, creation of immunization algorithm, previsit planning, placing reminders on clinic forms, and sending reminder e-mails to providers. Chart reviews were performed, and control charts were established to portray change in immunization rates. RESULTS:The preintervention immunization rates for 90 patient visits compared with the immunization rates for the 53-week postintervention period with 1033 patient visits and 299 separate patients were all statistically significant. The 13-valent pneumococcal conjugate vaccine rate increased from 6.7% to 48.4% (x 2 = 58.3, P , .001), 23-valent pneumococcal polysaccharide vaccine rate increased from 8.9% to 28.4% (x 2 = 16.0, P , .001), and combined rate increased from 0% to 23.2% (x 2 = 25.2, P , .001). The improvement was sustained with shifts in the data for each vaccine and combined immunizations for final average rates of 60.9% for 13-valent pneumococcal conjugate vaccine, 39.2% for 23-valent pneumococcal polysaccharide vaccine, and 33.7% for combined.

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“…Similar initiatives have been successful in improving vaccination status in children and adults with chronic conditions [18][19][20] and those who are immunocompromised. 1,21,22 Furthermore, computerized clinical decision support systems have been shown to greatly improve physician performance, and their increasing use makes this well suited for quality improvement initiatives.…”

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confidence: 99%

Quality Improvement Initiative to Increase Influenza Vaccination in Pediatric Cancer Patients

Freedman¹,

Reilly

Powell

et al. 2015

Pediatrics

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BACKGROUND: Pediatric patients with cancer face more severe complications of influenza than healthy children. Although Centers for Disease Control and Prevention guidelines recommend yearly vaccination in these patients, in our large academic center, ,60% of oncology patients receiving chemotherapy were immunized at baseline. Our objective was to increase this rate through a multifaceted quality improvement initiative.METHODS: Eligible patients were .6 months old, within 1 year of receiving chemotherapy, .100 days from stem cell transplant, and had $1 outpatient oncology visit between September 1, 2012, and March 31, 2013. Five interventions were instituted concomitantly: (1) family education: influenza/ vaccine handouts were provided to families in clinic waiting rooms; (2) health informatics: daily lists of outpatients due for immunization were generated from the electronic medical record and sent automatically to triage staff and nurses; (3) outpatient clinic: patients due for vaccination were given colored wristbands during triage to alert providers; (4) inpatient: vaccine order was built into admission order set; and (5) provider education: staff education was provided at conferences on screening of patients, vaccine ordering, and documentation of refusals/contraindications. RESULTS:The complete influenza immunization rate increased by 20.1% to 64.5%, and the proportion of patients receiving $1 dose of vaccination increased by 22.9% to 77.7%. Similar changes were noted across all cancer types, with highest rates of immunization in leukemia/lymphoma patients (86.8%) and lowest in patients after stem cell transplant (66.7%).CONCLUSIONS: Technology, education, and multidisciplinary clinical process changes increased influenza vaccination rates. Ongoing efforts are targeting subgroups with lowest rates of immunization.

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Increasing pneumococcal vaccination for immunosuppressed patients: A cluster quality improvement trial

Cited by 55 publications

References 61 publications

A Multifaceted Intervention to Improve Influenza, Pneumococcal, and Herpes Zoster Vaccination among Patients with Rheumatoid Arthritis

A Multifaceted Intervention to Improve Influenza, Pneumococcal, and Herpes Zoster Vaccination among Patients with Rheumatoid Arthritis

Improving Pneumococcal Vaccination in Pediatric Rheumatology Patients

Quality Improvement Initiative to Increase Influenza Vaccination in Pediatric Cancer Patients

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