Missed opportunities for improving practice performance in adult immunizations: a meta-narrative review of the literature

Loskutova, Natalia; Smail, Craig; Webster, Brian; Ajayi, Kemi; Wood, Julie; Carroll, Jennifer K.

doi:10.1186/s12875-017-0694-1

Cited by 6 publications

(8 citation statements)

References 12 publications

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“…However, missed opportunities for immunization persist. A missed opportunity is any visit to a healthcare provider where a vaccine could have been provided but was not [ 15 ]. One study estimated that eliminating missed opportunities for adults could improve influenza vaccine coverage up to 23% nationally [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Patterns of recommended vaccine receipt among women ages 24–45 years: a cross-sectional analysis

et al. 2021

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Background Vaccine receipt among mid-adults remains low, with only one quarter of adults being up to date for all recommended vaccines. It is important to understand the myriad factors that influence vaccine receipt among mid-adult women to address these low rates. Methods We conducted a cross-sectional analysis of data from women ages 24–45 years collected as part of an ongoing case-control study of the effectiveness of HPV vaccine. We examined associations between demographic characteristics and healthcare utilization and receipt of individual vaccines and combinations of multiple vaccines using logistic regression analyses for three routinely recommended vaccines: tetanus, influenza and HPV. Results Among the 309 women enrolled in the study, only 19 (6.2%) were up to date for all three recommended vaccines and 41 (13.3%) had not received any of the recommended vaccines. A greater number of health care visits in the past year was associated with receipt of influenza (aOR = 6.37, 95% CI = 2.53, 16.1) and tetanus (aOR = 2.17, 95% CI = 1.14, 4.12) vaccines. White women were more likely to have received HPV vaccine (aOR = 2.39, 95% CI = 1.07, 5.36). Conclusions Uptake of recommended vaccines is low among young and mid-adult women. There is a need for greater understanding of the underlying factors influencing vaccine receipt in this population.

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Section: Discussionmentioning

confidence: 99%

Patterns of recommended vaccine receipt among women ages 24–45 years: a cross-sectional analysis

et al. 2021

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“…One of the distinctive elements of our intervention was a deliberate strategy of engaging frontline nursing staff (medical assistants, LPN/RNs) -who are not only responsible for administering vaccines, but through the emergence of team-based clinic workflows, are increasingly empowered to "tee up" health maintenance activities like vaccination on behalf of providers. This, in conjunction with tactics like standing orders, can reduce the likelihood of repeated "missed opportunities" [21,22]. This strategy appears to have succeeded, and was reflected in the dramatic increase, post-intervention, in clinics reporting that non-providers were initiating vaccine conversations with patients and/or reminding providers when the next patient to be seen was due for vaccination.…”

Section: Discussionmentioning

confidence: 99%

Duke Vaccinates: A Project to Increase Adult Immunization Rates for Four Major Vaccine Types Involving the Entire Primary Care Team

H¹,

Y²,

Anderson³

et al. 2020

Arch Fam Med Gen Pract

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Introduction: Current adult vaccination rates fall well below the Healthy People 2020 goals established by the Centers for Disease Control and Prevention for pneumococcal, influenza, pertussis, and herpes zoster vaccines. The objective of this study was to improve immunization rates in primary care through an enhanced, multi-component "audit & feedback" (A&F) intervention. Methods:The intervention took place over a one-year period (September 2016-August 2017) and involved 24 primary care clinics within one health system in North Carolina. It consisted of pre-specified targets and an online A&F platform, combined with multidisciplinary educational resources and non-physician clinic champions. Six control clinics in the same health system were also identified. Clinic and provider performance for immunization for pneumococcal, influenza, pertussis, and herpes zoster vaccines were tabulated on a monthly basis. Rates were benchmarked against a clinic-defined target, other participating clinics' immunization rates, and national targets. Results were displayed on an electronic dashboard within the online platform, and printable reports were given to each clinic to post in work areas and discuss at practice meetings on a monthly basis. Educational efforts primarily focused on non-physician clinical personnel (nurses, medical assistants) and consisted of online learning modules and 5-minute videos. Frontline nurses or medical assistants served as site champions to receive and distribute monthly immunization reports and attend quarterly project calls to discuss barriers and solutions with champions from the other clinics. Comparisons between intervention and control clinic groups were made using the t-test or Wilcoxon rank-sum test for continuous variables depending on normality, or Pearson's chi square test for categorical variables. To assess the effectiveness of the intervention, the likelihood of immunization during the intervention period was compared between intervention and control clinics using logistic regression models. The generalized estimating equations method was used to account for clustering of outcomes within clinics. Analyses included adjusting for baseline vaccination rates and differences in case mix between intervention and control clinics.Results: A total of 209,533 and 64,133 patients were seen in the intervention and control clinics, respectively. Intervention patients were younger (mean age 51 years vs. control 53 years, p < 0.0001) and had higher proportions of patients who were female (60% vs. control 55%, p < 0.0001), and privately insured (65% vs. control 58%, p < 0.0001), but a lower proportion of Caucasian patients (65% vs. control 72%, p < 0.0001). All vaccine types showed increases in immunization rates during the intervention period in both intervention and control practices. After accounting for covariates, patients seen in the intervention clinics were more likely to receive an influenza vaccine (adjusted OR 1.27, 95% CI 1.02-1.58, p = 0.03) and complete the pneumococcal vaccine series (...

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“…We established baseline immunization rates via EHR data pulls by reviewing immunization performance data for patients seen in the year or influenza season prior to the beginning of the intervention. The definitions for missed opportunities were based on operational methodologies developed by the project team and included population-based, patient/visit-based, and reminder-based approaches [5].…”

Section: Data Collection and Evaluation Data Sourcesmentioning

confidence: 99%

“…We recently explored the missed opportunities in adult vaccinations in a meta-narrative literature review and concluded that missed opportunities are present in various health care settings [5]. Moreover, we reported two methodologies for quantifying missed opportunities: 1.…”

Section: Introductionmentioning

confidence: 99%

“…Based on the number of healthcare encounters without appropriate vaccination services, defined as a number or percentage of visits per patient with no vaccination related services (missed opportunities per patient or patientlevel); and 2. Based on vaccination status as "non-vaccinated" among a group of patients who had a health care encounter where the vaccination should/could have happened, presented as percentage of non-vaccinated patients who had an encounter with health care providers (missed opportunities per patient population or population-level) [5]. We suggested that missed opportunities could represent a more accurate measure of provider and health care organization performance as compared to populationwide immunization rates because missed opportunities are clearly associated with a patient encounter.…”

Section: Introductionmentioning

confidence: 99%

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Effects of multicomponent primary care-based intervention on immunization rates and missed opportunities to vaccinate adults

et al. 2020

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Background: Adult immunization rates are below Healthy People 2020 targets. Our objective was to evaluate the effectiveness of a multicomponent intervention to improve adult immunization rates. Methods: This prospective interventional before-and-after non-randomized study was conducted through the American Academy of Family Physicians National Research Network with 43 primary care physicians from a large multi-specialty healthcare organization (multicomponent intervention group n = 23; comparator group n = 20) in the United States. The multicomponent intervention included provider reminders, quarterly provider-level performance reports, provider education, patient visual aid materials, and standing orders on adult pneumococcal, influenza, and zoster immunizations. We assessed individual and comparative provider-level vaccination rates and missed opportunities detailing concordance with targets established by Healthy People 2020 for pneumococcal, influenza, and zoster immunizations. Results: Vaccination rates increased after 12 months in intervention and comparator groups respectively for: a). influenza from 44.4 ± 16.7 to 51.3% ± 12.9% (by 6.9 percentage points, p = 0.001) and from 35.1 ± 19.1 to 41.3% ± 14.2%, (by 6.2 percentage points, p = 0.01); b). pneumococcal vaccinations in older adults from 62.8 ± 17.6 to 81.4% ± 16.6% (by 18.6 percentage points, for p < 0.0001) and from 55.9 ± 20.0 to 72.7% ± 18.4% (by 16.7 percentage points, p < 0.0001); and c). zoster from 37.1 ± 13.4 to 41.9% ± 13.1% (by 4.8 percentage points, p < 0.0001) and from 35.0 ± 18.7 to 42.3% ± 20.9% (7.3 percentage points, p = 0.001).

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Missed opportunities for improving practice performance in adult immunizations: a meta-narrative review of the literature

Cited by 6 publications

References 12 publications

Patterns of recommended vaccine receipt among women ages 24–45 years: a cross-sectional analysis

Patterns of recommended vaccine receipt among women ages 24–45 years: a cross-sectional analysis

Duke Vaccinates: A Project to Increase Adult Immunization Rates for Four Major Vaccine Types Involving the Entire Primary Care Team

Effects of multicomponent primary care-based intervention on immunization rates and missed opportunities to vaccinate adults

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