Adult immunization improvement in an underserved family medicine practice

Objective: Vaccines prevent many cases of infectious disease, yet immunization campaigns are hindered by various barriers. This work presents the results of a quality improvement project addressing barriers to vaccine compliance in an underserved teaching practice by reducing missed opportunies and increasing provider and patient compliance rates for pneumococcal, Tdap, influenza, and zoster vaccines in adults.

Methods: The study intervention aimed to address patient knowledge, provider knowledge and skills, proactive care coordination, and outreach and counselling of high-risk groups. Aggregate patient data from intervention at year-end were compared to the prior year. Outcome targets were as follows: improved vaccination rates by one-half of the difference between baseline and Healthy People 2020 goals; reduced patient refusals by 10%; and reduced missed opportunities by 50%.

Results: All of the vaccination rates improved, but with mixed results regarding the target outcomes. The rates of vaccine refusal were mixed in terms of the direction of the change, the significance, and achieving targets. Missed opportunities all improved, but the significance was mixed and none reached targets.

Conclusion: This project has helped to identify patient and provider knowledge of vaccination as a key to increasing compliance, and missed opportunities as the greatest challenge in achieving targets. The burden of documentation is significant on providers, and future work should focus on methods to improve the ease of documentation. Clinical outcomes and improvements were encouraging; however, it is clear that there remain challenges to reaching Healthy People 2020 goals within the study population and nationally.

Keywords: Immunization; influenza; pneumococcal; practice improvement; Tdap; vaccine; zoster


Affiliations: Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA