Improving the Quality of Immunization Delivery to an At-Risk Population: A Comprehensive Approach

Fu, Linda Y.; Weissman, Mark; McLaren, Rosie; Thomas, Cherie; Campbell, Jacquelyn; Mbafor, Jacob; Doshi, Urvi; Cora‐Bramble, Denice

doi:10.1542/peds.2010-3610

Cited by 25 publications

(17 citation statements)

References 14 publications

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“…[19][20][21][22]25 This program, employing a multifaceted intervention, demonstrated that combining health information technology, education, and clinical process changes is feasible and can successfully lead to increased rates of influenza vaccination in pediatric patients with cancer. Given conflicting data on the number of influenza vaccines immunocompromised patients ought to receive, the primary end point chosen was proportion of patients receiving $1 dose of the vaccine.…”

Section: Discussionmentioning

confidence: 99%

“…The vaccination rate in patients with leukemia/lymphoma, which started at a higher baseline than other disease groups, rose by only 16.4% (P , .001). Conversely, for patients with solid tumors, who had the lowest baseline rate, the increase was 26% (P , .001), with an intermediate rise of 21.7% (P , .001) for patients with brain tumors. Although immunization increased in patients who had undergone a SCT, the difference did not reach significance.…”

Section: Diagnosis Subtypesmentioning

confidence: 93%

“…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. 23 We therefore implemented a multifaceted initiative with concurrent interventions in the areas of clinical informatics, education, and multidisciplinary clinical process interventions to increase the rate of vaccination in the pediatric cancer population.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Diagnosis Subtypesmentioning

confidence: 93%

mentioning

confidence: 99%

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Quality Improvement Initiative to Increase Influenza Vaccination in Pediatric Cancer Patients

Freedman¹,

Reilly

Powell

et al. 2015

Pediatrics

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“…14,18,23 Our study also supports the effectiveness of multicomponent interventions for improving immunization coverage for socioeconomically disadvantaged populations. 8,24 …”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] Increasing immunization rates therefore remains a perennial target for quality improvement (QI) in pediatrics. [8][9][10][11][12] Our practice began immunization improvement work in 1996 with the development of a home-grown immunization database. This database preceded the Massachusetts Immunization Information System (MIIS), launched in 2011 by the state Department of Public Health.…”

mentioning

confidence: 99%

Improving Immunization Rates in a Hospital-Based Primary Care Practice

et al. 2014

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We implemented a quality improvement initiative aimed at reaching a 95% immunization rate for patients aged 24 months. The setting was a hospital-based pediatric primary care practice in Boston, Massachusetts. We defined immunization as full receipt of the vaccine series as recommended by the Centers for Disease Control and Prevention. METHODS:The initiative was team-based and structured around 3 core interventions: systematic identification and capture of target patients, use of a patient-tracking registry, and patient outreach and care coordination. We measured monthly overall and modified immunization rates for patients aged 24 months. The modified rate excluded vaccine refusals and practice transfers. We plotted monthly overall and modified immunization rates on statistical process control charts to monitor progress and evaluate impact. RESULTS:We measured immunization rates for 3298 patients aged 24 months between January 2009 and December 2012. Patients were 48% (n = 1576) female, 77.3% (n = 2548) were African American or Hispanic, and 70.2% (n = 2015) were publicly insured. Using control charts, we established mean overall and modified immunization rates of 90% and 93%, respectively. After implementation, we observed an increase in the mean modified immunization rate to 95%.CONCLUSIONS: A quality improvement initiative enabled our pediatric practice to increase its modified immunization rate to 95% for children aged 24 months. We attribute the improvement to the incorporation of medical home elements including a multidisciplinary team, patient registry, and care coordination.

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Patient reminder and recall interventions to improve immunization rates

Vann

Jacobson

Coyne‐Beasley

et al. 2018

Cochrane Database of Systematic Reviews

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170

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Improving the Quality of Immunization Delivery to an At-Risk Population: A Comprehensive Approach

Abstract: We were able to implement a comprehensive immunization QI program that was sustainable over time.

Cited by 25 publications

References 14 publications

Quality Improvement Initiative to Increase Influenza Vaccination in Pediatric Cancer Patients

Quality Improvement Initiative to Increase Influenza Vaccination in Pediatric Cancer Patients

Improving Immunization Rates in a Hospital-Based Primary Care Practice

Patient reminder and recall interventions to improve immunization rates

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