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Exporting a successful influenza vaccination program from a teaching hospital to a community outpatient setting
K L Margolis1, K L Nichol, J Wuorenma
1Dept. of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415.
Purpose:
To assess whether we could export a successful multifaceted influenza vaccination program from an academic medical center to a community setting.
Design:
Pre/post study using concurrent control groups.
Setting:
Clinics in a staff model Health Maintenance Organization (HMO). One urban and one suburban clinic were chosen as intervention clinics, while two similar clinics were selected as control clinics.
Patients:
All patients aged 65 and over enrolled in the four clinics.
Interventions:
An informational mailing to patients, a standing-order policy allowing nurses to administer vaccine, a vaccination reminder on daily appointment lists, and availability of walk-in visits for vaccination. Patients in the control clinics received usual care.
Measurements:
Vaccination rates were determined using a validated postcard survey of 150 randomly selected patients at each clinic both at baseline (1988-89) and after the intervention (1989-90).
Results:
The baseline vaccination rates ranged from 51.4% to 74.6%, with nearly all vaccinations taking place at the HMO. In one intervention clinic, the vaccination rate improved from 56.4% to 72.3%, P = 0.01. In the other, the baseline rate was 74.6% and did not change significantly after the intervention. There was no change in the vaccination rate in the control clinics after the intervention period.
Conclusions:
An influenza vaccination program that combines several organizational interventions may be successfully exported from an academic to a community setting and may serve as a useful model for others.