Improving Pneumococcal Vaccination Rates in Rheumatology Patients by Using Best Practice Alerts in the Electronic...

Area of Science:

• Rheumatology
• Immunology
• Public Health

Background:

• Rheumatology patients on immunosuppressive therapy are at increased risk for pneumococcal infections.
• Low pneumococcal vaccination (PV) rates in this vulnerable population necessitate targeted interventions.
• Outpatient rheumatology settings present an opportunity to improve vaccine administration.

Purpose of the Study:

• To enhance pneumococcal vaccination rates among rheumatology clinic patients receiving immunosuppressive therapy.
• To implement and evaluate the effectiveness of electronic best practice alerts (BPAs) in improving PV uptake.

Main Methods:

• A pre-post intervention quality improvement project conducted in 13 rheumatology clinics.
• Phase I: Targeted pneumococcal polysaccharide vaccine (PPSV23) for rheumatoid arthritis patients (Jan 2013-Jul 2015).
• Phase II: Expanded to all immunosuppressive medication users, including pneumococcal conjugate vaccine (PCV13) (Jan 2016-Oct 2017).
• Utilized electronic medical record-based BPAs to prompt vaccination, order, or document deferral/refusal.
• Interventions included education on guidelines, BPAs, vaccination process, and feedback.

Main Results:

• Phase I: PPSV23 vaccination rates increased from 28% to 61.5% (P < 0.0001).
• Phase II: Vaccination rates (PPSV23, PCV13, or both) rose from 49.6% to 77.4% (P < 0.0001).
• Significant improvements in documentation rates for vaccine status, orders, and reasons for refusal/deferral were observed in both phases.

Conclusions:

• Electronic identification of vaccine eligibility and BPA implementation significantly improved pneumococcal vaccination rates.
• The intervention demonstrated potential for self-sustainability and broad applicability across different rheumatology patient groups.
• This approach offers a scalable solution for increasing vaccine coverage in at-risk outpatient populations.