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Improving Pneumococcal Vaccination Rates in Immunosuppressed Pediatric Patients with Rheumatic Disease
Julia G Harris1,2, Jordan T Jones1,2, Leslie Favier1,2
1From the Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Mo.
Insights
Immunosuppressed patients with rheumatic diseases are at high risk for pneumococcal disease. A quality improvement project successfully increased pneumococcal vaccination rates, significantly reducing this risk.
Area of Science:
- Rheumatology
- Immunology
- Infectious Disease Prevention
Background:
- Patients with rheumatic diseases often experience immunosuppression, increasing their risk of invasive pneumococcal disease.
- Systemic lupus erythematosus, mixed connective tissue disease, juvenile dermatomyositis, and systemic vasculitis are key conditions associated with this heightened risk.
Purpose of the Study:
- To implement a quality improvement project to increase pneumococcal vaccination rates in high-risk, immunosuppressed patients.
- Aim 1: Increase pneumococcal vaccination in systemic lupus erythematosus and mixed connective tissue disease patients from 9.6% to 80% within one year.
- Aim 2: Increase vaccination in immunosuppressed patients with systemic lupus erythematosus, mixed connective tissue disease, juvenile dermatomyositis, and systemic vasculitis from 62.6% to 80% within one year.
Main Methods:
- Utilized a quality improvement framework with interventions including an immunization algorithm, patient reporting, education, reminders, and pre-visit planning.
- Monitored vaccination status for 13-valent pneumococcal conjugated vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23).
- Defined the primary outcome as being fully up-to-date on both PCV13 and PPSV23 vaccinations.
Main Results:
- Phase 1 saw a significant increase in combined pneumococcal vaccination rates from 9.6% to 91.1%, with sustained high rates.
- Phase 2 demonstrated substantial improvements: PCV13 rates rose from 68.8% to 93.4%, PPSV23 from 65.2% to 88.5%, and combined rates from 62.6% to 86.5%.
Conclusions:
- Quality improvement initiatives effectively increased and sustained pneumococcal vaccination coverage in high-risk, immunosuppressed patient populations.
- These efforts are crucial for mitigating the incidence of invasive pneumococcal disease in vulnerable individuals.
- Continued prioritization of vaccination programs is essential for patient safety and disease prevention.
Background:
Patients with rheumatic diseases are at a high risk of invasive pneumococcal disease due to immunosuppression. We conducted a quality improvement project, and the first aim was to increase the percentage of patients with systemic lupus erythematosus and mixed connective tissue disease that is up to date on pneumococcal vaccinations from 9.6% to 80% within one year. Subsequently, the second aim was to increase the percentage of patients on immunosuppression with systemic lupus erythematosus, mixed connective tissue disease, juvenile dermatomyositis and systemic vasculitis that is up to date on pneumococcal vaccinations from 62.6% to 80% within one year.
Methods:
Two process measures were up-to-date vaccination status on (1) 13-valent pneumococcal conjugated vaccine (PCV13) and (2) 23-valent pneumococcal polysaccharide vaccine (PPSV23). Our outcome measure was being fully up to date on both pneumococcal vaccinations. Interventions included an immunization algorithm, reporting of eligible patients, education, reminders, and pre-visit planning.
Results:
There were shifts in the centerline for all quality measures in both phases of this project. The combined pneumococcal vaccination rate for Phase 1 increased from 9.6% to 91.1%, and this centerline was sustained. Pneumococcal vaccination rates also significantly increased for Phase 2: 68.8% to 93.4% for PCV13, 65.2% to 88.5% for PPSV23, and 62.6% to 86.5% for the combined pneumococcal vaccination rate.
Conclusions:
Quality improvement methodology significantly increased and sustained pneumococcal vaccination rates in our high-risk, immunosuppressed patients. We continue to prioritize this important initiative to mitigate the risk of invasive pneumococcal disease.
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