Improving Pneumococcal Vaccination Coverage Among Older Adults in a Rural Hospital: A Plan-Do-Study-Act (PDSA)-Based...

Area of Science:

• Public Health
• Geriatrics
• Healthcare Quality Improvement

Background:

• Pneumococcal pneumonia is a major health concern for older adults, especially in rural areas with limited healthcare access.
• Vaccination rates for pneumococcal pneumonia in rural Japan are suboptimal despite national recommendations.
• Patient education, reminder systems, and workflow improvements can enhance preventive care in outpatient settings.

Purpose of the Study:

• To implement and evaluate a quality improvement project to increase pneumococcal vaccination rates by at least 20% within three months among older patients in a rural Japanese hospital.
• To assess the feasibility and scalability of a multicomponent intervention integrating electronic medical record (EMR)-based reminders, patient education, and interprofessional collaboration.

Main Methods:

• A Plan-Do-Study-Act (PDSA) framework was used at Unnan City Hospital from February to April 2025.
• Interventions included patient and staff educational brochures, EMR-based reminders, and a standardized vaccination flowsheet for patients aged ≥65 with chronic conditions.
• Interrupted time-series analysis (ITSA) was employed to evaluate changes in vaccination rates, physician recommendation rates, and reminder rates.

Main Results:

• Baseline pneumococcal vaccination coverage was 17.4%; it increased to 65.0% within three months post-intervention.
• ITSA showed a significant increase of 3.97 percentage points per week in vaccination rates (p < 0.001).
• Physician recommendation rates rose from 24% to 83%, and reminder rates exceeded 91%; staff satisfaction improved.

Conclusions:

• A multicomponent intervention significantly increased pneumococcal vaccination rates in older adults at a rural hospital.
• Integrating EMR reminders, patient education, and collaborative practice is a feasible and scalable model for enhancing adult vaccination in rural settings.
• This QI project provides a practical framework for improving vaccination coverage in similar healthcare environments.