Improving Rates of Routine Vaccinations in Adolescents at an Academic Children's Hospital

This project sought to increase the vaccination completion rate to 95% in an adolescent medicine practice. We aimed to increase the percentage of individuals who were up to date on their meningococcal, human papillomavirus, and tetanus, diphtheria, and pertussis vaccinations to 80% and to verify that these efforts led to more equitable care.

We used the Model for Improvement. After a current-state analysis, the team implemented a bundled intervention that included obtaining missing records, notifying providers about patients who needed vaccinations, and providing electronic medical record alerts when vaccinations were due. Patients received vaccine education, and nurses offered a numbing spray to mitigate needle-related vaccine hesitancy.

Statistical process control charts showed a shift in the percentage of complete vaccination records from 88% to 95%. There was a mean shift for the combined meningococcal, human papillomavirus, and tetanus, diphtheria, and pertussis completion percentage from 70% to 76%. All race and payer subgroups improved with the interventions. Racial disparity analysis for the completion percentage pre- and postintervention showed that there were 2 disparities observed between the reference group, Hispanic patients, and other racial groups. No disparities were observed between publicly and privately insured patients before or after the interventions.

The bundled intervention was associated with higher rates of vaccine documentation and administration. The highly engaged nursing staff and innovative technology drove success.