Article Figures & Data
Figures
- Figure 1.
Proportion of patients seen in the rheumatology clinic each study month who had an action performed at the visit (vaccination, documentation of a previous vaccination, or documentation of a patient reason for not giving a vaccination).
- Figure 2.
PVX rate (solid line) and documented exception rate (dashed line). EHR: electronic health record; PVX: pneumococcal vaccination.
- Figure 3.
Variation in PVX rate at baseline (grey) and followup (black) for patients associated with individual attending rheumatologists (PHY1–8). PVX: pneumococcal vaccination; PHY: physician.
Tables
Characteristics Values Female 1048 (83.5) Age, yrs, mean (SD) 56.8 (14.5) Race/ethnicity Hispanic or Latino 138 (11.0) White 633 (50.4) Black 200 (15.9) Other 63 (5.0) Unknown/declined/missing 221 (17.6) Insurance Medicare/Medicaid 468 (37.3) Commercial 726 (57.8) Uninsured/self-pay 61 (4.9) Treated with biologic medication 753 (60.0) Comorbidities 0 771 (61.4) 1 261 (20.8) 2 or more 223 (17.8) - Table 2.
Proportion of patients vaccinated against influenza, pneumococcus, and herpes zoster before and after the 12-month intervention period. Values are n (%).
Variables Preintervention Postintervention Influenza, n = 102,101* Ever received IVX 92 (90.2) 87 (86.1) Received IVX in previous season 81 (79.4) 79 (78.2) Pneumococcal, n = 1255† Ever received any type of vaccine 360 (28.7) 575 (45.8) PPSV23 only 351 (28.0) 293 (23.3) PCV13 only 5 (0.4) 151 (12.0) PPSV23 and PCV13 4 (0.3) 131 (10.4) No vaccine received, medical reason 0 9 (0.7) No vaccine received, patient reason 2 (0.2) 51 (4.1) Herpes zoster, n = 1255† Ever received vaccine 32 (2.5) 57 (4.5) Prescription to receive elsewhere, no record of receipt 0 28 (2.2) No vaccine received, medical reason 0 102 (8.1) No vaccine received, patient reason 0 46 (3.7) ↵* Rates of IVX are based on self-report from a random sample of 102 patients who were interviewed for the study prior to implementation of the intervention and 101 who were interviewed after implementation of the intervention.
↵† Rates of pneumococcal and herpes zoster vaccination are based on electronic health record data for all eligible patients. IVX: influenza vaccine; PPSV23: 23-strain pneumococcal polysaccharide vaccine; PCV13: 13-strain pneumococcal conjugated vaccine.
Topics Comments Provider education “I feel I have limited mastery and when my mastery is limited I’m sometimes skeptical about intervening. Because I might not do it right.” Scope of practice “From a broader perspective, really prior to this intervention and for many, many years, my view is that my scope of practice doesn’t really include preventive things… I’m sort of redefining scope a little, [but] this is not my area. I’m being dragged kicking and screaming into this.” EHR challenges “I gave up about a month into it. I couldn’t figure it out. Every time I would end up going around and around and around. I gave up. When I gave a vaccination I would just tell the RN to give an injection and document it.” Patient barriers “Patients hem and haw — ‘I need to go check with my primary care provider.’ Or they say, ‘I’m going to get it at Walgreens [pharmacy].’ And then when they come back, they haven’t.” Coordination of care “One of my concerns is always coordination of care. What am I going to do with these results? If they are abnormal, [I] want to make sure they’ll see their internist. I never know how to make sure that happens.” Performance reports “After realizing I’m terrible, I realized I wanted to get better. They provided motivation to improve. And it didn’t get as good as I would have liked, but it did improve.” EHR: electronic health record; RN: registered nurse.
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