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

Objective To improve pneumococcal vaccination (PV) rates among rheumatology clinic patients on immunosuppressive therapy in the outpatient settings.

Methods This quality improvement project was based on the pre-post-intervention design. Phase I of the project targeted rheumatoid arthritis patients from thirteen rheumatology clinics (1/2013 to 7/2015) on immunosuppressive therapy to receive pneumococcal polysaccharide vaccine (PPSV23). In Phase II study (1/2016-10/2017), all patients on immunosuppressive medications irrespective of diagnosis were targeted to receive PPSV23 and the pneumococcal conjugate vaccine (PCV13). The Best Practice Alert (BPA)s for both PVs were developed based on CDC guidelines which appeared on electronic medical records for eligible patient at the time of assessment by the medical assistant. The BPA was designed to inform the vaccination status and enable physician to order PV or document refusal or deferral reasons. Education regarding vaccine guidelines, the BPAs, vaccination process, and regular feedback of results were important project interventions. The vaccination rates during pre-post intervention for each study phase were compared using Chi square test.

Results During Phase I, PPSV23 vaccination rates improved from 27.9% pre-intervention rate to 61.5% (p<0.0001). During Phase II, 77% of patients had received either PPSV23 or PCV13 compared to 49.6% of patients in the pre-intervention period (p<0.0001). The documentation rates (vaccine received, ordered, patient refusal and deferral reasons) increased significantly in both phases.

Conclusion Electronic identification of vaccine eligibility and implementation of BPAs with capabilities to order and document significantly improved PV rates. The process has potential for self-sustainability and generalizability.