Improving Pneumococcal Polysaccharide 23-valent (Pneumovax) Vaccination Rates for Adults Age 18-64 with Asthma: CQI

Our two University-based continuity clinics have excellent age based vaccination rates (nearly 90%), however disease based vaccination rates for younger individuals are not at similar levels. Prior CQI projects in our clinics have looked at disease based vaccination rates, and identified asthma as the disease process with the lowest vaccination rates. Our project chose to focus on people with asthma from the age of 18-64. Per CDC-ACIP guidelines, these individuals should receive one dose of pneumococcal 23 valent vaccine. At the time of our investigation, our clinic vaccination rate was 28%. Our aim was to increase the rate of vaccination for these patients by 20%, to a total of 48%. Overall our intervention did not achieve our goal. We saw an initial bump during our first intervention month, however our intervention procedures had not been completely rolled out at that time. We then saw steadily declining monthly rates of vaccination through the remainder of our intervention period. Our process does an excellent job of identifying patients in need, but at this time it seems that education and information practices alone - even if aimed at patients, staff, and providers in separate intervention procedures - are not adequate to cause long lasting change in Pneumovax vaccination rates in the short time of our intervention. It could be because these are all based on an individual remembering and recognizing which patients need immunization. Future ideas would include changing EMR processes to help standardize this in asthma visits by creating computer based alerts or further standardizing our workflow processes.