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Show Pediatric Immunization Rate Increase Project at Two University of Utah Clinics Garon Coriz, MD; Charles White, MD; Kyle Bradford Jones, MD; Susan Cochella, MD, MPH; Bob Chestnut, MD; Jacob Whetzel, MD Background The decrease in morbidity and mortality through the use of immunizations has been one of the greatest public health accomplishments in history. We strive to continue this trend. The eradication of smallpox through vaccination shows its great potential, saving millions of young lives worldwide. Nationwide, pediatric immunization rates vary considerably depending on location. The AAFP recommends immunizing children 0-6 years of age who are between doses for vaccinations with the AAFP recommendation unless contraindicated. Across Utah, amongst children 19-35 months, completion of the trivalent series by multiple regimens ranged between 72.6-81%. Rotavirus immunization rates between 12-15 months for babies born between 3/2/13 and 7/1/13 showed a steady decrease with each subsequent vaccination. 82.1% received the first, 75.6% received the second, and only 61% received the third. Historically, the rates have hovered around 70% at the University of Utah Sugarhouse and Madsen Clinics. AIM Statement Increase the percentage of patients younger than 2 years of age at Sugarhouse and Madsen Health Clinics receiving all combo 3 vaccinations to 80% by March 31, 2016. Methods Results In the past, data were gathered at intervals over the course of the clinic quality improvement project but this past year, a data registry of pediatric patient immunizations integrated into EPIC offered near-daily updates. While analyzing these data, the total number of patient requiring vaccinations was relatively low; roughly 30 patients at each clinic. With the focus on high-yield efforts, these individual patients became targets of a concerted intervention. Large drops in the number of children requiring immunizations developed first at Sugarhouse Clinic in December, then in February at Madsen Clinic. Letters were formulated to request patients return to clinic for an appointment to catch up on immunizations, and phone calls were also made with the same purpose. However, as staff combed through the data registry, a significant number of patients behind on immunizations no longer obtained their medical care at the clinics. Many had resident physicians as PCPs who had long moved on. Clinic staff removed them from the registry first at Sugarhouse starting in December 2015/January 2016. Subsequent training of staff at Madsen clinic for this procedure allowed for another round of data clean-up in February 2016. With consideration to the percentage of patients being up-to-date, Sugarhouse Clinic maintained a level above 80% prior to the intervention. In December 2015, as rates increased in the younger patients <12 months of age, older children between 12-24 months had a decrease, which is the cause for the major percentage change that was expected. However, at Madsen Clinic, the vaccination rate rose from roughly 70% to 88% The number of pediatric patients in need of immunizations ranged in the low 30s and low 20s at Sugarhouse Clinic and Madsen Clinic, respectively. With the intervention, the numbers decreased to 23 and 8 at Sugarhouse and Madsen Clinics, respectively. References Barbeau, Bree. "Immunization Coverage Levels." Immunization Coverage Levels. Utah Department of Health, Nov. 2014. Web. 01 May 2016. "Immunizations - Clinical Preventive Service Recommendations." -- Clinical Recommendation. American Academy of Family Physicians, 2010. Web. 06 May 2016. "National, State, and Urban Area Vaccination Coverage Among Children Aged 19-35 Months- United States, 2005." National Immunization Survey 297.10 (2007): 1052. Cdc.gov. Centers for Disease Control and Prevention, 2014. Web. 1 May 2016. Results Acknowledgements A Special Thank You to Noah Dobson, Whitney Buckley, Ana Camacho, Brittany Baker, Monique Chacon and Brenda Higgs, RN for your support and hard work on this project. Conclusions The combined intervention of diuresing patients no longer receiving care at the clinics from the data registry and contacting patients in need of immunizations continuing care at the clinics allowed the achievement of the goal of >80% immunization rates in children younger than 2 years of age. The intervention was far more pronounced at Madsen Clinic, especially when considering the change in immunization rates. The increase in patients in the 12-24 month range that were not up-to-date during the month of December 2015 at Sugarhouse Clinic was the most likely contributor to the dampening of the results at that time. Why this occurred is unclear, though it can be postulated that it was a combination of non-adherent younger patients moving into the older children grouping as well as new patient visits during respiratory illness season. Overall, the immediate results from the data clean-up demonstrated the potential of sound data collection and the ability to stay current on a patient population's health parameters. Moving forward, the clinics will attempt an annual registry clean-up prior to the start of each clinic quality improvement project that begin each year in August. |
