Dr. Solomon receives royalties from UpToDate and has received research grants from Amgen and Eli Lilly.
Increasing pneumococcal vaccination for immunosuppressed patients: A cluster quality improvement trial
Version of Record online: 27 DEC 2012
Copyright © 2013 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 65, Issue 1, pages 39–47, January 2013
How to Cite
Desai, S. P., Lu, B., Szent-Gyorgyi, L. E., Bogdanova, A. A., Turchin, A., Weinblatt, M., Coblyn, J., Greenberg, J. O., Kachalia, A. and Solomon, D. H. (2013), Increasing pneumococcal vaccination for immunosuppressed patients: A cluster quality improvement trial. Arthritis & Rheumatism, 65: 39–47. doi: 10.1002/art.37716
- Issue online: 27 DEC 2012
- Version of Record online: 27 DEC 2012
- Accepted manuscript online: 8 OCT 2012 12:15PM EST
- Manuscript Accepted: 18 SEP 2012
- Manuscript Received: 10 MAY 2012
- American College of Rheumatology Research and Education Foundation Physician Scientist Development Award
- NIH. Grant Number: K24-AR-055989
Pneumococcal vaccination is important for patients taking immunosuppressive medications, but prior studies suggest that most patients do not undergo vaccination. The aim of this study was to evaluate the effects of a point-of-care paper reminder form as a quality improvement (QI) strategy to increase the numbers of immunosuppressed patients being kept up-to-date with pneumococcal vaccination in a rheumatology practice.
Selected rheumatologists at 5 ambulatory practice sites received a point-of-care paper reminder form to be applied to patients who were not up-to-date with pneumococcal vaccination. Interrupted time-series analyses were used to measure the effect of the intervention on the pneumococcal vaccination rates among patients, comparing the rates in the intervention group with those in a control group of rheumatologists who did not receive the intervention. Adjusted Cox proportional hazards models were examined to identify independent predictors of being up-to-date with pneumococcal vaccination.
We evaluated a total of 3,717 patients (66.0% with rheumatoid arthritis) who were taking immunosuppressive medications (74.1% women, mean age 53.7 years). Rheumatologists who received the intervention had a significant increase in the rate of patients who were up-to-date with pneumococcal vaccination, from 67.6% to 80.0% (P = 0.006), in the time period following the intervention, compared to a rate that remained stable, from 52.3% to 52.0% (P = 0.90), among patients in the nonintervention control group during this same time period. In regression models, positive predictors of being up-to-date with pneumococcal vaccination at the patient level included the following: having received the intervention (hazard ratio [HR] 3.58, 95% confidence interval [95% CI] 2.46–5.20), having a primary care physician affiliated with Brigham and Women's Hospital (HR 1.68, 95% CI 1.44–1.97), having a diagnosis of diabetes mellitus (HR 1.57, 95% CI 1.02–2.41), and being age 56–65 years at baseline, compared to age ≤45 years (HR 1.24, 95% CI 1.01–1.51).
A QI strategy involving a simple point-of-care paper reminder form significantly increased the rate of being up-to-date with pneumococcal vaccination among patients receiving immunosuppressive medications in our rheumatology practices over a 6-month period.