Quality Improvement Program Improves Pneumococcal Immunization Rates in High-Risk Patients

In this study published in the American Journal of Kidney Diseases (AJKD), a quality improvement program that used electronic best practice alerts in the electronic medical record increased pneumococcal vaccination rates by 53 % to 70% (P

Pneumococcal (PV) vaccination rates are low in patients with chronic kidney disease (CKD) stages 4, 5 and nephrotic syndrome, despite a higher incidence of pneumococcal pneumonia and increased mortality and cardiovascular complications in these patients compared to patients without CKD. Researchers at the University of Pittsburgh implemented a quality improvement (QI) project involving the implementation of Best Practice Alert (BPA) in CKD clinics to improve PV rates in these high-risk patients over a 2-year period.

The intervention consisted of a BPA designed to electronically screen patients for PV eligibility based on diagnosis, age, and vaccination status using a predetermined algorithm for eligibility criteria. The BPA appeared on the electronic medical record (EMR) screen at the start of the patient encounter, while the medical assistant (MA) was reviewing the patient’s medications. The BPA allowed the PA to order the vaccine or document the reason for vaccine denial or deferral. If the PV was delayed for any reason, the BPA reappeared in 6 months. If the patient refused the vaccine, an alert was sent to the clinician to better inform the patient and the BPA was deactivated for one year.

In the post-intervention group, 617 (53.8%) patients had been previously vaccinated and BPA appeared in 529 patients. There was a statistically significant increase in the percentage of patients who received at least one dose of PV in the post-intervention group compared to the pre-intervention group (70.2% versus 62.7%, P = 0.0008) mainly due to the increase in PV from 53% to 70% in patients aged 18-64 years (P = 65 years have not improved. GAP compliance, defined as documentation of vaccine administered/prescribed or reason for refusal or deferment, was 45.9%.

These data suggest that follow-up in the CKD clinic is a missed opportunity to administer PV, especially in people declared to be at high risk between 18 and 64 years of age. The authors demonstrated that implementing an MA-led intervention, i.e. decision support as BPA, can close this gap with minimal disruption to workflow or increased patient workload. doctors.


National Kidney Foundation

Journal reference:

Kapoor, S. et al. (2022) Alerts on best practices in electronic medical records to improve pneumococcal vaccination in CKD. American Journal of Kidney Diseases. doi.org/10.1053/j.ajkd.2022.06.010.

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