Improving Pneumococcal Vaccination Rates in a Community-Based Internal Medicine Resident Clinic

CONTEXT: Despite proven benefits of vaccination such as reduced morbidity and mortality, many patients remain out of date on their recommended vaccines. The goal of this pilot project was to develop and test a systematic vaccination review and ordering protocol aimed to increase the percentage of patients who were assessed under current pneumococcal vaccine recommendations by 5%. METHODS: The study location was set in a community-based internal medicine resident clinic in Muskegon, Michigan, with the patient population coming from the same setting. Data from 50 patients who had completed office visit appointments at a resident clinic from January 2016 through April 7th, 2017 were randomly extracted before implementation of the protocol. Two months post-implementation, the authors obtained office visit data from another randomly selected 50 clinic patients for comparison. The nurses and medical assistants in the office had been educated on the pneumonia vaccine protocol based on CDC (United States Centers for Disease Control and Prevention) vaccination guidelines and state registry records. They were also provided copies of the seven-step vaccine assessment and ordering protocol that included obtaining MCIR (Michigan Care Improvement Registry) data to update the patient’s chart for a possible provider order set. Clinic residents were also educated on CDC pneumonia vaccine guidelines, and the authors posted several guideline related posters on clinic walls. RESULTS: The authors initially compared the percentage of patients who providers had assessed regarding their vaccination status before protocol implementation to the percentage of patients after protocol implementation. There was a 10% post-implementation increase in pneumonia vaccination assessment. CONCLUSIONS: Although the results of this pilot project are obviously limited by methodological and sample size characteristics, the initially measured improvements in vaccination status suggests that this type of systematic protocol approach may warrant further testing in similar settings.