immunization, family medicine, infectious disease, vaccination, quality improvement
Background: In the United States, only 72.2% of children (age 19–35 months) are up-to-date on all of their immunizations. This rate is even lower for children from impoverished households (68.7%). Lack of encouragement by providers, as well as parent perceptions of vaccine safety and efficacy, have been cited as some of the reasons for lower vaccination rates.
Purpose: Our study aimed to collect and compare patient demographic data to age appropriate and comorbidity-specific vaccination rates.
Methods: We conducted a quality improvement study at Family Practice Center (Aurora St. Luke’s Medical Center, Milwaukee, WI) and Family Care Center (Aurora Sinai Medical Center, Milwaukee, WI). Patients who were seen by either a PGY-2 or PGY-3 resident provider from July 2017 to September 2017 were included. Charts were randomly selected and reviewed. Using Minitab, one-way ANOVAs were generated for multivariable data, Fisher’s exact tests were used for 2 × 2 tables, and binary logistic regression was used for vaccine completion outcomes. A P-value less than 0.05 was used to determine statistical significance.
Results: A total of 872 patients were reviewed, of which 59.3% were female, 45.7% were African American, 11.0% were refugees, and 61.0% were insured by Medicaid. Of the comorbidities studied, the most prevalent were heart/lung disease (36.9%, n = 322), liver disease (4.9%, n = 43), and diabetes (15.7%, n = 137). Overall vaccination rates were found to be higher than national averages for children 19–35 months old (85.7% [n = 28] vs 72.2% nationally). Adults ≥ 65 years of age also had higher rates of pneumococcal polysaccharide vaccine (PPSV23) immunizations (77.8% [n = 90] vs 63.6% nationally). Differing rates of PPSV23 were seen for those suffering from heart/lung disease (47.2%), liver disease (39.5%), and diabetes (68.6%). Also, differing rates for hepatitis B vaccination were seen among those with liver disease (41.9%) and diabetes (26.6%). The following groups of patients had higher rates of missed opportunities: Medicare patients (P < 0.001), Caucasian patients (P < 0.001), and patients at Family Practice Center (P = 0.043). A greater percentage of individuals were up-to-date on the adult dose of tetanus, diphtheria, and pertussis (Tdap), hepatitis B, and human papillomavirus (HPV) vaccines at Family Practice Center versus Family Care Center.
Conclusion: Baseline immunization rates at Aurora’s family medicine clinics in Milwaukee, Wisconsin, are higher than national averages. However, these rates significantly differed between clinics. Analysis of postintervention data, collected following 3 lectures given to nurses and medical assistants, will be carried out to determine the effects of the educational intervention on immunization rates.
Yacoob ZA, Cook C, Kram JJ, Klumph M, Baumgardner DJ, Stanley M, Hunter P, Kotovicz F. Enhancing immunization rates at Aurora family medicine clinics in Milwaukee, Wisconsin. J Patient Cent Res Rev. 2018;5:325.
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