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Publication Date

10-29-2018

Keywords

immunization, family medicine, infectious disease, vaccination, quality improvement

Abstract

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.

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